diseases of the aorta

Question 1

what is an AAA

Answer 1

Localized dilatation of a portion of the aorta, >1.5 times its normal diameter
Usually at a weakened area of the aortic wall

Question 2

risk factors for AAA

Answer 2

Smoking
Age
HTN
Lipid disorders
Atherosclerosis
Genetic predisposition

Question 3

stable symptoms of AAA

Answer 3

Palpable, pulsatile mass in the umbilical area of the abdomen
Abdominal pain
Lower back pain

Question 4

acute rupture AAA symptoms

Answer 4

Sudden onset of severe abdominal pain
Hypotension with abrupt loss of consciousness

Question 5

management of AAA

Answer 5

risk factor modification and elimination

surgical repair of aortic aneurysm versus endovascular aortic stent
- Aneurysm > 4.5-5.5 cm
- Rapidly expanding aneurysms
- Symptomatic aneurysm regardless of the size

Question 6

what is aortic dissection

Answer 6

Weakened aortic medial layers
A false channel or lumen is created as blood is pumped through the tear
Classified according to location

Question 7

symptoms of acute aortic dissection

Answer 7

• Severe and sudden hypertension
• Sudden onset of intense and excruciating pain present in the back between the shoulder blades, chest and arms
• Ripping or tearing sensation within the chest
• Radiation of pain down into the abdomen and lower back
• Worst pain in the patient’s life
• Syncope or loss of consciousness with onset of pain.
• Development of a murmur from aortic insufficiency; unequal pulses

Question 8

medical management of aortic dissection

Answer 8

BP reduction with: IV beta blockers such as Esmolol or beta plus alpha blocker combination such as Labetalol

Further Systolic BP reduction with IV vasodilators such as nitroprusside

Pain relief and sedation

Question 9

postoperative nursing management of aortic dissection

Answer 9

Prevent hypertension (afterload reduction)
- I.V. nitroprusside titrate to keep systolic BP below 120 mm Hg.
Monitoring
- Cardiac rhythm, hemodynamics, urine output/fluid balance, chest tube output, core body temperature, frequent neurologic assessments, gastrointestinal function
Monitor for complications
- Acute renal failure
- Ischemic colitis
- Spinal cord ischemia
Provide analgesia
Monitor lab values
- Creatinine and BUN
- Hemoglobin and hematocrit (hematocrit should be maintained at 28% or greater)
- Platelets, to detect thrombocytopenia
- White blood cell count and differential
- Electrolytes

Question 10

The nurse is caring for a patient post aortic dissection repair with the following vital signs: BP 189/102; P: 98; R 20; T 98° F, SpO2 99%. What is the priority nursing action for this patient?

A. Draw the ordered complete blood count (CBC)
B. Start the ordered nitroprusside to keep systolic < 120 mmhg
C. Start the ordered norepinephrine to keep systolic > 130 mmhg
D. Assess the patient’s urine output

Answer 10

B. Start the ordered nitroprusside to keep systolic < 120 mmhg

Rational: Aortic dissection patients need hypertension to be avoided due to the risk of acute rupture of the repair