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NURS 3512 - Class 1-6 > Week 4 - Aortic Aneurysm > Flashcards

Week 4 - Aortic Aneurysm Flashcards

1
Q

what is an aneurysm

A
  • outpouching or dilation of the vessel wall
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2
Q

what is the most common cause of an aortic aneurysm

A
  • atheroscleoriss
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3
Q

how does atherosclerosis lead to an aortic aneurysm

A
  • plaque causes degenerative canges in the arterial wall

= loss of elasticity, weakening, dilation

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4
Q

describe the growth rate of aortic aneurysm

A
  • unpredictable
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5
Q

what are the 3 main areas of aortic aneurysm

A
  • thoracic
  • aortic arch
  • abdominal
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6
Q

what determines the symptoms of aortic aneurysm

A
  • the area of the aortic aneurysm
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7
Q

describe the symptoms of a thoracic aneurysm

A
  • often asymptomatic
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8
Q

list some symptoms of a thoracic aneurysm

A
  • deep, diffuse chest pain extending to the interscapular area
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9
Q

what 3 places does an aneuryms of the aortic arch put pressure on

A
  • laryngeal nerve
  • esophagus
  • SVC
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10
Q

what symptom does pressure on the laryngeal nerve cause in an aortic arch aneurysm

A
  • hoarseness
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11
Q

what symptoms does pressure on the esophagus cause in an aortic arch aneurysm

A
  • dysphagia
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12
Q

what symptoms does pressure on the SVC cause in an aortic arch aneurysm (3)

A
  • decreased venous return
  • distended neck veins
  • swollen head and arms
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13
Q

describe symptoms of an abdominal aortic aneurysm (AAA)

A
  • often asymptomatic

- not detected until a routine physical exam

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14
Q

what are signs of AAA (6)

A
  • pulsatile mass in periumbical area , left to midline
  • bruits over the aneurysm
  • back pain (d/t pressure on lumbar nerve)
  • epigastric discomfort
  • alterations in bowel elimination (d/t pressure on bowel)
  • blue toe syndrome
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15
Q

what causes blue toe syndrome in AAA

A
  • spotaneous embolization of plaque = patchy mottling of feet and toes
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16
Q

how can an aortic aneuysm lead to embolization

A
  • the dilated aortic wall becomes lined w thrombi that can embolize
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17
Q

what is the most serious complication of an aneurysm

A
  • rupture
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18
Q

what happens if a rupture occurs in the retroperitoneal space

A
  • bleeding may be tamponaded by surrounding anatomic structures
    = prevents exsanguination and death
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19
Q

what are signs of a retroperitoneal rupture (2)

A
  • severe back pain

- grey turners sign

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20
Q

what happens if a rupture occurs in the abdominal or thoracic cavity (anterior)?

A
  • bleeds fast = poor prognosis

- most pts die from massive hemorrhage

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21
Q

what are signs of an anterior rupture (7)

A
  • hypovolemia shock
  • tachycardia
  • hypotension
  • pale, clammy skin
  • decreased UO
  • altered LOC
  • andominal tenderness
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22
Q

what is required treatment of an aortic aneurysm rupture (2)

A
  • resuscitation

- surgery

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23
Q

what are some diagnostic studies for an aortic aneurysm (7)

A
  • chest xray
  • abdominal xray
  • ECG (to rule out MI if thoracic aneurysm)
  • US
  • CT scan
  • MRI
  • angiography
24
Q

what is the goal of management of an aortic aneurysm

A
  • prevent rupture and extension of dissection

= early detection and prompt treatment essential

25
Q

what are 2 types of treatments done for aortic aneurysm

A
  • conservative therapy

- surgery

26
Q

when is conservative therapy done

A
  • for small aneurysms (less than 5 cm)
27
Q

what type of conservative therapy is done for small aneurysm (3)

A
  • risk factor modification
  • decreased BP
  • annual monitoring of aneurysm size w US, CT, or MRI
28
Q

what risk factors are modified for conservative therapy of small aneurysms (4)

A
  • stress
  • athersclerosis risk factors
  • diet
  • excess weight
29
Q

when is surgery done for treatment of aortic aneurysm (3)

A
  • if larger than 5 cm & growing rapidly
  • if symptomactic
  • if risk of rupture high
30
Q

what are 2 types of surgery done for aneurysms

A
  1. open

2. endovascular graft procedure (EVAR)

31
Q

what does open surgery for aneurysm involve (6)

A
  • large abdominal incision
  • cross clamps (above and below the aneurysm)
  • incises the diseased aortic segment
  • removes any plaque and thrombus
  • inserts a synthetic graft
  • sutures the native aortic wall around the graft for protection

replaces the weakened portion of the aorta with a graft to avoid rupture

32
Q

how quickly do open surgeries for aneurysms have to be done?

