Aortic Aneurysm/Test 2 Flashcards
Definintion of Aortic Aneurysm
*Weakness within the arterial wall
*Localized ballooning of an artery
*Increases to about 50% of it’s size
Exact cause unknown
Risks for Aortic Aneurysm
- HTN, HTN, HTN
- Atherosclerosis
- Congenital weakening of the wall
- Weakening due to connective tissue diseases
Significance of Aortic Aneurysm
- 2-3% of unselected population
- M:F 5:1
- Age >60 years
- High risk of rupture if:
- > 5 cm
- expanding rapidly
- saccular
Locations in the aorta
- Thoracic- above diaphragm
* Abdominal- below diaphragm
Aortic Aneurysm Labels
- Fusiform
- Saccular
- Dissecting
- Ruptured
Fusiform
Entire circumference affected- football
Saccular
on side of the vessel (easiest to rupture-bike tire)
Dissecting
blood accumulates between layers of vessel r/t tears in intimal lining
Ruptured
Bursts
Symptoms of aortic aneurysm
- Thoracic:
- Tearing pain, tearing sensation within chest
- HTN
- Abdominal
- pulsating mass in the abdomin
- Pain- abdominal, flank, back, groin
- HTN
Diagnostics of Aortic Aneurysm
- Ultrasound
- Cat Scan
- Xray
- Arteriogram/Aortagram
Nursing Diagnoses of Aortic Aneurysm
- Ineffective Tissue Perfusion
- Pain
- Impaired gas exchange
- PC: Rupture or hemorrhage
- Many PC’s
Medical Management for Aortic Aneurysm
- Control risks, trend size
- Prevent increase in size
- Surgical treatment if >5 cm
Treatment for Aortic Aneurysm
- Anit-hypertensives
- Keep stress under control
- Surgery or resection of the aneurysm and creation of a new artery or graft.
- Endovascular procedures
Endovascular procedures
- New method for non-emergency treatment to repair
- 2 small incisions in groin
- catheter with balloon and graft inserted
- inflated at aneurysm site
Traditional Graft Surgery
- Recommended if >6 cm wide
- May be elective if 4-6 cm
- Midline abdominal incision
- Aorta clamped above and below aneurysm-quick procedure*
- Aneurysm opened
- Dacron graft placed within
- Aneurysm sac wrapped around the graft
- pre op note pedal pulses
- post op: assess bowel sounds
- *Reglan med
Pre Op Care
- Prop respiratory and cardiac assessment
- Perpheral pulses for baseline
- BP must be under control
- Measure abdominal girth
- Type and cross
Post Operative Patient
- oxygenation
- circulation
- perfusion
- wound
- GI elimination
- renal function
- mobility
- pain
Post Op Nursing
- Impaired gas exchange
- respirations
- O2 sat
- breath sounds
- depth
- sputum
- Free from atelectasis/pneumonia
- position
- pulmonary toilet
- ISE
- splinting
- abdominal binder
- out of bed
Post op potential complications
- Hemorrhage Nurse prevents
- pulse -Measures
- b/p -trends
- skin -reports
- metal status -plans ahead
- UO -available IV sites
- abdominal girth
- CVP
Post Op complications
- Ineffective tissue perfusion r/t temporary decrease in blood supply in sx
- pulses
- skin
- color
- movement
- sensation
- pain
- Maintain perfusion to periphery
- extremity assmt
- assess/mark pulses
- heparin/lovenox SQ
- TEDS/SCDs
- positioning
- ***NEVER CRIMP A GRAFT
Post Operative Nursing
- Altered tissue integrity
- large abdominal incision
- Free from dehiscence
- assess
- report redness, swelling, disruption, abd. distention
- abdominal binder and splinting
- DM- keep blood sugar controlled, increased chance of impaired wound healing
Post Operative Complications
- Ischemic Bowel
- Abdominal distention
- decreased or absent bowel sounds
- Return of normal GI function
- Assess
- NG to intermittent suction
- Ambulate
- Reglan
- Document return of BS or passing flatus
- Stool softeners later
Post Operative Complications
- Renal failure
- decreased urine output
- swelling
- increased BUN/Cr
- Manage to prevent or detect early
- I&O
- wt qd
- daily labs, BUN/Cr
- Changes in HR, BP
Post Op Nursing
- Pain
- anxious
- uncooperative
- grimace
- rating at 10
- Pain level at 3
- medicate-morphine/dilaudid
- turn and reposition
- skin care
- abd binder
- pillow for splinting
Post Op Nursing
- decrease mobility
- major surgery
- weakness
- pain
- Return to ADL functioning
- early ambulation
- up to chair TID
- progressive
- bedside rehab
- rehab
- strenghthening
Nurse Discharge
- Teach
- Home medications BP, BP, BP
- No straining, no constipation, no lifting >10 lb
- Progressive activities
- Control risk factors
Aortic Dissection
- Usually acute, life threatening
- Blood accumulates between the tear
- More pressure at the site, less blood flow to organs
Symptoms of aortic dissection
- Severe pain, tearing or ripping
- chest, intrascapular, abdomen to legs
- Cardiovascular
- Neurological
- Respiratory
Conservative Treatment if slow dissection
- Bed rest
- Pain relief
- Prevent ischemia to organs
- Control of b/p- Nipride (med)
- Control cardiac contractility- Beta Blockers
- Transfuse if blood loss
- Prepare for surgery
Emergency-Ruptured Abdominal Aortic Aneurysm
- pulsating sensation in the abdomen
- severe, sudden pain in abdomen
- radiation to groin and back
- abdominal rigidity
- signs of hypovolemic shock
- Pallor
- anxiety
- increased HR, decreased BP, decreased urine output
- dry skin
- excessive thirst
Rupture
- Immediate surgery
- 50% mortality rate
- results
- more blood loss
- more ischemic disease
Treatment: ruture
- Transfuse
- blood
- IV fluids
- Support airway
- Immediate surgery
Post op care
- More critical
* Greater chance of ischemic complications
