Aneurysm: Thoracic and Abdominal/ Tissue Perfusion Flashcards
Aneurysm Thoracic & Abdominal
What is an aneurysm?
- A localized sac or dilation formed at a weak point in the artery wall
- Classified by its shape or form
- Types
— Saccular – projects from one side
— Fusiform – entire segment is dilated
Common sites of Aneurysms
most commonly in the abdominal aorta
Characteristics of arterial aneurysms
A – Normal artery
B – False aneurysm – pulsating hematoma
C – True aneurysm; 1,2,or 3 of all layers may be involved
D – Fusiform aneurysm; symmetric, spindle- shaped expansion of entire circumference
E – Saccular aneurysm – a bulbous protrusion of one side of the arterial wall
F – Dissecting aneurysm – usually a hematoma that splits the layers
Thoracic Aortic Aneurysm
- Approximately 70 % caused by atherosclerosis
- Occur most frequently in men 50-70 years
- Most common site for dissecting aneurysms
- Symptoms vary and depend on how rapidly the aneurysm dilates
- How is the pulsating mass affecting surrounding areas
- Patients can be asymptomatic
- Or have pain when supine, dyspnea, cough, hoarseness, stridor, dysphagia
- Can be mistaken for MI
Medical Management of Thoracic Aortic Aneurysm
- Is the Aneurysm symptomatic; expanding in size?
- Caused by a iatrogenic injury?
- Is it dissecting?
- Involving branch vessels?
- General measures
— Control the blood pressure
— Correct risk factors - Surgical intervention
— Repair aneurysm and restore vascular continuity
— Endovascular graft repair
Aortic Disection
- on aortic, disection occurs when blood penetrates the aortic intima and forms an expanding hematoma within the vessel wall
- A dissection result in a separation of the intima and media to create a “ false lumen” or dissecting hematoma
- The intima is compressed by the advancing hematoma
Repair of an ascending aortic aneurysm
Abdominal Aortic Aneurysm
- Caused by atherosclerosis
- Affects men 2 to 6 times more often than women
- Most often occur below the renal arteries
- If untreated; may rupture and cause death
- Pathophysiology
— Weakened middle layer of an artery
— HTN worsens a weak vessel wall
— Rupture
Abdominal Aortic Aneurysm clinical manifestations
- Only about 40% of patients have symptoms
- Feel their heart beating in their abdomen when lying down
- May occlude major vessels if associated with a thrombus
- Severe back pain or abdominal pain may be a sign of impending rupture
- A rupturing aneurysm symptoms may include constant intense back pain, decreasing BP, decreasing H & H.
Abdominal Aortic Aneurysm Medical Management
- Pharmacological – antihypertensive agents
- Endovascular and Surgical interventions
— Endovascular repair for infrarenal AAA
— Can be performed under local or regional anesthetic
Nursing Management of Aortic Aneurysms
- Nursing assessment – Anticipate possible rupture
- Post endovascular repair
— Must lie supine for 6 hours post repair
— Head of bed may be lifted to 45 degrees after 2 hours
— Assess vital signs and Doppler assessment of peripheral pulses every 15 minutes initially
— Assess access site
— Monitor for bleeding
— Notify surgeon of persistent coughing, vomiting or elevated BP
— Assess all systems - Provide Education – blood pressure control, medications
HYPERTENSIVE CRISIS
Patho
Hypertensive Emergency
Blood pressure > 180/120mm Hg and must be lowered immediately to prevent damage to target organs
Hypertensive Urgency
Blood pressure is very elevated but no evidence of immediate or progressive target organ damage
