Aortic Aneurysm/Test 2 Flashcards Preview

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Flashcards in Aortic Aneurysm/Test 2 Deck (34):
1

Definintion of Aortic Aneurysm

*Weakness within the arterial wall
*Localized ballooning of an artery
*Increases to about 50% of it's size
Exact cause unknown

2

Risks for Aortic Aneurysm

*HTN, HTN, HTN
*Atherosclerosis
*Congenital weakening of the wall
*Weakening due to connective tissue diseases

3

Significance of Aortic Aneurysm

*2-3% of unselected population
*M:F 5:1
*Age >60 years
*High risk of rupture if:
->5 cm
-expanding rapidly
-saccular

4

Locations in the aorta

*Thoracic- above diaphragm
*Abdominal- below diaphragm

5

Aortic Aneurysm Labels

*Fusiform
*Saccular
*Dissecting
*Ruptured

6

Fusiform

Entire circumference affected- football

7

Saccular

on side of the vessel (easiest to rupture-bike tire)

8

Dissecting

blood accumulates between layers of vessel r/t tears in intimal lining

9

Ruptured

Bursts

10

Symptoms of aortic aneurysm

*Thoracic:
-Tearing pain, tearing sensation within chest
-HTN
*Abdominal
-pulsating mass in the abdomin
-Pain- abdominal, flank, back, groin
-HTN

11

Diagnostics of Aortic Aneurysm

*Ultrasound
*Cat Scan
*Xray
*Arteriogram/Aortagram

12

Nursing Diagnoses of Aortic Aneurysm

*Ineffective Tissue Perfusion
*Pain
*Impaired gas exchange
*PC: Rupture or hemorrhage
*Many PC's

13

Medical Management for Aortic Aneurysm

*Control risks, trend size
*Prevent increase in size
*Surgical treatment if >5 cm

14

Treatment for Aortic Aneurysm

*Anit-hypertensives
*Keep stress under control
*Surgery or resection of the aneurysm and creation of a new artery or graft.
*Endovascular procedures

15

Endovascular procedures

*New method for non-emergency treatment to repair
-2 small incisions in groin
-catheter with balloon and graft inserted
-inflated at aneurysm site

16

Traditional Graft Surgery

*Recommended if >6 cm wide
*May be elective if 4-6 cm
*Midline abdominal incision
*Aorta clamped above and below aneurysm-quick procedure*
*Aneurysm opened
*Dacron graft placed within
*Aneurysm sac wrapped around the graft
-pre op note pedal pulses
-post op: assess bowel sounds
**Reglan med

17

Pre Op Care

*Prop respiratory and cardiac assessment
*Perpheral pulses for baseline
*BP must be under control
*Measure abdominal girth
*Type and cross

18

Post Operative Patient

*oxygenation
*circulation
*perfusion
*wound
*GI elimination
*renal function
*mobility
*pain

19

Post Op Nursing

*Impaired gas exchange
-respirations
-O2 sat
-breath sounds
-depth
-sputum
*Free from atelectasis/pneumonia
-*position*
-pulmonary toilet
-ISE
-splinting
-abdominal binder
-out of bed

20

Post op potential complications

*Hemorrhage Nurse prevents
-pulse -Measures
-b/p -trends
-skin -reports
-metal status -plans ahead
-UO -available IV sites
-abdominal girth
-CVP

21

Post Op complications

*Ineffective tissue perfusion r/t temporary decrease in blood supply in sx
-pulses
-skin
-color
-movement
-sensation
-pain
*Maintain perfusion to periphery
-extremity assmt
-assess/mark pulses
-heparin/lovenox SQ
-TEDS/SCDs
-positioning
****NEVER CRIMP A GRAFT

22

Post Operative Nursing

*Altered tissue integrity
-large abdominal incision
*Free from dehiscence
-assess
-report redness, swelling, disruption, abd. distention
-abdominal binder and splinting
-DM- keep blood sugar controlled, increased chance of impaired wound healing

23

Post Operative Complications

*Ischemic Bowel
-Abdominal distention
-decreased or absent bowel sounds
*Return of normal GI function
-Assess
-NG to intermittent suction
-Ambulate
-Reglan
-Document return of BS or passing flatus
-Stool softeners later

24

Post Operative Complications

*Renal failure
-decreased urine output
-swelling
-increased BUN/Cr
*Manage to prevent or detect early
-I&O
-wt qd
-daily labs, BUN/Cr
-Changes in HR, BP

25

Post Op Nursing

*Pain
-anxious
-uncooperative
-grimace
-rating at 10
*Pain level at 3
-medicate-morphine/dilaudid
-turn and reposition
-skin care
-abd binder
-pillow for splinting

26

Post Op Nursing

*decrease mobility
-major surgery
-weakness
-pain
*Return to ADL functioning
-early ambulation
-up to chair TID
-progressive
-bedside rehab
-rehab
-strenghthening

27

Nurse Discharge

*Teach
*Home medications BP, BP, BP
*No straining, no constipation, no lifting >10 lb
*Progressive activities
*Control risk factors

28

Aortic Dissection

*Usually acute, life threatening
*Blood accumulates between the tear
*More pressure at the site, less blood flow to organs

29

Symptoms of aortic dissection

*Severe pain, tearing or ripping
-chest, intrascapular, abdomen to legs
*Cardiovascular
*Neurological
*Respiratory

30

Conservative Treatment if slow dissection

*Bed rest
*Pain relief
*Prevent ischemia to organs
*Control of b/p- Nipride (med)
*Control cardiac contractility- Beta Blockers
*Transfuse if blood loss
*Prepare for surgery

31

Emergency-Ruptured Abdominal Aortic Aneurysm

*pulsating sensation in the abdomen
*severe, sudden pain in abdomen
*radiation to groin and back
*abdominal rigidity
*signs of hypovolemic shock
-Pallor
-anxiety
-increased HR, decreased BP, decreased urine output
*dry skin
*excessive thirst

32

Rupture

*Immediate surgery
*50% mortality rate
*results
*more blood loss
*more ischemic disease

33

Treatment: ruture

*Transfuse
-blood
-IV fluids
*Support airway
*Immediate surgery

34

Post op care

*More critical
*Greater chance of ischemic complications