Paced Pia — Pacemakers & ICDs
Hiccups after pacemaker placement can mean the lead is stimulating the diaphragm — check the pocket and the rhythm strip
Pia had a pacemaker placed for symptomatic sinus bradycardia, and on day one she develops rhythmic hiccups that worry her nurse enough to check the rhythm strip and the generator pocket.
Pia receives a permanent pacemaker for symptomatic bradycardia and later an ICD after a life-threatening arrhythmia. Nursing priorities after implantation include immobilizing the affected arm to prevent lead dislodgement, monitoring the incision site for hematoma or infection, and watching the rhythm strip for appropriate pacing spikes followed by capture. Persistent hiccups, failure to capture, or a shock from the ICD each signal a distinct problem requiring specific nursing action.
Read Paced Pia's full story →The story arc
The setup
Pia has symptomatic bradycardia with dizziness and near-syncope, and a permanent pacemaker is implanted transvenously with the generator placed subcutaneously below her left clavicle.
The turn
On the first postoperative day Pia develops persistent, rhythmic hiccups, and the nurse notices they correspond to the pacing spikes on her monitor.
The crisis
The rhythm strip shows pacing spikes without a following QRS complex, and Pia's heart rate drops to 34 with new dizziness.
The save
The nurse immobilizes Pia's left arm, notifies the provider immediately about failure to capture and the hiccups, and prepares for possible lead repositioning while continuously monitoring her rhythm and vital signs.
NCLEX study section — Pacemakers & ICDs
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.