Aneurysm (Me rn) Flashcards
What is an Aneurysm?
A dilation of the arterial wall
In which arteries can an Aneurysm occur?
Any of them, but the Aortic Aneurysm is the most common
Risk factors of Aneurysm?
Atherosclerosis + male gender + age 65 or older + whites + tobacco use + Peripheral Artery Disease + Hypertension + high cholesterol + Coronary Artery Disease + previous stroke + obesity + trauma
Whenever a dilated arterial wall becomes lined with thrombi, there is a risk of-
Embolization
What meds can be used to treat an Aneurysm?
Simvastatin and/or Doxycycline + Propanol + Captopril
Largest artery in the body =
Aorta
An abdominal aorta would have to be how big in order for it to be considered an Aortic Aneurysm?
Larger than 3 cm
Most important modifiable risk factor for an Aneurysm?
Tobacco
Most common cause for an Aneurysm?
Atherosclerosis
What things make an Aneurysm so deadly?
The sluggish blood flow within the aneurysm may cause a blood clot and they can become Emboli and travel.
They may Rupture with Hemorrhage and Hypovolemic Shock.
Where are most Aneurysm’s located?
Between the Renal Arteries and Aortic Bifurcation
How should you assess for an Aortic Aneurysm (AAA) during a physical assessment?
Auscultate for Bruit, DON’T PALPATE (Can cause a Rupture)
What are the symptoms of AAA?
Often asymptomatic
Deep, diffuse chest pain or angina + Pulsating mass in periumbilical area to left of midline + Bruit over mass + Mid-abdominal or lower back pain (due to aneurysm compression) + Patient states can feel his or her heart beating
How can an Aneurysm be diagnosed?
Physical Exam + X-Ray + MRI + CT Scan
How can an Aneurysm be monitored?
Ultrasound
This is the most accurate way to gauge length, diameter, and presence of an Aneurysm =
CT Scan
The more pain from an aneurysm, the higher the risk for-
Rupture
What’s the main goal of treatment for an AAA?
Prevent Rupture
What diameter of Aneurysm would have conservative treatment?
What diameter of Aneurysm would have aggressive treatment (Surgery)?
Conservative = 5.4 cm or lower
Surgery needed asap = 5.5 or higher
What would Conservative Treatment for a AAA include?
Minimize the Growth of the Aneurysm with meds (Beta blockers, ACE inhibitors, ARBs, Statins, and Antibiotics)
After an Acute Rupture, what is the mortality rate?
90%
When a pt with an AAA starts complaining of a Searing, Ripping Pain in their abdomen or retrosternal area, it is a sign of-
Impending Rupture
What are the surgeries that can be used for an AAA?
Conventional
Endovascular Graft
What is Grey Turner’s Sign?
Ecchymosis (Bruising) on the Flanks
What is Grey Turner’s Sign an indicator of?
Never normal, indicates some type of abdominal bleed. Can be caused by an AAA
Signs of a slow leak of an Aneurysm =
Pallor + Weak + Increasing HR & Pulse + Dropping BP + Decreased LOC + Diaphoresis
Signs of Hypovolemic Shock caused by abdominal bleeding =
Hypotension + High Pulse + Pallor + Clammy Skin + Oliguria + Altered LOC + Abdominal Tenderness
When conservatively treating an AAA, how often should the pt have their Aneurysm size monitored? What would you use?
Every 6 Months to Annually
(Use CT, MRI, Ultrasound)
What is done during Conventional Surgery to treat an AAA?
Incise area, remove plaque, insert graft, sew original walls around graft
What is done during a Endovascular Graft?
Minimally invasive.
Femoral cut down, graft (Enclosed in a sheath) is inserted and advanced to aneurysm area. Once at proper spot, it’s deployed and opens. The blood now flows through this
What are some post-operative nursing interventions after an Aortic Aneurysm Repair is done on a pt?
Graft Patency:
Monitor CVP readings or PA pressures hourly
IV Diuretics- Furosemide
IV Antihypertensives- sodium nitroprusside, metoprolol, hydralazine labetalol
Renal Perfusion:
Accurate I&O; Urine output hourly
Daily BUN/creatinine
Daily weights
Infection:
Broad Spectrum Antibiotics
Assess temp and WBC
CV Status:
Continuous ECG monitoring
Frequent electrolytes and ABGs
Oxygen
IV antidysrhythmic meds and antihypertensives
Adequate pain control
Resumption of heart meds
GI Status:
NG tube to LWS
Assess bowel sounds
Neurological status
Peripheral perfusion
Check all pulses
Note color, temperature, capillary refill, sensation and movement of extremities
What does it mean if a pt’s graft patency is too high?
Stress on Anastomoses, causes leaking or rupture
What does it mean if a pt’s graft patency is too low?
Graft Thrombosis
What’s some pt education for a pt who got treated for an AAA?
No heavy lifting for 6 weeks.
Report redness, swelling, increased pain, temp >100, & drainage from incisions.
Teach patient how to monitor peripheral pulses and to report changes in color/warmth.
Sexual dysfunction…urologist referral if erectile dysfunction.
What’s an Aortic Dissection?
Tear in innermost lining of arterial wall of aorta
Risk factors for an Aortic Dissection?
Hypertension, male gender, advancing age, pregnancy, Marfan syndrome, blunt trauma, congenital heart disease, cocaine or methamphetamine use, history of cardiac surgery, atherosclerosis
Symptoms of an Aortic Dissection?
Sudden severe angina or back pain, often described as a ripping or tearing sensation + syncope, dizziness, weakness
Is an Aortic Dissection life threatening?
Yes
What’s the most common cause of an Aortic Dissection?
Chronic Hypertension
Complications of an Aortic Dissection =
Cardiac Tamponade (If blood enters the Pericardial Sac) + Dissected area weak and prone to rupture
An Aortic Dissection is diagnosed the same way a AAA is.
True or false?
True
An Aortic Dissection will be treated conservatively if-
No Severe Complications
What is some conservative treatment for an Aortic Dissection?
Lower BP + Decrease myocardial contractility + Treat pain + Bed rest
What is the standard treatment for surgery on an Aortic Dissection?
Endovascular Surgery
Symptoms of Cardiac Tamponade =
Hypotension + Narrowed Pulse Pressure + JVD + Muffled Heart Sounds + Pulsus Pardoxus
What is Pulsus Paradoxus?
Abnormally large decrease in SBP during inspiration
If an acute descending aorta dissection occurs, what’s a must?
Emergency Surgery
Beta blockers can be used to decrease-
Contractility
Calcium beta blockers can be used to decrease-
BP
How low do you want a pt’s BP to be if they’ve got an Aortic Dissection?
As low as possible while still keeping the organs perfused
Following an aortic aneurysm repair, for which complication is most important should the nurse monitor the patient?
A.) Infection
B.) Bleeding from the graft site
C.) Prolonged surgical hypothermia
D.) Dislodged thrombi
D
