Unit 2 and 3 Chapter 33 Aortic Dissection

Question 1

Clinical manifestation of Aortic Dissection

Answer 1

 “Tearing”,“ripping”,“stabbing” Described as “worst ever” 10/10

 Pulsating sensation in abdomen

 aortic regurgitation, which is characterized by a musical murmur best heard along the right sternal border.
 Neurologic deficits such as an altered level of consciousness, paraparesis, and strokes also can occur.
 A decrease or absence of peripheral pulses is common,(cold pale skin)
 Dissection pain can be differentiated from MI pain which is more gradual in onset and has increasing intensity .

 As the dissection progresses, pain may migrate.

 Severe Pain Radiates (Depends on site) – chest, neck, throat, jaw, teeth or back, abdomen, legs

 Older–more likely to present with hypotension/vague s/s

 Diaphoresis (excessive sweating),
 nausea,
 vomiting,
 faintness,
 pallor, (due to decreased peripheral perfusion)
 a rapid and weak pulse and apprehension are also common.

Question 2

Where would you hear a murmur for Aortic Dissection?
A. 5th intercostal space midclavlicular line
B. 3rd intercostal space
C. near umbilicus
D. right sternal border

Answer 2

D. right sternal border

 aortic regurgitation, which is characterized by a musical murmur best heard along the right sternal border.

Question 3

What is Aortic Dissection

Answer 3

Aortic dissection is thought to be caused by a sudden tear in the aortic intima(inner lining of aorta), allowing blood to enter the aortic wall.

Question 4

What are the two complications of Aortic Dissection?

Answer 4

-Cardiac tamponde
-Rupture

Question 5

What diagnostic tool is used to confirm dissection?

Answer 5

CT
TEE

(CTA) is the test of choice to confirm diagnosis. However, the patient is often too unstable to be transported, and transesophageal echocardiography (TEE) may be performed at the bedside to confirm diagnosis.

Question 6

What is the medication of choice for Aortic dissection?

Answer 6

Antihypertensives and Vasodialatirs

The health care provider prescribes IV morphine sulfate to relieve pain and IV beta blocker, such as esmolol,to lower heart rate and blood pressure If this regimen is not effective, nitroprusside or nicardipine hydrochloride may be used.

Question 7

Does Myocardial Infarction or Aortic Dissection have a onset of severepain that radiates?

A. Aortic Dissection
B. Myocardial Infarction

Answer 7

A. Aortic Dissection

Dissection pain can be differentiated from MI pain that is
more gradual in onset and has increasing intensity . As the
dissection progresses, pain may migrate.

Question 8

What is the medication of choice for a patient with Aortic dissection that reports a 10/10 pain intensity?
A. PO Tylenol 325mg
B. Transdermal 2mg Fentanyl
C. 5mg IV morphine
D. Gabapentin 50MG

Answer 8

C. 5mg IV morphine

The health care provider prescribes IV morphine sulfate to relieve pain

Question 9

What is the long term recommended blood pressure for a patient with Aortic Dissection?
A. 105/70mm Hg
B. 125/80mm Hg
C. 150/100mm Hg
D. 170/80mm Hg

Answer 9

A. 105/70mm Hg

For long-term medical treatment, the recommended target for blood pressure is less than 120/80 mm Hg

HYPERTENSION IS A CAUSE OF AORTIC DISECTION

Question 10

Antihypertensives that are used for Aortic dissection patients who are stable?

Answer 10

Beta blockers (e.g., propranolol) and calcium channel antagonists (e.g., amlodipine) are prescribed to assist with blood pressure maintenance once the patient is stabilized.

Question 11

Are patients with Cardiac Tamponade hypertensive or hypotensive?

Answer 11

HYPOTENSIVE

cardiac tamponade or rupture have occurred. In these cases, the patient becomes rapidly hypotensive.