Unit 2 and 3 Chapter 33 Aortic Abdominal Aneurysm and Thoracic Aneurysm

Question 1

What is an Aneursym

Answer 1

An aneurysm is a permanent localized dilation of an artery, which enlarges the artery to at least two times its normal diameter.

Question 2

What is the most common life threatening complication of Aneurysms

Answer 2

. Rupture is the most frequent complication and is life threatening because abrupt and massive hemorrhagic shock results.

Question 3

Are nonsymptomatic aneusryms usually discovered during imaging procedures?

Answer 3

Yes

Discovery on physical exam or
x-ray, when it reaches 5 cm
can be palpated, bruits can
be heard over aneurysms .

Question 4

Which of the following is the most common tool to diagnose an ANEURSYM?
A.palpation
B.ausculation
C. computed tomography(CT)
D. Doppler

Answer 4

C. computed tomography(CT)

Question 5

What is Abdominal Aortic Aneursyms

Answer 5

Abdominal aortic aneurysms (AAAs) account for most aneurysms, are commonly asymptomatic, and frequently rupture. Most of these are located between the renal arteries and the aortic bifurcation (dividing area).

Question 6

Risk factors for Aneurysms, what is the most common cause

Answer 6

Atherosclerosis is the most common cause of aneurysms,
-hypertension,
-hyperlipidemia, and
-cigarette smoking being contributing factors.

NOMODIFIABLE
Age, gender, and family history also play a role

Question 7

S/s of Abdominal Aortic Aneurysm

Answer 7

Assess patients with a known or suspected abdominal aortic aneurysm (AAA) for abdominal, flank, or back pain. Pain is usually described as steady with a

gnawing quality, unaffected by movement, and lasting for hours or days.

-A pulsation in the upper abdomen slightly to the left of the midline between the xiphoid process and the umbilicus may be present.
-. A detectable aneurysm is at least 5 cm in diameter.
- If expansion and impending rupture of an AAA are suspected, assess for
- WHEN RUPTURED
- severe pain of sudden onset in the back or lower abdomen, which may radiate to the groin, buttocks, or legs.
- Hematoma at the flank area
- hypotension

Question 8

Nursing consideration for Abdominal Aortic Aneurysm

Answer 8

Auscultate for a bruit over the mass, but avoid palpating the mass because it may be tender, and there is risk for rupture!

Question 9

Should you palpate the aneurysm?

Answer 9

No

Question 10

What are pt’s at risk for when the aneursym ruptures

Answer 10

Patients with a rupturing AAA are critically ill and are at risk for hypovolemic shock caused by hemorrhage. Signs and symptoms include hypotension, diaphoresis, decreased level of consciousness, oliguria (scant urine output), loss of pulses distal to the rupture, and dysrhythmias. Retroperitoneal hemorrhage manifests with hematomas in the flanks (lower back). Rupture into the abdominal cavity causes abdominal distention.

Question 11

What should the nurse do first for a patient with Aortic Abdoniaml Aneursym?

Answer 11

The size of the aneurysm and the presence of symptoms determine patient management. The nurse’s role is to perform frequent patient assessments, including blood pressure, pulse, and peripheral circulation checks.

Question 12

Can hypertension worsen or decrease the size of an aneurysm?
A. decrease
B. worsen

Answer 12

B. worsen

patients with hypertension are treated with antihypertensive drugs to decrease the rate of enlargement and the risk for early rupture.

Question 13

The desired outcome for a patient with an aneurysm?

Answer 13

-decrease size of aneurysm
-decrease hypertension
-PREVENT FROM RUPTURE

The desired outcome of nonsurgical management is to monitor the growth of the aneurysmand maintain the blood pressure at a normal level to decrease the risk for rupture.

Question 14

What type of medications are used in the tx of Aneursyms

Answer 14

-antihypertensives

Question 15

Is frequent vital signs amd imaging test necessary for a patient with a present Aneursym?
A. yes
B. no

Answer 15

A. yes

For those with small or asymptomatic aneurysms, frequent ultrasound or CT scans are necessary to monitor the growth of the aneurysm.

Emphasize the importance of following through with scheduled tests to monitor the growth.

Also explain the signs and symptoms of aneurysms that need to be promptly reported.