A
  • in 35-40 min

- so clamps can be removed and perfusion restored before any organ damage occurs

33
Q

what needs to be monitored post-op open surgery for aortic aneurysm (7)

A

ICU for 24-48 hr for close monitoring of:

  • graft patency
  • CVS
  • infection (v. invasive)
  • GI
  • neuro
  • peripheral perfusion
  • renal perfusion
34
Q

what has to be monitored to maintain graft patency? why?

A

maintain adequate BP:

  • hypotension = graft thrombosis
  • hyptertension = stress = leakage of blood or rupture of suture lines
35
Q

what is a pt at risk for after open surgery r/t the cardio system? (2)

A
  • MI

- dysrhythmias

36
Q

how can an open surgery for aneurysm cause a risk of MI (2)

A
  • increased myocardial O2 demands

- decreased myocardial O2 supply

37
Q

how can an open surgery for aneurysm cause a risk of dysrhythmias (4)

A
  • electrolyte imbalances
  • hypoxemia
  • hypothermia
  • MI
38
Q

what are nursing interventions to prevent MI or dysrhytmias post-open surgery (7)

A
  • ECG monitoring
  • O2
  • antidysrhythmics
  • antiHTNs
  • electrolytes
  • pain control
  • cardiac meds
39
Q

what are nursing interventions to prevent hypotension after open surgery

A
  • IV fluids and blood components
40
Q

what are nursing interventions to prevent hypertension post open surgery (2)

A
  • Iv diuretics

- antiHTN

41
Q

what should you monitor regarding infection post open surgery (3)

A
  • temp
  • WBC
  • assess surgical site for infection
42
Q

what are nursing interventions for infection post open surgery (2)

A
  • broad spectrum antibiotic

- aseptic technique

43
Q

what is a pt at risk for post open surgery r/t GI system

A
  • paralytic ileus
44
Q

why is a pt at risk for paralytic ileus post-open surgery (4)

A
  • d/t anasthesia
  • handling of bowel during surgery
  • disrupted blood supply to the bowel
  • intestines may become swollen and bruised
45
Q

what are nursing interventions for the GI tract post-open surgery (4)

A
  • assess BS
  • NG tube to decompress stomach and decrease P on suture lines
  • NPO –> ice chips, oral care
  • encourage early ambulation
46
Q

what is a neuro risk post-open surgery

A
  • emboli to the brain
47
Q

what should be assessed post-open surgery for the neuro system (7)

A
  • LOC
  • pupil size & response to light
  • facial symmetry
  • tongue deviation
  • speech
  • ability to move upper extremities
  • hand grasps
48
Q

what is a pt at risk for post-open surgery r/t peripheral perfusion

A
  • emboli to the periphery
49
Q

what should be assessed post-open surgery r/t peripheral perfusion (5)

A
  • pedal pulses
  • skin temp & color
  • cap refill time
  • sensation and movement of extremities
  • pain at extremities
50
Q

what is a pt at risk for post-open surgery r/t renal perfusion (2)

A
  • emboli to the kidney’s

- and decreased perfusion to the kidneys during surgery

51
Q

what should be assessed post-open surgery r/t renal perfusin (6)

A
  • will have indwelling urinary catheter
  • hourly UO
  • daily weights
  • intake and output
  • BUN
  • creatinine
52
Q

what is EVAR

A
  • endovascular graft procedure
  • alternative to conventional surgical repair
  • minimally invasive procedure
  • involves placement of a sutureless aortic graft into the abdominal aorta inside the aneurysm via femoral artery catheter
53
Q

what are benefits of EVAR (6)

A
  • decreased anaesthesia
  • decreased operative time
  • limited blood loss
  • decreased morbidity
  • more rapid resumption of physical activity
  • quicker recovery
54
Q

what is post-op care for EVAR (4)

A
  • care of groin site
  • keep affected leg straight for 4-6 hr
  • monitor peripheral pulrses
  • monitor for ischemic complications (emboli)
55
Q

what should you assess in a pt with aortic aneurysm (4)

A
  • signs of rupture
  • peripheral pulses
  • neuro status
  • renal status

NURS 3512 - Class 1-6 (47 decks)

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