Week 4 - Aortic Dissection Flashcards
what is aortic dissection
- tearing of the inner layer of the aorta
= blood surges thru the tear causing layers of the vessel to separate
what can cause aortic dissection
- degeneration of the elastic fibres in the medial layer
- -> HTN
what does aortic dissection cause
- cut off blood supply to critical areas such as the brain, kidneys, spinal cord, extremities
what are predisposing factors to aortic dissection (6)
- HTN
- age
- male sex
- CHD
- CT disorders
- atherosclerosis
what signs are seen in an ascending aortic dissection (3)
- sudden, severe onset of excruciating chest pain, back pain, or both
- pain radiates to back or soulder
- sharp, ripping, tearing, pain
where is pain seen in a descending aortic dissrection (2)
- pain to back, abdomen, legs
if the aortic arch is involved in the dissection, what signs will you see (5)
- neuro deficits
- altered LOC
- weakened or absent carotid & temporal pulses
- dizziness
- syncope
an ascending aortic dissection produced disrupted blood flow to??
- the coronary arteries
a descending aortic dissection produces disrupted blood flow to?? (2)
- abdominal organs
- lower extremities
an aortic dissrection involving the aortic arch will cause disrupted blood flow to??
- the brain (= emergency)
what are 3 complications of aortic dissection
- cardiac tamponade
- aortic rupture
- occlusion of blood supply to organs
how does aortic dissections lead to cardiac tamponade
- when blood flow the dissection leaks into the pericardial sac
what are clinical manifestations of cardiac tamponade (4)
heart not pumping well due to pressure on heart:
- hypotension
- narrowed pulse pressure
- jugular venous distension
- muffled heart sounds
how can aortic dissection lead to aortic rupture
- if it is weakened by the dissection
what does aortic rupture lead to
- hemorrhage into the mediastinal, pleural, or abdominal cavities
= exsanguination and death
an aortic dissection can lead to occlusion of blood supply to which organs (4)
- spinal cord,
- kidneys
- brain
- the mesentry
what are symptoms of spinal cord iscemia (3)
- weakness
- decreased sensation to lower extremities
- paralysis of lower extremities
what can renal ischemia lead to
- renal failure
what are symptoms of abdominal (mesentry) ischemia (4)
- abdominal pain
- decreased BS
- altered bowel fnxn
- bowel necrosis
what diagnostics can be used to diagnose aortic dissection (4)
- chest xray
- CT
- transesophageal echo (TEE)
- MRI
what are the initial goals of therapy for aortic dissection (2)
- BP control
- pain control
why is BP control imp for aortic dissection
- reduces stress on aortic wall
what is the other goal of treatment of aortic dissection
- prevent rupture and progression of dissection
what are different types of treatment for aortic dissection (3)
- conservative therapy (BP and pain control, if no complications)
- endovascular dissection reapir
- surgery
what is endovascular dissection repair
- similar to EVAR
- synthetic graft attached to end of catheter which goes thru femoral artery
- graft is threaded thru the artery to the affected parts for repair
what is a different between endovascular dissection repair and EVAR
- endovascular dissection repair may insert a temporary lumbar drain for cerebrospinal fluid to reduce spinal cord edema and prevent paralysis
when is endovascular dissection repair a good option for treatment of aortic dissection
- if has symptoms or complications (hemodynamically unstable, peripheral ischemia, etc.)
when is surgery indicated as the treatment for aortic dissection
- acute ascending aortic dissection
- if drug therapy ineffective
- if complications occur
describe surgery for aortic dissection
- involves resection of the aortic segment containing the tear and replacement with a synthetic graft
describe nursing care for a pt with aortic dissection preop (11)
- semi-fowler position
- maintain quiet enviro
- keep systolic BP at lowest possible lvl that maintains organ perfusion (110-120)
- opioids (pain control)
- sedatives
- manage pain and anxiety (for comfort and to prevent increase in BP)
- VS frequently (q2-3 min until target BP reached)
- ECG
- assess for changes in peripheral pulses
- assess pain
- assess LOC
describe postop care for a pt with aortic dissection
- similar for aortic aneurysm repair
describe discharge teaching for a pt with aortic dissection (4)
- will require long-term therapy to control BP
- teach drug regimen, side effects, etc.
- require follow up wit regularly scheduled MRI or CTs
- if pain or sx return, call 911 (could indicate redissection or aneurysm)
a nursing diagnosis r/t surgical repair of aorta is risk for peripheral neurovascular dysfunction d/t graft thrombosis, prolonged aortic cross clamping, hypotension, & blood loss. what interventions could help maintain effective peripheral tissue perfusion (5)
- perform comprehensive assessment of peripheral circulation (establish baseline and detect changes)
- maintain adequate hydration (decrease blood viscosity)
- avoid applying direct heat to extremitity
- admin antiplt or anticoag
what neuro monitoring should be done r/t the risk of peripheral neurovascular dysfunction in surgical repair of the aorta (3)
- monitor VS
- monitor invasive hemodynamic parameters
- monitor for parasthesia
a nursing diagnosis r/t surgical repair of the aorta is risk for infection. what infection protecting nursing interventions can be done (5)
- monitor for S&S
- monitor CBC
- maintain asepsis
- instruct pt to take ab as prescribed
- promote sufficient nutritional intake to promote healing
