AORTIC ANEURYSM AORTIC ANEURYSMS Definition Outpouchings Common Occur

AORTIC ANEURYSM AORTIC ANEURYSMS  Definition Outpouchings Common Occur

AORTIC ANEURYSM AORTIC ANEURYSMS Definition Outpouchings Common Occur or dilations of the arterial wall problems involving aorta in men more often than in women Incidence with age CLINICAL MANIFESTATIONS

AORTIC ANEURYSM Ascending aorta/aortic arch Produce angina Hoarseness If presses on superior vena cava Decreased venous return can cause Distended neck veins Edema of head and arms CLINICAL MANIFESTATIONS

AORTIC ANEURYSM Abdominal aortic aneurysms (AAA) Often asymptomatic Frequently detected On physical exam Pulsatile mass in periumbilical area Bruit may be auscultated When patient examined for unrelated problem (i.e., CT scan, abdominal x-ray) CLINICAL MANIFESTATIONS

AORTIC ANEURYSM Abdominal Aortic Aneurysms (AAA), (cont) May mimic pain associated with abdominal or back disorders May spontaneously embolize plaque Causing blue toe syndrome patchy mottling of feet/toes with presence of palpable pedal pulses AORTIC ANEURYSM COMPLICATIONS

Rupture- serious complication related to untreated aneurysm Posterior rupture Bleeding may be tamponaded by surrounding structures, thus preventing exsanguination and death Severe pain May/may not have back/flank ecchymosis Anterior rupture Massive hemorrhage Most do not survive long enough to get to the hospital

AORTIC ANEURYSM COLLABORATIVE CARE Goal - prevent aneurysm from rupturing Early detection/treatment imperative Once detected Studies done to determine size and location AORTIC ANEURYSM NURSING MANAGEMENT

Nursing Assessment Thorough history and physical exam Watch for signs of cardiac, pulmonary, cerebral, lower extremity vascular problems Establish baseline data to compare postoperatively Note quality and character of peripheral pulses and neurologic status Mark/document pedal pulse sites and any skin lesions on lower extremities before surgery

AORTIC ANEURYSM NURSING MANAGEMENT Nursing Assessment Monitor for indications of rupture Diaphoresis Paleness Weakness Tachycardia Abdominal, back, groin or periumbilical pain Changes in level of consciousness Pulsating abdominal mass AORTIC ANEURYSM NURSING MANAGEMENT Planning

Overall goals include Normal tissue perfusion Intact motor and sensory function No complications related to surgical repair AORTIC ANEURYSM NURSING MANAGEMENT Health Promotion Alert for opportunities to teach health promotion to patients and their families Encourage

patient to reduce cardiovascular risk factors These measure help ensure graft patency after surgery AORTIC ANEURYSM NURSING MANAGEMENT Acute Intervention Patient/family teaching Providing support for patient/family Careful assessment of all body systems Pre-op teaching

Brief explanation of disease process Planned surgical procedure Pre-op routines (scheduled) Bowel prep, NPO, shower Pre-op (emergent) Fluids Expectations after surgery Recovery ICU room, tubes, drains AORTIC ANEURYSM

NURSING MANAGEMENT Acute Intervention (contd) Postop Maintain graft patency Normal blood pressure CVP or PA pressure monitoring Urinary output monitoring Avoid severe hypertension Cardiovascular status Continuous ECG monitoring

Electrolyte monitoring Arterial blood gas monitoring Oxygen administration AORTIC ANEURYSM NURSING MANAGEMENT Acute Intervention (contd) Infection Antibiotic administration Assessment of body temperature Monitoring of WBC Adequate nutrition Observe

surgical incision for signs of infection Gastrointestinal status Nasogastric tube Abdominal assessment Passing of flatus is key sign of returning bowel function Watch for manifestations of bowel ischemia AORTIC ANEURYSM NURSING MANAGEMENT Acute Intervention (contd)

Neurologic status Level of consciousness Pupil size and response to light Facial symmetry Speech Ability to move upper extremities Quality of hand grasps Peripheral perfusion status Pulse assessment Mark pulse locations with felt-tip pen Extremity assessment Temperature, color, capillary refill time, sensation and movement of extremities AORTIC ANEURYSM NURSING MANAGEMENT

Acute Intervention (contd) Renal perfusion status Urinary output Fluid intake Daily weight CVP/PA pressure Blood urea nitrogen/Creatinine AORTIC ANEURYSM NURSING MANAGEMENT Ambulatory and Home Care

Encourage patient to express concerns Patient instructed to gradually increase activities No heavy lifting Educate on signs and symptoms of complications Infection Neurovascular changes AORTIC ANEURYSM NURSING MANAGEMENT Evaluation Expected Outcomes Patent arterial graft with adequate distal perfusion Adequate urine output Normal body temperature

No signs of infection AORTIC DISSECTIO N AORTIC DISSECTION Not a type of aneurysm Result of a tear in the intimal (innermost)lining of the arterial wall Men>women

Acute and life-threatening Mortality rate 90% if acute dissection and not treated surgically AORTIC DISSECTION Tear in intimal lining allows blood to track between the intima and media, creating a false lumen of blood flow

With heart contraction, increased pressure on damaged area results in further dissection Retrieved from http://aorticclinic.com/images/aorticdissection.jpg CLINICAL MANIFESTATIONS: AORTIC DISSECTION Sudden, severe, pain in anterior chest

Radiation down spine into abdomen and legs tearing or ripping Mimics MI If involves aortic arch: Neuro deficiencies (decreased LOC, dizziness) COMPLICATIONS: AORTIC DISSECTION Cardiac tamponade

Blood escapes from dissection into pericardial sac Hypotension, distended neck veins, muffled heart sounds Rupture May lead to hemorrhage in mediastinal, pleural, or abdominal cavity Results in death Occlusion of supply to vital organs Spinal cord, kidneys, and abdominal organs

DIAGNOSTIC STUDIES Chest x-ray EEG Rule out MI MRI Diagnostic procedure of choice Assists in determining severity of dissection

Echocardiogram Left ventricular hypertrophy COLLABORATIVE CARE Lower the BP Sodium nitroprusside (Nipride) Calcium channel blockers ACE inhibitors Decrease myocardial contractility blockers

Esmolol (Brevibloc) Rapid onset and short life COLLABORATIVE CARE Treat conservatively If no symptoms and complications Pain relief Blood transfusion Management of heart failure

Surgical Therapy If ineffective drug therapy of complications of aortic dissection are present 30-day mortality of acute aortic dissections is 10 28% MI, cerebral ischemia, uncontrolled bleeding, abdominal ischemia, sepsis, multiorgan failure NURSING MANAGEMENT Preoperatively Semi-Fowler position Quiet environment

Pain medications IV administration of antihypertensive drug Continuous ECG monitoring Assess for changes in CMS Frequent VS Discharge teaching Antihypertensive drugs SE, action, drug regimen Follow-up and reoccurrence of symptoms

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