My Heart Is Failing and I Am Pregnant

Abstract

A 34-year-old, gravida 2, para 0, woman who was at 29 4/7-weeks gestation. The patient had a history of rheumatic heart disease and mitral stenosis with severe pulmonary artery hypertension (New York Heart Association Heart Failure Class III). A 34-year-old woman, gravida 2, para 0 who was at 29 4/7-weeks gestation. The patient had a history of rheumatic heart disease and mitral stenosis with severe pulmonary artery hypertension (New York Heart Association Heart Failure Class III); she presented for admission for medical management with worsening symptoms of heart failure. Care management of this complex patient required multiple medical and nursing disciplines to ensure an optimal outcome. From a nursing perspective, during the antepartum course, the patient was managed by our antepartum nurses; however, she required cardiac telemetry, which was monitored remotely by a telemetry-certified nurse. As the physicians collaborated and their plan unfolded, gaps were identified by nursing leadership. These gaps included information sharing regarding patient acuity, potential for mortality, resources required for birth and the immediate postpartum period, and lack of a compressive emergency plan for deteriorating cardiac status. Cardiac nursing and obstetric nursing leadership were instrumental in compelling all medical disciplines to come together in a formal setting to discuss the patient’s plan of care for birth and the immediate postpartum period. It is critical to identify comorbidities during patient assessment and the determination of nursing interventions, recognizing that some interventions go beyond the scope of cardiac or obstetric nurses and must be done collaboratively.