Part 5 The Rossi Family
5.3 Rossi family case study 2: John Rossi – Myocardial infarction, coronary artery bypass grafting (CABG) surgery
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 disease.
- Identify the impact of acute coronary disease.
- Discuss required lifestyle modifications for patients living with acute coronary disease.
- Identify required self-management strategies to manage acute coronary disease.
- Discuss the role of the nurse managing patients following cardiac surgery.
Scenario
John is a 47-year-old man, whose wife died 5 years ago. Recently he has been experiencing signs of health deterioration, including high blood pressure, cold sweats and radiating chest pain to his left arm. John has kept these signs and symptoms confidential, not sharing his health issues with the family. His signs are exacerbated by continual stress, anxiety, unresolved grief and the pressures of looking after his family’s farm. He recently restarted smoking, as a coping mechanism against the stresses that he has in his life. At a recent community event, with people gathering in a well-known tavern to celebrate Easter Sunday after a church mass, John experiences an episode of shortness of breath and crushing sensations of chest pain. His cousin Alberto rushes John to the emergency department of the nearest hospital (Lismore base). Upon arrival at the hospital, the emergency doctor sees on the electrocardiogram tracing that John has developed an elevated ST myocardial infraction, which requires emergency coronary artery bypass grafting surgery (CABGX4).
The family becomes really concerned about John’s diagnosis, especially as they have always known him as a healthy, active man. John is transferred to a large tertiary hospital in Queensland so he can have his surgery within 24 hours. This news is very difficult and scary for Elisabeth. She is extremely concerned about her dad undergoing a complex surgery and very frightened about losing her father. Elisabeth starts to show signs of extreme anxiety, especially as she lost her mother at a young age. Maria, Maximo and Elisabeth decide to move to a hotel nearby so they can visit John and support him during his recovery from a complex surgery.
After his surgery John is transferred to the intensive care unit (ICU) for 48 hours. During his stay in the ICU, John struggles with his breathing due to his history of smoking. The healthcare team supports John to use an incentive spirometer and try some deep breathing exercises. He also requires a high flow of oxygen (45 litres at 45% of oxygen). During his stay at the hospital, John also experiences high levels of blood glucose. An ongoing diagnosis of coronary heart disease makes him very anxious about his surgical wound and recovery after discharge.
During visits by Elisabeth, Maria and Maximo in the post-opera