Week 4 - Aortic Aneurysm Flashcards
what is an aneurysm
- outpouching or dilation of the vessel wall
what is the most common cause of an aortic aneurysm
- atheroscleoriss
how does atherosclerosis lead to an aortic aneurysm
- plaque causes degenerative canges in the arterial wall
= loss of elasticity, weakening, dilation
describe the growth rate of aortic aneurysm
- unpredictable
what are the 3 main areas of aortic aneurysm
- thoracic
- aortic arch
- abdominal
what determines the symptoms of aortic aneurysm
- the area of the aortic aneurysm
describe the symptoms of a thoracic aneurysm
- often asymptomatic
list some symptoms of a thoracic aneurysm
- deep, diffuse chest pain extending to the interscapular area
what 3 places does an aneuryms of the aortic arch put pressure on
- laryngeal nerve
- esophagus
- SVC
what symptom does pressure on the laryngeal nerve cause in an aortic arch aneurysm
- hoarseness
what symptoms does pressure on the esophagus cause in an aortic arch aneurysm
- dysphagia
what symptoms does pressure on the SVC cause in an aortic arch aneurysm (3)
- decreased venous return
- distended neck veins
- swollen head and arms
describe symptoms of an abdominal aortic aneurysm (AAA)
- often asymptomatic
- not detected until a routine physical exam
what are signs of AAA (6)
- 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
what causes blue toe syndrome in AAA
- spotaneous embolization of plaque = patchy mottling of feet and toes
how can an aortic aneuysm lead to embolization
- the dilated aortic wall becomes lined w thrombi that can embolize
what is the most serious complication of an aneurysm
- rupture
what happens if a rupture occurs in the retroperitoneal space
- bleeding may be tamponaded by surrounding anatomic structures
= prevents exsanguination and death
what are signs of a retroperitoneal rupture (2)
- severe back pain
- grey turners sign
what happens if a rupture occurs in the abdominal or thoracic cavity (anterior)?
- bleeds fast = poor prognosis
- most pts die from massive hemorrhage
what are signs of an anterior rupture (7)
- hypovolemia shock
- tachycardia
- hypotension
- pale, clammy skin
- decreased UO
- altered LOC
- andominal tenderness
what is required treatment of an aortic aneurysm rupture (2)
- resuscitation
- surgery
what are some diagnostic studies for an aortic aneurysm (7)
- chest xray
- abdominal xray
- ECG (to rule out MI if thoracic aneurysm)
- US
- CT scan
- MRI
- angiography
what is the goal of management of an aortic aneurysm
- prevent rupture and extension of dissection
= early detection and prompt treatment essential
what are 2 types of treatments done for aortic aneurysm
- conservative therapy
- surgery
when is conservative therapy done
- for small aneurysms (less than 5 cm)
what type of conservative therapy is done for small aneurysm (3)
- risk factor modification
- decreased BP
- annual monitoring of aneurysm size w US, CT, or MRI
what risk factors are modified for conservative therapy of small aneurysms (4)
- stress
- athersclerosis risk factors
- diet
- excess weight
when is surgery done for treatment of aortic aneurysm (3)
- if larger than 5 cm & growing rapidly
- if symptomactic
- if risk of rupture high
what are 2 types of surgery done for aneurysms
- open
2. endovascular graft procedure (EVAR)
what does open surgery for aneurysm involve (6)
- 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
how quickly do open surgeries for aneurysms have to be done?
- in 35-40 min
- so clamps can be removed and perfusion restored before any organ damage occurs
what needs to be monitored post-op open surgery for aortic aneurysm (7)
ICU for 24-48 hr for close monitoring of:
- graft patency
- CVS
- infection (v. invasive)
- GI
- neuro
- peripheral perfusion
- renal perfusion
what has to be monitored to maintain graft patency? why?
maintain adequate BP:
- hypotension = graft thrombosis
- hyptertension = stress = leakage of blood or rupture of suture lines
what is a pt at risk for after open surgery r/t the cardio system? (2)
- MI
- dysrhythmias
how can an open surgery for aneurysm cause a risk of MI (2)
- increased myocardial O2 demands
- decreased myocardial O2 supply
how can an open surgery for aneurysm cause a risk of dysrhythmias (4)
- electrolyte imbalances
- hypoxemia
- hypothermia
- MI
what are nursing interventions to prevent MI or dysrhytmias post-open surgery (7)
- ECG monitoring
- O2
- antidysrhythmics
- antiHTNs
- electrolytes
- pain control
- cardiac meds
what are nursing interventions to prevent hypotension after open surgery
- IV fluids and blood components
what are nursing interventions to prevent hypertension post open surgery (2)
- Iv diuretics
- antiHTN
what should you monitor regarding infection post open surgery (3)
- temp
- WBC
- assess surgical site for infection
what are nursing interventions for infection post open surgery (2)
- broad spectrum antibiotic
- aseptic technique
what is a pt at risk for post open surgery r/t GI system
- paralytic ileus
why is a pt at risk for paralytic ileus post-open surgery (4)
- d/t anasthesia
- handling of bowel during surgery
- disrupted blood supply to the bowel
- intestines may become swollen and bruised
what are nursing interventions for the GI tract post-open surgery (4)
- assess BS
- NG tube to decompress stomach and decrease P on suture lines
- NPO –> ice chips, oral care
- encourage early ambulation
what is a neuro risk post-open surgery
- emboli to the brain
what should be assessed post-open surgery for the neuro system (7)
- LOC
- pupil size & response to light
- facial symmetry
- tongue deviation
- speech
- ability to move upper extremities
- hand grasps
what is a pt at risk for post-open surgery r/t peripheral perfusion
- emboli to the periphery
what should be assessed post-open surgery r/t peripheral perfusion (5)
- pedal pulses
- skin temp & color
- cap refill time
- sensation and movement of extremities
- pain at extremities
what is a pt at risk for post-open surgery r/t renal perfusion (2)
- emboli to the kidney’s
- and decreased perfusion to the kidneys during surgery
what should be assessed post-open surgery r/t renal perfusin (6)
- will have indwelling urinary catheter
- hourly UO
- daily weights
- intake and output
- BUN
- creatinine
what is EVAR
- 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
what are benefits of EVAR (6)
- decreased anaesthesia
- decreased operative time
- limited blood loss
- decreased morbidity
- more rapid resumption of physical activity
- quicker recovery
what is post-op care for EVAR (4)
- care of groin site
- keep affected leg straight for 4-6 hr
- monitor peripheral pulrses
- monitor for ischemic complications (emboli)
what should you assess in a pt with aortic aneurysm (4)
- signs of rupture
- peripheral pulses
- neuro status
- renal status
