Aortic Aneurysms Flashcards
what is an aortic aneurysms?
Are out pouching or dilations of the arterial wall
what are the causes of aortic aneurysms?
degenerative
congenital
inflammatory
infectious
mechanical
aortic aneurysm may involve the aortic arch and thoracic aorta
however most of the time, they are found where?
abdominal aorta below the level of the renal arteries
the larger the aneurysm, the greater risk for what ?
rupture
what are the 2 main risk factors for patients in developing an aortic aneurysms?
family history
hypertension
patients who have a thoracic aortic aneurysm normally are often dont have any what ?
however if they do have symptoms, what would it be ?
symptoms
very symptomatic
deep diffuse chest pain that could rate to the interscapualr area
patient who have an ascending aortic aneurysm typically will have symptoms like ?
angina
coughing
shortness of breathe
hoarseness
distended neck veins and edema on face and arms if it pressures on the superior vena cava
most of the time patients with the common abdominal aortic aneurysm dont have ?
symptoms
often asymptomatic
how is abdominal aortic aneurysms usually found ?
physical exam or during exam for unrelated problem
how does the physical exam present itself in an abdominal aortic aneurysm ?
describe how it feels like and how it sounds like
pulsatile mass in periumbilical area slightly left of midline
- bruit asucltated over aneurysm
what does a bruit sounds like and mean ?
terbulent blood flow through your vessels
its very rare for patients to get symptoms for abdominal aortic aneurysm however if they do, what are the clinical manifestations?
back pain
epigastric discomfort
altered bowel elimination
intermittent caludicaiton
abdominal aortic aneurysm, patients may experience something called _____syndrome which is ?
blue toe syndrome
where the clots will migrate down to the toes and cause your toes to become cold and blue
what is the most serious complication related to an untreated aneurysm ?
rupture and bleeding
what happens if you have aortic aneurysm rupture for patients that have it in retropertioneal space ? (abdomen)(3)
its a steps
bleeding may be tampondaed
( bleed but eventually run out of space, causes pressures on the vessel and stops the bleeding, this pressures causes severe back pain )
severe back pain
grey turners sign
( back, flank ecchymosis)
what does grey turners syndrome mean?
bruising of your flanks, bleeding in the back of the abdomen !
what happens if you have an aortic aneurysm rupture in your thoracic or abdominal cavity ? (3)
think of the steps for this
massive hemorrhage causes hypoveolmic shock
patients dont survive long enough to get into the hospital
if survive, immediate resusistcitation and immediate surgery
what are some diagnostic studies for aortic aneurysm ?
x-ray
ultrasound
echocardiography
ECG
what is a small aneurysm considered to be ?
what is a large aneurysm considered to be ?
less than 5.4
greater than 5.4
what is the interprofessional care we are going to be wanting to help patients with a small aneurysm?
really going to be watching for changes in size and symptoms
ultrasound checks every 6-12months
increase in physical acitivity, stop smoking, watch cholesterol levels
what is the interprofessional care we are going to be wanting to help patients with a large aneurysm?
surgery
what are the two types of surgery we can do for patients who have large aortic aneurysm ?
open aneurysm repair (oar)
end-vascular aneurysm respair
describe what we are doing in open aneurysm repair for large aneurysm?
clamp the aorta ; proximal and distal aneurysm
put in a graft
sew in the vessels around the graft
what is the biggest concern and risk for patients who have oar?
acute kidney injury
( decrease perfusion can occur from the clamping and graft )
what is a end-vascular aneurysm repair ?
describe it
thred in the graft to the anerusym and hook it in place, and it will stay in place
how does the endovascular graft procedure help the patient overtime?
shrink the aneurysm overtime
post procedure from an endovascular graft, we usually like to get what done for the patient in order to check for leaks and confirm the patency of the procedure?
angiography
what are the potential complications that can occur to patients after an end-vascular graft procedure?
dont overthink it, think about the graft itself in the patient and what It can cause
stent will migrate
thrombus
infection
dysfunction
need lifelong follow up
in general what are some potential complications with any aneurysm repair ?
aneurysm growth
rupture
aortic dissection
bleeding
what’s the most common complication after an aneurysm repair?
endoleak
patients who experience the 6ps after a repair, what do we do ?
call the doctor and emergency surgery because they could lose their leg
what is a really lethal complication that can occur from aneurysm repair?
