Week 4 - Aortic Aneurysm Flashcards
1
Q
what is an aneurysm
A
- outpouching or dilation of the vessel wall
2
Q
what is the most common cause of an aortic aneurysm
A
- atheroscleoriss
3
Q
how does atherosclerosis lead to an aortic aneurysm
A
- plaque causes degenerative canges in the arterial wall
= loss of elasticity, weakening, dilation
4
Q
describe the growth rate of aortic aneurysm
A
- unpredictable
5
Q
what are the 3 main areas of aortic aneurysm
A
- thoracic
- aortic arch
- abdominal
6
Q
what determines the symptoms of aortic aneurysm
A
- the area of the aortic aneurysm
7
Q
describe the symptoms of a thoracic aneurysm
A
- often asymptomatic
8
Q
list some symptoms of a thoracic aneurysm
A
- deep, diffuse chest pain extending to the interscapular area
9
Q
what 3 places does an aneuryms of the aortic arch put pressure on
A
- laryngeal nerve
- esophagus
- SVC
10
Q
what symptom does pressure on the laryngeal nerve cause in an aortic arch aneurysm
A
- hoarseness
11
Q
what symptoms does pressure on the esophagus cause in an aortic arch aneurysm
A
- dysphagia
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
13
Q
describe symptoms of an abdominal aortic aneurysm (AAA)
A
- often asymptomatic
- not detected until a routine physical exam
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
15
Q
what causes blue toe syndrome in AAA
A
- spotaneous embolization of plaque = patchy mottling of feet and toes
16
Q
how can an aortic aneuysm lead to embolization
A
- the dilated aortic wall becomes lined w thrombi that can embolize
17
Q
what is the most serious complication of an aneurysm
A
- rupture
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
19
Q
what are signs of a retroperitoneal rupture (2)
A
- severe back pain
- grey turners sign
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
21
Q
what are signs of an anterior rupture (7)
A
- hypovolemia shock
- tachycardia
- hypotension
- pale, clammy skin
- decreased UO
- altered LOC
- andominal tenderness
22
Q
what is required treatment of an aortic aneurysm rupture (2)
A
- resuscitation
- surgery
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
what are 2 types of treatments done for aortic aneurysm
- conservative therapy
| - surgery
26
when is conservative therapy done
- for small aneurysms (less than 5 cm)
27
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
28
what risk factors are modified for conservative therapy of small aneurysms (4)
- stress
- athersclerosis risk factors
- diet
- excess weight
29
when is surgery done for treatment of aortic aneurysm (3)
- if larger than 5 cm & growing rapidly
- if symptomactic
- if risk of rupture high
30
what are 2 types of surgery done for aneurysms
1. open
| 2. endovascular graft procedure (EVAR)
31
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*
32
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
33
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
34
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
35
what is a pt at risk for after open surgery r/t the cardio system? (2)
- MI
| - dysrhythmias
36
how can an open surgery for aneurysm cause a risk of MI (2)
- increased myocardial O2 demands
| - decreased myocardial O2 supply
37
how can an open surgery for aneurysm cause a risk of dysrhythmias (4)
- electrolyte imbalances
- hypoxemia
- hypothermia
- MI
38
what are nursing interventions to prevent MI or dysrhytmias post-open surgery (7)
- ECG monitoring
- O2
- antidysrhythmics
- antiHTNs
- electrolytes
- pain control
- cardiac meds
39
what are nursing interventions to prevent hypotension after open surgery
- IV fluids and blood components
40
what are nursing interventions to prevent hypertension post open surgery (2)
- Iv diuretics
| - antiHTN
41
what should you monitor regarding infection post open surgery (3)
- temp
- WBC
- assess surgical site for infection
42
what are nursing interventions for infection post open surgery (2)
- broad spectrum antibiotic
| - aseptic technique
43
what is a pt at risk for post open surgery r/t GI system
- paralytic ileus
44
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
45
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
46
what is a neuro risk post-open surgery
- emboli to the brain
47
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
48
what is a pt at risk for post-open surgery r/t peripheral perfusion
- emboli to the periphery
49
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
50
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
51
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
52
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
53
what are benefits of EVAR (6)
- decreased anaesthesia
- decreased operative time
- limited blood loss
- decreased morbidity
- more rapid resumption of physical activity
- quicker recovery
54
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)
55
what should you assess in a pt with aortic aneurysm (4)
- signs of rupture
- peripheral pulses
- neuro status
- renal status
