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RNSG 2539 (Healthcare Concepts) > Aneurysms > Flashcards

Aneurysms Flashcards

1
Q

What is an aneurysm?

A

ANEURYSM = outpouching or dilation of a vessel

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2
Q

What happens when an aneurysm ruptures?

A

When an aneurysm ruptures, the vessel ruptures or breaks, allowing the blood to flow outward = NOT GOOD

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3
Q

Is an aneurysm very common?

A

No; however, it is the most common issue/problem to occur in the aorta!

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4
Q

Who is at highest risk?

A

Men more than women, and the highest risk ethnicity is whites; elderly = higher risk

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5
Q

is it better to have a smaller or larger aneurysm?

A

smaller; the larger the aneurysm = the higher risk for rupture

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6
Q

what can cause/lead to an aneurysm? - DEGENERATIVE

A

smooth muscles start to degenerate; allowing for/increases chance of outpouching/dilation of vessels

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7
Q

what can cause/lead to an aneurysm? -ATHEROSCLEROSIS

A

weakening of the aortic wall

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8
Q

what can cause/lead to an aneurysm? - MECHANICAL

A

mechanical issues = blunt trauma/penetration to aorta; cardiac catheterization can even lead to one; the cath can penetrate the aorta

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9
Q

what can cause/lead to an aneurysm? - INFLAMMATORY RESPONSE

A

infections can lead to inflammation; inflammation of the aorta and can lead to an aneurysm!

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10
Q

what are some risk factors that can lead to an aneurysm? - MODIFIABLE

A
  • smoking
  • HTN
  • CAD
  • high cholesterol
  • obesity
  • PAD of lower extremities
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11
Q

what are some risk factors that can lead to an aneurysm? - SMOKING; what can we do?

A

Encourage smoke cessation; offer education on how to stop smoking; advocate for Rx for quitting smoking, etc.

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12
Q

what are some risk factors that can lead to an aneurysm? - HTN; what can we do?

A

ensure patient is taking their medications to lower their B/P; advocate for Rx prescribed for HTN if patient doesn’t already have one, etc.

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13
Q

what are some risk factors that can lead to an aneurysm? - CAD; what can we do?

A

help patient lower risk of/reduce issue of CAD; medications, exercise, etc.

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14
Q

what are some risk factors that can lead to an aneurysm? - HIGH CHOLESTEROL

A

ensure cholesterol lowering medications are being taken by patient; encourage good exercise and diet!

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15
Q

what are some risk factors that can lead to an aneurysm? - OBESITY; what can we do?

A

encourage good exercise and diet!

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16
Q

what are some risk factors that can lead to an aneurysm? - PAD in LOWER EXTREMITIES; what can we do?

A

help with this issue; treat this disease; ***INCREASED RISK for developing AORTIC ANEURYSM!

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17
Q

what are some risk factors that can lead to an aneurysm? - NON-MODIFIABLE

A
  • family hx
  • age (increased)
  • male
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18
Q

TRUE vs FALSE aneurysms

A

TRUE aneurysm = the aneurysm is really there, really outpouching, really dilating, etc.

FALSE aneurysm = artery wall integrity has been interrupted; however, because of the makeup of your body, the bleeding has been contained; not bleeding out!

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19
Q

True Aneurysm: FUSIFORM

A

FUSIFORM - true = the outpouching is on both sides; balloon like > same shape/symmetrical

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20
Q

True Aneurysm: SACCULAR

A

SACCULAR - true = aneurysm with narrow neck + outpouching on ONE side of artery; looks like a small sack

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21
Q

what are some types of false aneurysms?

A
  • trauma
  • infection
  • surgeries
22
Q

can a clot form/block an aneurysm?

A

YES; if a clot forms, keeping the blood inside the artery; this is good; but still concerning because the clot could eventually become dislodged!

23
Q

what are some S/S of thoracic aortic aneurysms?

A 
#1: chest pain
#2: stroke like symptoms
#3: pressure of laryngeal nerve
24
Q

what are some S/S of thoracic aortic aneurysms? #1 CHEST PAIN

A
  • **MAJOR S/S OF THORACIC AORTIC ANEURYSM
  • chest pain occurs because there is decreased blood flow to the coronary arteries; the chest pain occurs because the blood isnt getting to the heart muscles like normal!
25
Q

what are some S/S of thoracic aortic aneurysms? #2 STROKE LIKE S/S

A

stoke like symptoms occur because of transient ischemic attacks due to DECREASED perfusion/blood flow/oxygen to brain and other organs

26
Q

what are some S/S of thoracic aortic aneurysms? #3 PRESSURE OF LARYNGEAL NERVE

A

-coughing + choking because of laryngeal nerve pressure; increased pressure; swelling in face + arms because of the location of the aneurysm; causes reduced fluid to return = swelling

27
Q

what are some S/S of abdominal aortic aneurysms?

A
  • ***generally asymptomatic and detected during an assessment via palpable mass
  • palpable mass
  • bruit heard
  • back pain (not definitive)
  • patchy, blue feet/toe syndrome (poor perfusion)
  • stomach discomfort/bowel issues (actual location of aneurysm)
28
Q

Complications of ruptured aneurysms: retroperitoneal

A

***MOST SERIOUS COMPLICATION W/ ANEURYSM

RETROPERITONEAL rupture: you MIGHT see a bleed in the peritoneal cavity; BUT hopefully/commonly it is controlled by surrounding organs

29
Q

Complications of ruptured aneurysms: thoracic/abdominal

A
  • ***VERY EMERGENT; may lead to death, quickly, because of the quick loss of blood.
  • NEEDS BLOOD PRODUCTS + FLUIDS + SURGICAL REPAIR; some or all interventions may be necessary due to location/severity.
30
Q

how is an aneurysm diagnosed; what diagnostics are used?

