Aneurysm (Me rn)

Question 1

What is an Aneurysm?

Answer 1

A dilation of the arterial wall

Question 2

In which arteries can an Aneurysm occur?

Answer 2

Any of them, but the Aortic Aneurysm is the most common

Question 3

Risk factors of Aneurysm?

Answer 3

Atherosclerosis + male gender + age 65 or older + whites + tobacco use + Peripheral Artery Disease + Hypertension + high cholesterol + Coronary Artery Disease + previous stroke + obesity + trauma

Question 4

Whenever a dilated arterial wall becomes lined with thrombi, there is a risk of-

Answer 4

Embolization

Question 5

What meds can be used to treat an Aneurysm?

Answer 5

Simvastatin and/or Doxycycline + Propanol + Captopril

Question 6

Largest artery in the body =

Answer 6

Aorta

Question 7

An abdominal aorta would have to be how big in order for it to be considered an Aortic Aneurysm?

Answer 7

Larger than 3 cm

Question 8

Most important modifiable risk factor for an Aneurysm?

Answer 8

Tobacco

Question 9

Most common cause for an Aneurysm?

Answer 9

Atherosclerosis

Question 10

What things make an Aneurysm so deadly?

Answer 10

The sluggish blood flow within the aneurysm may cause a blood clot and they can become Emboli and travel.

They may Rupture with Hemorrhage and Hypovolemic Shock.

Question 11

Where are most Aneurysm’s located?

Answer 11

Between the Renal Arteries and Aortic Bifurcation

Question 12

How should you assess for an Aortic Aneurysm (AAA) during a physical assessment?

Answer 12

Auscultate for Bruit, DON’T PALPATE (Can cause a Rupture)

Question 13

What are the symptoms of AAA?

Answer 13

Often asymptomatic

Deep, diffuse chest pain or angina + Pulsating mass in periumbilical area to left of midline + Bruit over mass + Mid-abdominal or lower back pain (due to aneurysm compression) + Patient states can feel his or her heart beating

Question 14

How can an Aneurysm be diagnosed?

Answer 14

Physical Exam + X-Ray + MRI + CT Scan

Question 15

How can an Aneurysm be monitored?

Answer 15

Ultrasound

Question 16

This is the most accurate way to gauge length, diameter, and presence of an Aneurysm =

Answer 16

CT Scan

Question 17

The more pain from an aneurysm, the higher the risk for-

Answer 17

Rupture

Question 18

What’s the main goal of treatment for an AAA?

Answer 18

Prevent Rupture

Question 19

What diameter of Aneurysm would have conservative treatment?

What diameter of Aneurysm would have aggressive treatment (Surgery)?

Answer 19

Conservative = 5.4 cm or lower

Surgery needed asap = 5.5 or higher

Question 20

What would Conservative Treatment for a AAA include?

Answer 20

Minimize the Growth of the Aneurysm with meds (Beta blockers, ACE inhibitors, ARBs, Statins, and Antibiotics)

Question 21

After an Acute Rupture, what is the mortality rate?

Answer 21

90%

Question 22

When a pt with an AAA starts complaining of a Searing, Ripping Pain in their abdomen or retrosternal area, it is a sign of-

Answer 22

Impending Rupture

Question 23

What are the surgeries that can be used for an AAA?

Answer 23

Conventional
Endovascular Graft

Question 24

What is Grey Turner’s Sign?

Answer 24

Ecchymosis (Bruising) on the Flanks

Question 25

What is Grey Turner’s Sign an indicator of?

Answer 25

Never normal, indicates some type of abdominal bleed. Can be caused by an AAA

Question 26

Signs of a slow leak of an Aneurysm =

Answer 26

Pallor + Weak + Increasing HR & Pulse + Dropping BP + Decreased LOC + Diaphoresis

Question 27

Signs of Hypovolemic Shock caused by abdominal bleeding =

Answer 27

Hypotension + High Pulse + Pallor + Clammy Skin + Oliguria + Altered LOC + Abdominal Tenderness

Question 28

When conservatively treating an AAA, how often should the pt have their Aneurysm size monitored? What would you use?