intraabdominal hypertension
what is intraabdominal hypertension?
pressure increases that puts more pressure on abdominal organs and diaphragm
intraabdominal hypertension is often associated with what?
abdominal compartment syndrome
abdominal compartment syndrome also can occur in what other disease process?
obtstrutive shock
what is the treatment for patients who experience intraadbominal hypertension ? (2)
open surgical compression
percutaneous drainage
nursing management
assessment
- history and physical exam
- watch for signs of cardiac, pulmonary, cerebral and lower extremity vascular problems
- establish baseline data to compare postoperatively
mark pedal pulses
monitor renal function
monitor mental status & neurological function
what are some clinical manifestations for aneurysm rupture?
diaphoresis
pallor
weakness
tachycardia
hypotension
abdominal, back or groin pain
changes in LOC
pulsating abdominal mass
Overall goals
- Normal tissue perfusion
- Intact motor and sensory function
- No complications related to surgical repair
Thrombosis
Infection
Rupture
health promotion
- Alert for opportunities to teach health promotion to patients and their caregivers
- Encourage patient to reduce cardiovascular risk factors (Table 33-2)
- These measures help ensure graft patency after surgery
preoperative TEST!!
- Patient/caregiver teaching about disease, treatment plan, and postoperative care
- Providing emotional support for patient/caregiver
- Preoperative routines
- Bowel prep
- NPO
- Shower
- IV antibiotics right before incision made
ICU monitoring 24 to 48 hours
postoperative TEST!!
- Central lines
- Endotracheal tube and mechanical ventilation
- Peripheral IV lines
- Urinary catheter
- NG tube
- Chest tube and Lumbar drain possible
- Continuous ECG monitoring
- Pulse oximetry
- Pain medication
Acute care
Normal blood pressure
IV fluids and blood components
CVP or PA pressure monitoring
Urinary output monitoring - hourly
Avoid severe hypertension
Drug therapy may be indicated
ONGOING MONITORING
CV status
Infection control
GI function
Neurologic function
Peripheral perfusion
Renal function
cardiovascular status
Continuous ECG monitoring
Electrolyte monitoring
Arterial blood gas monitoring
Oxygen administration
Antidysrhythmic and antihypertensive meds
Pain control
Resume heart medications
infection
Antibiotic administration
Assessment of temperature
Monitoring of WBC
Adequate nutrition
Observe surgical incision for signs of infection
Hand hygiene and aseptic technique for all invasive catheters; perineal care to risk of UTI
GI
Monitor for paralytic ileus; bowel sounds
Passing of flatus = return of bowel function
Record amount and character of NG tube output
NPO; provide oral care
Abdominal assessment
Assess for signs of bowel ischemia—absent bowel sounds, fever, abdominal distention, diarrhea, and bloody stools
neurologic status
- Level of consciousness
- Pupil size and response to light
- Facial symmetry
- Speech
- Ability to move upper extremities
- Quality of hand grasps
- Descending aorta—neurovascular check to lower extremities
Frequent pulse assessment —doppler, if needed
Ascending aorta and aortic arch-Carotid, radial, and temporal
Descending aorta-Femoral, popliteal, posterior tibial, and dorsalis pedis
Extremity assessment
Temperature, color, capillary refill time, sensation, and movement of extremities
Vasospasm and hypothermia can cause absence of lower extremity pulses (temporary)
Absent pulses + cool, pale, mottled, or painful extremity means embolization or graft occlusion
Report immediately
vasospasm is ____ normal
not!!!
renal notes
- Hourly urinary output (initially)
- Accurate I & O
- Daily weight
- CVP pressure
- Blood urea nitrogen/creatinine
- Decrease renal perfusion may occur with: embolization of plaque to renal arteries, hypotension, prolonged aortic clamping or blood loss
Ambulatory care
- Encourage patient to express concerns
Fatigue, poor appetite, irregular bowel habits, and male sexual dysfunction are common - Instruct patient to gradually increase activities
- No heavy lifting for 6 weeks
- Teach about signs and symptoms of complications
- Infection
- Neurovascular changes
Expected outcomes
- Patent arterial graft with adequate distal perfusion
- Adequate urine output
- No signs of infection
something I just want to emphasize that I feel like might be on the test, we want patients to gradually increase acitivyt but avoid heavy lifting for about ___weeks
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