A
  • chest x-ray
  • abdominal x-ray
  • ultrasound
  • CT scan
  • MRI
  • angiography
31
Q

how is an aneurysm diagnosed; what diagnostics are used? - CHEST X-RAY

A

the chest x-ray is used to see if there is any abnormal widening of the aorta

32
Q

how is an aneurysm diagnosed; what diagnostics are used? - ABDOMINAL X-RAY

A

the abdominal x-ray is used to see if there is any abnormal widening of the aorta

33
Q

how is an aneurysm diagnosed; what diagnostics are used? - ULTRASOUND

A

the ultrasound is used to screen + detect size of the aneurysm

34
Q

how is an aneurysm diagnosed; what diagnostics are used? - CT SCAN

A

***GOLD STANDARD for diagnosing an aneurysm!

-this helps us detect where the aneurysm is AND how big/diameter of it

35
Q

how is an aneurysm diagnosed; what diagnostics are used? - MRI

A

the MRI is used for determining the size + location of the aneurysm

36
Q

What should I know, as a nurse, to care for my patient with an aneurysm?

A
  • **GOAL = PREVENT GROWTH & RUPTURE
  • medications helping with decreased B/P, decreased HR, decreased clotting, etc.

—MEDICAL MANAGEMENT can be used for aneurysms less than 5.4 cm

-monitor your patient

37
Q

when is surgical repair needed?

A
  • Aneurysms that are 5.5cm or LARGER may require surgical repair/intervention
  • aneurysms that are RAPIDLY growing may require surgical repair/intervention
  • aneurysms that are HIGH RISK FOR RUPTURE may require surgical repair/intervention
38
Q

why surgically intervene?

A

for aneurysms that require/may require surgical repair, surgery may be preferred because of the ability to resolve it in a controlled environment vs spontaneously&raquo_space; which can lead to bleeding out/uncontrolled bleeding

39
Q

what is MARFARN SYNDROME?

A

MARFARN SYNDROME = disease that causes over stretching of the aorta = higher risk for aneurysm!

***INCREASED RISK FOR RUPTURE TOO

40
Q

surgical repair-open abdominal repair (OAR)

A
  • surgical operation
  • LARGE abdominal incision
  • cleans up aorta too
  • places graft in aorta + closes the aorta AROUND graft
41
Q

what does the nurses assessment need to include/look like?

A
  • must obtain a thorough hx + in-depth physical assessment
  • ensure you know if any atherosclerosis exists - hx of it
  • OBTAIN BASELINE PULSES, VITALS, RENAL VITALS and NEURO VITALS

—-monitor for S/S of RUPTURE

42
Q

What are the post-op GOALS of a patient with an aneurysm?

A
  • *MAINTAIN NORMAL TISSUE PERFUSION
  • ensure motor/sensory functions are fully intact
  • ensure no complication have arose from the surgical repair
43
Q

what are some GOALS for POST-OP CARE?

A
  • adequate respiratory function
  • F&E balance
  • pain control/reduced pain/increased comfort
  • graft patency
  • renal perfusion
  • cardiac perfusion
  • NO INFECTION
  • NO BLOOD CLOTS
  • NO NEURO PROBLEMS
44
Q

how can you ensure graft patency?

A
  • *ADEQUATE B/P: assess CVP, PA pressure; replace fluid/blood as needed; good/proper hourly urine output
  • AVOID severe HTN; increased risk for post-op issues

**IV diuretics, beta blockers, hydralazine, nitro

45
Q

what changes can we see in cardiovascular status?

A
  • *dysrhythmias: can occur - due to electrolyte imbalances
  • hypoxemia can occur
  • hypothermia can occur
  • MI or ischemia
  • **MONITOR + REPLACE ELECTROLYTES
  • **MONITOR EKG + PULSE OX
  • **FREQUENT ABGs
  • **ADMINISTER IV anti-dys medications as needed
46
Q

what to do to prevent/treat infections post-op aneurysm repair:

A
  • assess for S/S of infection: fever, indicative labs, etc.
  • *broad spectrum antibiotics
  • assess surgical site for: redness, drainage, pain, etc.
  • ensure good nutrition for proper healing
  • monitor central lines + foley cath!

—-graft infection is RARE

47
Q

what is important to remember/understand about gastrointestinal status after aneurysm repair?

A
  • **HIGH RISK for PERIOP ILLEUS w/ OAR
  • NG tube placement might be necessary
  • record I&O - strict monitoring
  • assess for bowel sounds Q4 hours
  • ensure patient is passing gas (shows bowels are active/movement is present)
  • encourage EARLY AMBULATION
48
Q

what can be a bad sign with peripheral pulses?

A

BAD = cool, pale, mottled skin/extremity + PAINFUL

49
Q

are there any weight bearing restrictions post-op?

A

NO HEAVY LIFTING FOR 6 weeks post-op

50
Q

what education do I need to give to my post-op patient?

A
  • gradually increase your activity levels; may become fatigued easier/more often
  • your appetite might be poor for a bit
  • monitor bowel habits; encourage fluid intake, monitor for constipation - discourage bearing down
  • educate for S/S of infection at the surgical site
  • educate how to monitor their own pulses to ensure good perfusion/circulation

RNSG 2539 (Healthcare Concepts) (13 decks)

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