Aortic Aneurysm/Test 2 Flashcards
(34 cards)
1
Q
Definintion of Aortic Aneurysm
A
*Weakness within the arterial wall
*Localized ballooning of an artery
*Increases to about 50% of it’s size
Exact cause unknown
2
Q
Risks for Aortic Aneurysm
A
- HTN, HTN, HTN
- Atherosclerosis
- Congenital weakening of the wall
- Weakening due to connective tissue diseases
3
Q
Significance of Aortic Aneurysm
A
- 2-3% of unselected population
- M:F 5:1
- Age >60 years
- High risk of rupture if:
- > 5 cm
- expanding rapidly
- saccular
4
Q
Locations in the aorta
A
- Thoracic- above diaphragm
* Abdominal- below diaphragm
5
Q
Aortic Aneurysm Labels
A
- Fusiform
- Saccular
- Dissecting
- Ruptured
6
Q
Fusiform
A
Entire circumference affected- football
7
Q
Saccular
A
on side of the vessel (easiest to rupture-bike tire)
8
Q
Dissecting
A
blood accumulates between layers of vessel r/t tears in intimal lining
9
Q
Ruptured
A
Bursts
10
Q
Symptoms of aortic aneurysm
A
- Thoracic:
- Tearing pain, tearing sensation within chest
- HTN
- Abdominal
- pulsating mass in the abdomin
- Pain- abdominal, flank, back, groin
- HTN
11
Q
Diagnostics of Aortic Aneurysm
A
- Ultrasound
- Cat Scan
- Xray
- Arteriogram/Aortagram
12
Q
Nursing Diagnoses of Aortic Aneurysm
A
- Ineffective Tissue Perfusion
- Pain
- Impaired gas exchange
- PC: Rupture or hemorrhage
- Many PC’s
13
Q
Medical Management for Aortic Aneurysm
A
- Control risks, trend size
- Prevent increase in size
- Surgical treatment if >5 cm
14
Q
Treatment for Aortic Aneurysm
A
- Anit-hypertensives
- Keep stress under control
- Surgery or resection of the aneurysm and creation of a new artery or graft.
- Endovascular procedures
15
Q
Endovascular procedures
A
- New method for non-emergency treatment to repair
- 2 small incisions in groin
- catheter with balloon and graft inserted
- inflated at aneurysm site
16
Q
Traditional Graft Surgery
A
- 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
Q
Pre Op Care
A
- Prop respiratory and cardiac assessment
- Perpheral pulses for baseline
- BP must be under control
- Measure abdominal girth
- Type and cross
18
Q
Post Operative Patient
A
- oxygenation
- circulation
- perfusion
- wound
- GI elimination
- renal function
- mobility
- pain
19
Q
Post Op Nursing
A
- 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
Q
Post op potential complications
A
- Hemorrhage Nurse prevents
- pulse -Measures
- b/p -trends
- skin -reports
- metal status -plans ahead
- UO -available IV sites
- abdominal girth
- CVP
21
Q
Post Op complications
A
- 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
Q
Post Operative Nursing
A
- 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
Q
Post Operative Complications
A
- 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
Q
Post Operative Complications
A
- 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
