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

Week 4 - Aortic Dissection Flashcards

1
Q

what is aortic dissection

A
  • tearing of the inner layer of the aorta

= blood surges thru the tear causing layers of the vessel to separate

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2
Q

what can cause aortic dissection

A
  • degeneration of the elastic fibres in the medial layer

- -> HTN

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3
Q

what does aortic dissection cause

A
  • cut off blood supply to critical areas such as the brain, kidneys, spinal cord, extremities
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4
Q

what are predisposing factors to aortic dissection (6)

A
  • HTN
  • age
  • male sex
  • CHD
  • CT disorders
  • atherosclerosis
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5
Q

what signs are seen in an ascending aortic dissection (3)

A
  • sudden, severe onset of excruciating chest pain, back pain, or both
  • pain radiates to back or soulder
  • sharp, ripping, tearing, pain
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6
Q

where is pain seen in a descending aortic dissrection (2)

A
  • pain to back, abdomen, legs
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7
Q

if the aortic arch is involved in the dissection, what signs will you see (5)

A
  • neuro deficits
  • altered LOC
  • weakened or absent carotid & temporal pulses
  • dizziness
  • syncope
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8
Q

an ascending aortic dissection produced disrupted blood flow to??

A
  • the coronary arteries
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9
Q

a descending aortic dissection produces disrupted blood flow to?? (2)

A
  • abdominal organs

- lower extremities

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10
Q

an aortic dissrection involving the aortic arch will cause disrupted blood flow to??

A
  • the brain (= emergency)
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11
Q

what are 3 complications of aortic dissection

A
  • cardiac tamponade
  • aortic rupture
  • occlusion of blood supply to organs
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12
Q

how does aortic dissections lead to cardiac tamponade

A
  • when blood flow the dissection leaks into the pericardial sac
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13
Q

what are clinical manifestations of cardiac tamponade (4)

A

heart not pumping well due to pressure on heart:

  • hypotension
  • narrowed pulse pressure
  • jugular venous distension
  • muffled heart sounds
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14
Q

how can aortic dissection lead to aortic rupture

A
  • if it is weakened by the dissection
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15
Q

what does aortic rupture lead to

A
  • hemorrhage into the mediastinal, pleural, or abdominal cavities
    = exsanguination and death
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16
Q

an aortic dissection can lead to occlusion of blood supply to which organs (4)

A
  • spinal cord,
  • kidneys
  • brain
  • the mesentry
17
Q

what are symptoms of spinal cord iscemia (3)

A
  • weakness
  • decreased sensation to lower extremities
  • paralysis of lower extremities
18
Q

what can renal ischemia lead to

A
  • renal failure
19
Q

what are symptoms of abdominal (mesentry) ischemia (4)

A
  • abdominal pain
  • decreased BS
  • altered bowel fnxn
  • bowel necrosis
20
Q

what diagnostics can be used to diagnose aortic dissection (4)

A
  • chest xray
  • CT
  • transesophageal echo (TEE)
  • MRI
21
Q

what are the initial goals of therapy for aortic dissection (2)

A
  • BP control

- pain control

22
Q

why is BP control imp for aortic dissection

A
  • reduces stress on aortic wall
23
Q

what is the other goal of treatment of aortic dissection

A
  • prevent rupture and progression of dissection
24
Q

what are different types of treatment for aortic dissection (3)

A
  • conservative therapy (BP and pain control, if no complications)
  • endovascular dissection reapir
  • surgery
25
Q

what is endovascular dissection repair

A
  • 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
26
Q

what is a different between endovascular dissection repair and EVAR

A
  • endovascular dissection repair may insert a temporary lumbar drain for cerebrospinal fluid to reduce spinal cord edema and prevent paralysis
27
Q

when is endovascular dissection repair a good option for treatment of aortic dissection

A
  • if has symptoms or complications (hemodynamically unstable, peripheral ischemia, etc.)
28
Q

when is surgery indicated as the treatment for aortic dissection

A
  • acute ascending aortic dissection
  • if drug therapy ineffective
  • if complications occur
29
Q

describe surgery for aortic dissection

A
  • involves resection of the aortic segment containing the tear and replacement with a synthetic graft
30
Q

describe nursing care for a pt with aortic dissection preop (11)

A
  • 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
31
Q

describe postop care for a pt with aortic dissection

A
  • similar for aortic aneurysm repair
32
Q

describe discharge teaching for a pt with aortic dissection (4)

A
  • 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)
33
Q

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)

A
  • 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
34
Q

what neuro monitoring should be done r/t the risk of peripheral neurovascular dysfunction in surgical repair of the aorta (3)

A
  • monitor VS
  • monitor invasive hemodynamic parameters
  • monitor for parasthesia
35
Q

a nursing diagnosis r/t surgical repair of the aorta is risk for infection. what infection protecting nursing interventions can be done (5)

A
  • monitor for S&S
  • monitor CBC
  • maintain asepsis
  • instruct pt to take ab as prescribed
  • promote sufficient nutritional intake to promote healing

NURS 3512 - Class 1-6 (47 decks)

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