Aneurysms Flashcards
What is an aneurysm?
ANEURYSM = outpouching or dilation of a vessel
What happens when an aneurysm ruptures?
When an aneurysm ruptures, the vessel ruptures or breaks, allowing the blood to flow outward = NOT GOOD
Is an aneurysm very common?
No; however, it is the most common issue/problem to occur in the aorta!
Who is at highest risk?
Men more than women, and the highest risk ethnicity is whites; elderly = higher risk
is it better to have a smaller or larger aneurysm?
smaller; the larger the aneurysm = the higher risk for rupture
what can cause/lead to an aneurysm? - DEGENERATIVE
smooth muscles start to degenerate; allowing for/increases chance of outpouching/dilation of vessels
what can cause/lead to an aneurysm? -ATHEROSCLEROSIS
weakening of the aortic wall
what can cause/lead to an aneurysm? - MECHANICAL
mechanical issues = blunt trauma/penetration to aorta; cardiac catheterization can even lead to one; the cath can penetrate the aorta
what can cause/lead to an aneurysm? - INFLAMMATORY RESPONSE
infections can lead to inflammation; inflammation of the aorta and can lead to an aneurysm!
what are some risk factors that can lead to an aneurysm? - MODIFIABLE
- smoking
- HTN
- CAD
- high cholesterol
- obesity
- PAD of lower extremities
what are some risk factors that can lead to an aneurysm? - SMOKING; what can we do?
Encourage smoke cessation; offer education on how to stop smoking; advocate for Rx for quitting smoking, etc.
what are some risk factors that can lead to an aneurysm? - HTN; what can we do?
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.
what are some risk factors that can lead to an aneurysm? - CAD; what can we do?
help patient lower risk of/reduce issue of CAD; medications, exercise, etc.
what are some risk factors that can lead to an aneurysm? - HIGH CHOLESTEROL
ensure cholesterol lowering medications are being taken by patient; encourage good exercise and diet!
what are some risk factors that can lead to an aneurysm? - OBESITY; what can we do?
encourage good exercise and diet!
what are some risk factors that can lead to an aneurysm? - PAD in LOWER EXTREMITIES; what can we do?
help with this issue; treat this disease; ***INCREASED RISK for developing AORTIC ANEURYSM!
what are some risk factors that can lead to an aneurysm? - NON-MODIFIABLE
- family hx
- age (increased)
- male
TRUE vs FALSE aneurysms
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!
True Aneurysm: FUSIFORM
FUSIFORM - true = the outpouching is on both sides; balloon like > same shape/symmetrical
True Aneurysm: SACCULAR
SACCULAR - true = aneurysm with narrow neck + outpouching on ONE side of artery; looks like a small sack
what are some types of false aneurysms?
- trauma
- infection
- surgeries
can a clot form/block an aneurysm?
YES; if a clot forms, keeping the blood inside the artery; this is good; but still concerning because the clot could eventually become dislodged!
what are some S/S of thoracic aortic aneurysms?
#1: chest pain #2: stroke like symptoms #3: pressure of laryngeal nerve
what are some S/S of thoracic aortic aneurysms? #1 CHEST PAIN
- **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!
what are some S/S of thoracic aortic aneurysms? #2 STROKE LIKE S/S
stoke like symptoms occur because of transient ischemic attacks due to DECREASED perfusion/blood flow/oxygen to brain and other organs
what are some S/S of thoracic aortic aneurysms? #3 PRESSURE OF LARYNGEAL NERVE
-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
what are some S/S of abdominal aortic aneurysms?
- ***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)
Complications of ruptured aneurysms: retroperitoneal
***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
Complications of ruptured aneurysms: thoracic/abdominal
- ***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.
how is an aneurysm diagnosed; what diagnostics are used?
- chest x-ray
- abdominal x-ray
- ultrasound
- CT scan
- MRI
- angiography
how is an aneurysm diagnosed; what diagnostics are used? - CHEST X-RAY
the chest x-ray is used to see if there is any abnormal widening of the aorta
how is an aneurysm diagnosed; what diagnostics are used? - ABDOMINAL X-RAY
the abdominal x-ray is used to see if there is any abnormal widening of the aorta
how is an aneurysm diagnosed; what diagnostics are used? - ULTRASOUND
the ultrasound is used to screen + detect size of the aneurysm
how is an aneurysm diagnosed; what diagnostics are used? - CT SCAN
***GOLD STANDARD for diagnosing an aneurysm!
-this helps us detect where the aneurysm is AND how big/diameter of it
how is an aneurysm diagnosed; what diagnostics are used? - MRI
the MRI is used for determining the size + location of the aneurysm
What should I know, as a nurse, to care for my patient with an aneurysm?
- **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
when is surgical repair needed?
- 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
why surgically intervene?
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»_space; which can lead to bleeding out/uncontrolled bleeding
what is MARFARN SYNDROME?
MARFARN SYNDROME = disease that causes over stretching of the aorta = higher risk for aneurysm!
***INCREASED RISK FOR RUPTURE TOO
surgical repair-open abdominal repair (OAR)
- surgical operation
- LARGE abdominal incision
- cleans up aorta too
- places graft in aorta + closes the aorta AROUND graft
what does the nurses assessment need to include/look like?
- 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
What are the post-op GOALS of a patient with an aneurysm?
- *MAINTAIN NORMAL TISSUE PERFUSION
- ensure motor/sensory functions are fully intact
- ensure no complication have arose from the surgical repair
what are some GOALS for POST-OP CARE?
- 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
how can you ensure graft patency?
- *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
what changes can we see in cardiovascular status?
- *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
what to do to prevent/treat infections post-op aneurysm repair:
- 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
what is important to remember/understand about gastrointestinal status after aneurysm repair?
- **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
what can be a bad sign with peripheral pulses?
BAD = cool, pale, mottled skin/extremity + PAINFUL
are there any weight bearing restrictions post-op?
NO HEAVY LIFTING FOR 6 weeks post-op
what education do I need to give to my post-op patient?
- 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