Question 16

Which of the following signs and symptoms should be reported immediately for a patient diagnosed with Abdominal Aortic Aneursyn?
A. headache
B. Abdominal distention
C. hypertension
D. bruit over mass

Answer 16

B. Abdominal distention

sign of peritonitis and hemmorhage

Question 17

What are the Clinical manifestations of a ruptured Abdominal Aortic Aneurysm

Answer 17

Patients with a rupturing AAA are critically ill and are at risk for

hypovolemic shock caused by hemorrhage.
**hypotension,
diaphoresis,
-decreased level of consciousness,
oliguria (scant urine output),
loss of pulses distal to the rupture, -dysrhythmias.
-Retroperitoneal hemorrhage manifests with hematomas in the flanks (lower back). -Rupture into the abdominal cavity causes abdominal distention.
Monitor:
√ Abdominal, back, groin, or peri-umbilical pain
(Gnawing pain lasting hours/days) √ Pulsating abdominal mass √ Diaphoresis √ Paleness √ Weakness √ Tachycardia √ Hypotension √ Changes in level of consciousness
-flank bruising

Question 18

What is Thoracic Aortic Aneursym

Answer 18

Thoracic aortic aneurysms (TAAs) are not quite as common and are frequently misdiagnosed. They are typically discovered when advanced imaging is used to assess other conditions. TAAs commonly develop between the origin of the left subclavian artery and the diaphragm. They are located in the descending, ascending, and transverse sections of the aorta. They can also occur in the aortic arch and are very difficult to manage surgically.

Question 19

Clinical manifestation of Thoracic Aortic Aneurysm

Answer 19

Signs include shortness of breath, hoarseness, and difficulty swallowing.

mass may be visible above the suprasternal notch.

Question 20

Clinical Manifestations of Thoracic Aortic Aneurysm Rupture

Answer 20

Assess the patient with suspected rupture of a thoracic aneurysm for sudden and excruciating back or chest pain. Hypovolemic shock also occurs with TAA.

Question 22

Which of the following is the standard tool of assessing the size and location of aneurysms

A.xray
B. CT
C.Doppler
D. Echocardiogram

Answer 22

B. CT

Computed tomography (CT) scanning with contrast is the standard tool for assessing the size and location of an abdominal or thoracic aneurysm.
Ultrasonography is also used.

Question 23

Patient teaching /signs of rupture for AAA OR TAA

Answer 23

Teach patients receiving treatment for hypertension about the importance of continuing to take prescribed drugs. Instruct them about the signs and symptoms that must be reported promptly to the primary health care provider, which include:
* Abdominal fullness or pain or back pain
* Chest or back pain
* Shortness of breath’
* Difficulty swallowing or hoarseness

Question 24

Surgical management of an aneurysm

Answer 24

For patients with a rupturing abdominal aortic or a thoracic aneurysm, emergency surgery is performed.

Patients with smaller aneurysms that are producing symptoms are advised to have elective surgery.

Those with smaller aneurysms that are not causing symptoms are treated nonsurgically until symptoms occur or the aneurysm enlarges.

Question 25

Is the mortality rate high for aneursym procedure

Answer 25

The most common surgical procedure for AAA has traditionally been a resection or repair (aneurysmectomy).

-However, the mortality rate for elective resection is high and markedly increases for emergency surgery.

Question 26

POST OP CARE OF SURGICAL MANAGEMENT OF RUPTURED ANEURYSM

Answer 26

If discharged to home, the patient must follow instructions regarding activity level and incisional care.

Because stair climbing may be restricted initially, he or she may need a bedside commode if the bathroom is inaccessible.

Teach the patient who has undergone surgical repair about activity restrictions, wound care, and pain management.

Patients may not perform activities that involve lifting heavy objects (usually more than 15 to 20 lb [6.8 to 9.1 kg]) for 6 to 12 weeks after surgery.

Advise them to use caution for activities that involve pulling, pushing, or straining.

Most patients are restricted from driving a car for several weeks after discharge.

Question 27

Are patients with a small aneurysm mandated to go to consistent visits for imaging to assess size and location of Aneurysm

Answer 27

For patients who have not undergone surgical aneurysm repair,

The teaching plan emphasizes the importance of compliance with the schedule of frequent ultrasound scanning to monitor the size of the aneurysm.