Part 5 The Rossi Family
5.2 Rossi family case study 1: Maria Rossi – heart failure
Dima Nasrawi and Donna Wilson
Introduction to case study
Learning Objectives
By the end of this case study, you should be able to:
- Identify associated risk factors with the development of chronic cardiac failure.
- Identify the impact of a chronic cardiac failure diagnosis.
- Discuss required lifestyle modifications for patients living with a cardiac failure diagnosis.
- Identify required self-management strategies to manage cardiac failure diagnosis with a specific focus on rural health.
- Discuss the role of the nurse managing a cardiac failure diagnosis.
Scenario: Maria’s diagnosis of chronic cardiac failure
Early last month, Maria began to experience some light-headed episodes, heart palpitations and dizziness at home. She did not report these symptoms to her family or visit a doctor, as she believed it was just ‘a part of ageing’. She believed she could manage with an improvement in her hydration and additional rest. However, last week her husband Maximo finds her after a fall. Maria has collapsed in the dining room and sustains a small bleeding laceration above her left eyebrow. Maximo realises she has likely hit her head on the edge of the chair as she collapsed. As Maria is semi-conscious when Maximo finds her, he calls out to their son John for help. Both John and Elisabeth rush to assist and Elisabeth immediately calls for an ambulance.
When the ambulance arrives, the paramedics explain to Maria’s family that it looks like her heart is not working properly. They say that whilst it does not look like a heart attack, they believe she needs to be urgently transported to the local hospital in Lismore, about 20 minutes away by road. Later that day, Maria’s family are informed that she is in a serious condition, with a new diagnosis of heart block.
Thinking point
The hospital staff start Maria on an isoprenaline infusion, which has a mode of action known as a ‘beta-agonist’, which relaxes the muscles of the airways. This drug increases cardiac output via positive chronotropic and inotropic actions. Cardiac automaticity and atrioventricular nodal conduction are improved under this drug, which can also improve coronary blood flow.
With the isoprenaline infusion underway, Maria is airlifted to a larger hospital just over one hour away from Lismore by road. This tertiary facility specialises in complex cardiac care. On arrival, Maria is transferred urgently to the cardiac catheterisation laboratory (CCL) where she is diagnosed with complete heart block, leading to the need for emergency pacemaker implantation. The cardiac team inform Maximo and John that the infusion has played a big part in saving her as it keeps her heart reasonably stable, long enough for her to be delivered safely to the cardiac facility.
Reflective Questions
- Can you imagine how Maria and her family would have felt during the transport stage of her care?
- As a healthcare professional, how