Answer 28

Every 6 Months to Annually (Use CT, MRI, Ultrasound)

Question 29

What is done during Conventional Surgery to treat an AAA?

Answer 29

Incise area, remove plaque, insert graft, sew original walls around graft

Question 30

What is done during a Endovascular Graft?

Answer 30

Minimally invasive. Femoral cut down, graft (Enclosed in a sheath) is inserted and advanced to aneurysm area. Once at proper spot, it’s deployed and opens. The blood now flows through this

Question 31

What are some post-operative nursing interventions after an Aortic Aneurysm Repair is done on a pt?

Answer 31

Graft Patency: Monitor CVP readings or PA pressures hourly IV Diuretics- Furosemide IV Antihypertensives- sodium nitroprusside, metoprolol, hydralazine labetalol Renal Perfusion: Accurate I&O; Urine output hourly Daily BUN/creatinine Daily weights Infection: Broad Spectrum Antibiotics Assess temp and WBC CV Status: Continuous ECG monitoring Frequent electrolytes and ABGs Oxygen IV antidysrhythmic meds and antihypertensives Adequate pain control Resumption of heart meds GI Status: NG tube to LWS Assess bowel sounds Neurological status Peripheral perfusion Check all pulses Note color, temperature, capillary refill, sensation and movement of extremities

Question 32

What does it mean if a pt’s graft patency is too high?

Answer 32

Stress on Anastomoses, causes leaking or rupture

Question 33

What does it mean if a pt’s graft patency is too low?

Answer 33

Graft Thrombosis

Question 34

What’s some pt education for a pt who got treated for an AAA?

Answer 34

No heavy lifting for 6 weeks. Report redness, swelling, increased pain, temp >100, & drainage from incisions. Teach patient how to monitor peripheral pulses and to report changes in color/warmth. Sexual dysfunction…urologist referral if erectile dysfunction.

Question 35

What’s an Aortic Dissection?

Answer 35

Tear in innermost lining of arterial wall of aorta

Question 36

Risk factors for an Aortic Dissection?

Answer 36

Hypertension, male gender, advancing age, pregnancy, Marfan syndrome, blunt trauma, congenital heart disease, cocaine or methamphetamine use, history of cardiac surgery, atherosclerosis

Question 37

Symptoms of an Aortic Dissection?

Answer 37

Sudden severe angina or back pain, often described as a ripping or tearing sensation + syncope, dizziness, weakness

Question 38

Is an Aortic Dissection life threatening?

Answer 38

Yes

Question 39

What’s the most common cause of an Aortic Dissection?

Answer 39

Chronic Hypertension

Question 40

Complications of an Aortic Dissection =

Answer 40

Cardiac Tamponade (If blood enters the Pericardial Sac) + Dissected area weak and prone to rupture

Question 41

An Aortic Dissection is diagnosed the same way a AAA is. True or false?

Answer 41

True

Question 42

An Aortic Dissection will be treated conservatively if-

Answer 42

No Severe Complications

Question 43

What is some conservative treatment for an Aortic Dissection?

Answer 43

Lower BP + Decrease myocardial contractility + Treat pain + Bed rest

Question 44

What is the standard treatment for surgery on an Aortic Dissection?

Answer 44

Endovascular Surgery

Question 45

Symptoms of Cardiac Tamponade =

Answer 45

Hypotension + Narrowed Pulse Pressure + JVD + Muffled Heart Sounds + Pulsus Pardoxus

Question 46

What is Pulsus Paradoxus?

Answer 46

Abnormally large decrease in SBP during inspiration

Question 47

If an acute descending aorta dissection occurs, what’s a must?

Answer 47

Emergency Surgery

Question 48

Beta blockers can be used to decrease-

Answer 48

Contractility

Question 49

Calcium beta blockers can be used to decrease-

Answer 49

BP

Question 50

How low do you want a pt’s BP to be if they’ve got an Aortic Dissection?

Answer 50

As low as possible while still keeping the organs perfused

Question 51

Following an aortic aneurysm repair, for which complication is most important should the nurse monitor the patient? A.) Infection B.) Bleeding from the graft site C.) Prolonged surgical hypothermia D.) Dislodged thrombi

Answer 51

D