Aneurysms

Question 1

What is an aneurysm?

Answer 1

A permanent localized dilation of an ARTERY.

Question 2

How much does the artery enlarge?

Answer 2

at least 2Xs normal

Question 3

What is the outermost layer of the artery?

Answer 3

tunica adventitia

Question 4

What is the role of the tunica adventitia?

Answer 4

connective tissue for support

Question 5

What is the middle layer of the artery?

Answer 5

tunica media

Question 6

What is the tunica media made of?

Answer 6

vascular smooth muscle

Question 7

What is the innermost layer of the artery?

Answer 7

tunica intima

Question 8

What is the tunica intima made of?

Answer 8

endothelial cells

Question 9

What is the role of the tunica intima?

Answer 9

responsible for constriction and relaxation of the vessel

Question 10

Which layer of the artery is abnormally dialyzed causing an aneurysm?

Answer 10

all 3 layers

Question 11

What is a normal diameter of the aorta?

Answer 11

2-3.5 cm

Question 12

With an aneurysm, what can the aorta dilate to?

Answer 12

in excess of 6 cm

Question 13

What may repeated tension on a dilated arterial wall cause?

Answer 13

leakage

Question 14

What are the 4 types of aneurysms?

Answer 14

Fusiform
Saccular
Dissecting
Pseudo

Question 15

What are pseudo aneurysms normally caused from?

Answer 15

Procedures, such as in the cath lab, that cause the aneurysm

Question 16

What are the common locations of aneurysms?

Answer 16

Thoracic aorta
Abdominal aorta
Iliac arteries
Femoral arteries

Question 17

What is the most common site for aneurysm?

Answer 17

abdominal aorta

Question 18

Where are 25% of aneurysms located?

Answer 18

above the diaphragm (Thoracic)

Question 19

Where are 75% of aneurysms located?

Answer 19

in the abdomen most below renal arteries

Question 20

What are 3 common complications of aneurysms?

Answer 20

Rupture
Pressure on surrounding structures
Thrombosis and embolism

Question 21

What has 80% mortality and is the 13th leading cause of death?

Answer 21

ruptured aortic aneurysm

Question 22

Who are aneurysms common in?

Answer 22

4X more common in men than women and more common among Caucasian men than African American men

Question 23

What are assessment findings for aneurysms (tho these are not usually present until dissecting)

Answer 23

Bruit
Pulsating mass
Abdominal pain, BACK pain, groin and flank or hip pain
Shock

Question 24

How are most aortic aneurysms found?

Answer 24

found accidentally with a routine chest or abdominal X-ray.

Question 25

Are aneurysms normally symptomatic?

Answer 25

no, most are asymptomatic

Question 26

What does pain from an aneurysm come from?

Answer 26

the aneurysm exerting pressure on surrounding structures or during rupture

Question 27

If the aneurysm is in the ascending aorta or aortic arch, what s/s may they have?

Answer 27

Dyspnea, cough or hemoptysis

Question 28

If the aneurysm is in the descending aorta, what s/s may be present?

Answer 28

back or shoulder pain is likely

Question 29

What s/s may abdominal aortic aneurysms cause?

Answer 29

abdominal pain, bloating, lubosacral tenderness, nausea and vomiting.

Question 30

What will shock occur with?

Answer 30

rupture

Question 31

When may death occur?

Answer 31

if hypovolemic

Question 32

What may happen if aneurysm is left untreated?

Answer 32

thrombi may form and clots may become emboli and obstruct distal vessels.

Question 33

What are the types of thoracic aneurysms?

Answer 33

Ascending Transverse Descending Thracoabdomin

Question 34

Assessment findings of thoracic aneurysms?

Answer 34

``` Intrascapula pain (“tearing”) Dyspnea Cough Dysphagia Hoarseness ```

Question 35

Treatment of aneurysms

Answer 35

stent bypass surgery

Question 36

What size aneurysm is at a high risk for rupture and is no longer surgery candidate?

Answer 36

greater than 6 cm

Question 37

What is a large aneurysm usually treated with?

Answer 37

excision of thrombi within the vessel and a synthetic graft is inserted.

Question 38

What is the mortality rate for aneurysm surgery?

Answer 38

85% or higher

Question 39

What is the surgical approach for thoracic aneurysm?

Answer 39

midsternal

Question 40

What is the surgical approach for descending aneurysm?

Answer 40

left thorocotomy

Question 41

What is the surgical approach for abdominal aneurysm repair?

Answer 41

midline abdominal incision

Question 42

What are risks for surgery?

Answer 42

decreased perfusion to spine, kidneys, heart during cross clamping

Question 43

What type of stenting alternative to surgical treatment?

Answer 43

intra femoral

Question 44

What are pre-op nursing considerations?

Answer 44

Teach to turn, cough, deep breathe after surgery prevent infection manage pain

Question 45

What type of infection is high after aneurysm repair?

Answer 45

pneumonia

Question 46

What should they be taught to continue to control?

Answer 46

HTN and atherosclerosis

Question 47

Post op care for aneurysm repair

Answer 47

``` Monitor for bleeding Assess resp. status Maintain BP Assess peripheral pulses Monitor for bloody stools Monitor for spinal cord injury NG tube Watch for s/s emboli Assess renal function ```

Question 48

How should the body be positioned post op?

Answer 48

to decrease flexion on graphs

Question 49

What may bloody stools indicate post op?

Answer 49

indicate ischemic bowel damage due to reduced perfusion during surgery

Question 50

What are s/s of spinal cord injury post op?

Answer 50

parasthesia and numbness