aneurysms

Question 1

aneurysms

Answer 1

. Abnormal dilation in a portion of the

   arterial wall.  Caused by weakness in

   medial ( muscle ) layer of vessel.  Intima

   & adventitia then stretch.

b. Creates high arterial wall tension in

   area of aneurysm.  Can burst, causing

   hemorrhage.

Question 2

saccular aneurysm

Answer 2

•bubble in portion of arterial wall

Question 3

fusiform aneurysms

Answer 3

•dilation entirely encircles a portion

of the arterial wall

Question 4

dissecting aneurysm

Answer 4

•blood separates layers of arterial

                       wall.  Blood is lost & blood flow

                       to organs is diminished.

more common in thoracic area than abdominal area

Question 5

false aneurysm

Answer 5

•rupture of an artery but blood collects

next to vessel. Occur as result of

             vessel injury or trauma.

Question 6

worst aneurysm is

Answer 6

dissecting

Question 7

aortic aneurysm

Answer 7

•May involve aortic arch, thoracic aorta and

abdominal aorta.

Question 8

abdominal aortic aneurysms

Answer 8

•arise between

renal and iliac arteries.

Question 9

thoracic aortic aneurysms

Answer 9

•arise between

subclavian and renal arteries.

Question 10

Thoracic aortic aneurysm

Answer 10

•Not as common as AAA. Most frequently

in men between 40-70 years old.

•Most common site for dissection. Often

misdiagnosed.  1/3 die from rupture.

• Most caused by atherosclerosis & hypertension.
• Other causes are trauma, coarctation of aorta,and Marfan’s Syndrome.

Question 11

dissecting thoracic aortic aneurysm

Answer 11

•Considered life-threatening emergency caused by tear in intima of aorta with hemorrhage into media. Splits vessel wall forming blood filled channel between its layers.

hypertension is major predisposing risk factor

Question 12

Type A dissecting thoracic aorta aneurysm

Answer 12

•called proximal dissection. Affects ascending aorta.

Question 13

Type B dissecting thoracic aortic aneurysm

Answer 13

•Distal dissection limited to descending aorta.

Question 14

symptoms of dissecting aortic aneurysm

Answer 14

• Severe anterior chest pain or intrascapular pain radiating down spine into abdomen and legs. May be in neck, jaw, and teeth.
• Pain is described as tearing or ripping and boring.
• If in the aortic arch, may see changes in levels of consciousness, dizziness, and weakened or absent carotid and temporal pulses.
• Superficial veins in chest, neck, arms may be dilated and edema and cyanosis may be seen.
• Diaphoresis, nausea, and vomiting, fainting, and apprehension are also common.
• Blood pressure changes, decrease or absent peripheral pulses may be seen.
• Complications: rupture and hemorrhage

Question 15

abdominal aortic aneurysm

Answer 15

• Most common cause is atherosclerosis.
• Affects men 4xs more than women. Prevalent in the elderly.
• 2/3 people are symptomatic.
• Most occur below renal arteries, usually at branch of iliac arteries.
• Associated with hypertension, increased age, and smoking. Most people over 70 years.

Question 16

symptoms of abdominal aortic aneurysm

Answer 16

• May see pulsatile mass in periumbilical area, slightly left of midline.
• Bruits may be heard.
• Feeling like there is a heart beat in the abdomen.
• When pain is present, may be constant or intermittent. Usually is mid abdominal area or lower back. Severe pain usually indicates impending rupture.
• Can cause “blue toe syndrome” with patchy mottling of feet and toes in the presence of pedal pulses.
• Sluggish blood flow to small vessels can cause thrombi and embolization.
• Complication: rupture and hemorrhage. Up to 50% patients die from rupture before hospitalization. Only 10 to20% survive.

Question 17

rupture of abdominal aortic aneurysm

Answer 17

• If posterior rupture into retroperitoneal space, bleeding may be tamponaded by surrounding structure, preventing exsanquination.
• Have severe back pain and may or may not have back and flank ecchymosis ( Turner’ssign ).
• If rupture is anterior into abdominal cavity, death from exsanquination is likely.
• If the person survives can have ischemia or infarct to myocardium, kidneys and bowels. Paraplegia is rare.

Question 18

assessment/ diagnostic of thoracic aneurysm

Answer 18

If large veins in chest compressed, superficial veins in chest, neck, arms may be dilated and edematous. Cyanosis may be seen.

b. Pressure against cervical sympathetic chain can cause unequal pupils.
c. Diagnosis by chest Xray, MRI, CT, transesophageal echocardiogram (TEE)

Question 19

assessment/diagnostic of abdominal aneurysm

Answer 19

a. Pulsatile mass, systolic bruit
b. Diagnosis by ultrasound, CT. If it is too small for surgery, have ultrasounds every six months to monitor status.
c. Aortagraphy via femoral artery can be used to anatomically map the system with contrast dye. Can be nephrotoxic.

Question 20

management of an aneurysm

Answer 20

very important to keep systolic BP low

•Control SB/P to 100 to 120 with antihypertensives. Correct risk factors like smoking.

Question 21

surgery for aneurysm

Answer 21

Symptomatic & expanding anerysm

b. Thoracic more than 6cm. Abdominal

            more than 5cm.

c. Dissecting:
1. Type A- ASAP
2. Type B- depends on involvement & possibility

               of rupture.

d. Can be open surgery or endovascular surgery.

Question 22

benefits of endocascular repair

Answer 22

• Decreased anesthesia and operative time.
• Smaller blood loss.
• Decreased morbidity & mortality.
• Small bilateral groin incisions.
• More rapid resumption of physical activity.
• Shortened hospital time. Reduced costs.
• Quicker recovery.
• Higher patient satisfaction.

Question 23

potential complications of an endocascular repair

Answer 23

• Has higher reintervention risk.
• Aneurysm growth & rupture.
• Perigraft leaks. Most common problem
• Aortic dissection
• Bleeding, graft dislocation, embolization, renal artery occlusion due to graft migration, graft thrombosis, incisional hematoma & infection.

Question 24

nursing pre-op care for endovascular approach

Answer 24

• Patient may be hydrated. Electrolyte, coagulation, hgb & hct abnormalities corrected.
• VS, cardiopulmonary, vascular and neurovascular baseline assessment.
• Assess patient’s level of understanding of surgery
• Pre-op teaching
• Assess other risk factors with surgery
• Orientation to ICU if open surgery
• NPO, pre-op antibiotics

Question 25

post op care for endocascular approach

Answer 25

• Monitor VS, LOC, cardiopulmonary status, skin temperature & color, peripheral pulses
• Check dressing, IV site, s&s of shock. Monitorblood work ( cbc, coagulation, chemistry )
• Evaluate pain. Pain control.
• Strict aseptic technique. Deep breathe, incentive spirometer
• Monitor I&O, EKG, Chest tube if applicable.
• Report manifestations of graft leakage

Question 26

manifestations of graft leakage

Answer 26

• Ecchymosis of perineum, scrotum, penis, or new expanding hematoma
• Increasing abdominal girth
• Weak, absent peripheral pulses.
• Decreased motor function/ sensation to extremities
• Fall in Hgb & Hct, decreased urine output, decreased CVP, BP & increased HR
• Increased abdominal, pelvic, back, & groin pain.

Question 27

home care instructions for after endovascular repair surgery

Answer 27

• Measures to control HTN. Stop smoking
• Complications to report
• Wound care. Review prescribed antihypertensives & anticoagulant meds
• Need for adequate rest and nutrition
• Measures to prevent constipation and straining
• Avoid prolonged sitting, heavy lifting, strenuous activities and having sex for 6 to 12 weeks.