Aortic Aneurysms

Question 1

what is an aortic aneurysms?

Answer 1

Are out pouching or dilations of the arterial wall

Question 2

what are the causes of aortic aneurysms?

Answer 2

degenerative
congenital
inflammatory
infectious
mechanical

Question 3

aortic aneurysm may involve the aortic arch and thoracic aorta
however most of the time, they are found where?

Answer 3

abdominal aorta below the level of the renal arteries

Question 4

the larger the aneurysm, the greater risk for what ?

Answer 4

rupture

Question 5

what are the 2 main risk factors for patients in developing an aortic aneurysms?

Answer 5

family history
hypertension

Question 6

patients who have a thoracic aortic aneurysm normally are often dont have any what ?

however if they do have symptoms, what would it be ?

Answer 6

symptoms
very symptomatic

deep diffuse chest pain that could rate to the interscapualr area

Question 7

patient who have an ascending aortic aneurysm typically will have symptoms like ?

Answer 7

angina
coughing
shortness of breathe
hoarseness

distended neck veins and edema on face and arms if it pressures on the superior vena cava

Question 8

most of the time patients with the common abdominal aortic aneurysm dont have ?

Answer 8

symptoms
often asymptomatic

Question 9

how is abdominal aortic aneurysms usually found ?

Answer 9

physical exam or during exam for unrelated problem

Question 10

how does the physical exam present itself in an abdominal aortic aneurysm ?

describe how it feels like and how it sounds like

Answer 10

pulsatile mass in periumbilical area slightly left of midline
- bruit asucltated over aneurysm

Question 11

what does a bruit sounds like and mean ?

Answer 11

terbulent blood flow through your vessels

Question 12

its very rare for patients to get symptoms for abdominal aortic aneurysm however if they do, what are the clinical manifestations?

Answer 12

back pain
epigastric discomfort
altered bowel elimination
intermittent caludicaiton

Question 13

abdominal aortic aneurysm, patients may experience something called _____syndrome which is ?

Answer 13

blue toe syndrome

where the clots will migrate down to the toes and cause your toes to become cold and blue

Question 14

what is the most serious complication related to an untreated aneurysm ?

Answer 14

rupture and bleeding

Question 15

what happens if you have aortic aneurysm rupture for patients that have it in retropertioneal space ? (abdomen)(3)
its a steps

Answer 15

bleeding may be tampondaed
( bleed but eventually run out of space, causes pressures on the vessel and stops the bleeding, this pressures causes severe back pain )

severe back pain

grey turners sign
( back, flank ecchymosis)

Question 16

what does grey turners syndrome mean?

Answer 16

bruising of your flanks, bleeding in the back of the abdomen !

Question 17

what happens if you have an aortic aneurysm rupture in your thoracic or abdominal cavity ? (3)

think of the steps for this

Answer 17

massive hemorrhage causes hypoveolmic shock

patients dont survive long enough to get into the hospital

if survive, immediate resusistcitation and immediate surgery

Question 18

what are some diagnostic studies for aortic aneurysm ?

Answer 18

x-ray
ultrasound
echocardiography
ECG

Question 19

what is a small aneurysm considered to be ?

what is a large aneurysm considered to be ?

Answer 19

less than 5.4

greater than 5.4

Question 20

what is the interprofessional care we are going to be wanting to help patients with a small aneurysm?

Answer 20

really going to be watching for changes in size and symptoms

ultrasound checks every 6-12months

increase in physical acitivity, stop smoking, watch cholesterol levels

Question 21

what is the interprofessional care we are going to be wanting to help patients with a large aneurysm?

Answer 21

surgery

Question 22

what are the two types of surgery we can do for patients who have large aortic aneurysm ?

Answer 22

open aneurysm repair (oar)
end-vascular aneurysm respair

Question 23

describe what we are doing in open aneurysm repair for large aneurysm?

Answer 23

clamp the aorta ; proximal and distal aneurysm

put in a graft
sew in the vessels around the graft

Question 24

what is the biggest concern and risk for patients who have oar?

Answer 24

acute kidney injury
( decrease perfusion can occur from the clamping and graft )

Question 25

what is a end-vascular aneurysm repair ? describe it

Answer 25

thred in the graft to the anerusym and hook it in place, and it will stay in place

Question 26

how does the endovascular graft procedure help the patient overtime?

Answer 26

shrink the aneurysm overtime

Question 27

post procedure from an endovascular graft, we usually like to get what done for the patient in order to check for leaks and confirm the patency of the procedure?

Answer 27

angiography

Question 28

what are the potential complications that can occur to patients after an end-vascular graft procedure? dont overthink it, think about the graft itself in the patient and what It can cause

Answer 28

stent will migrate thrombus infection dysfunction need lifelong follow up

Question 29

in general what are some potential complications with any aneurysm repair ?

Answer 29

aneurysm growth rupture aortic dissection bleeding

Question 30

what's the most common complication after an aneurysm repair?

Answer 30

endoleak

Question 31

patients who experience the 6ps after a repair, what do we do ?

Answer 31

call the doctor and emergency surgery because they could lose their leg

Question 32

what is a really lethal complication that can occur from aneurysm repair?

Answer 32

intraabdominal hypertension

Question 33

what is intraabdominal hypertension?

Answer 33

pressure increases that puts more pressure on abdominal organs and diaphragm

Question 34

intraabdominal hypertension is often associated with what?

Answer 34

abdominal compartment syndrome

Question 35

abdominal compartment syndrome also can occur in what other disease process?

Answer 35

obtstrutive shock

Question 36

what is the treatment for patients who experience intraadbominal hypertension ? (2)

Answer 36

open surgical compression percutaneous drainage

Question 37

nursing management assessment - history and physical exam - watch for signs of cardiac, pulmonary, cerebral and lower extremity vascular problems - establish baseline data to compare postoperatively mark pedal pulses monitor renal function monitor mental status & neurological function

Question 38

what are some clinical manifestations for aneurysm rupture?

Answer 38

diaphoresis pallor weakness tachycardia hypotension abdominal, back or groin pain changes in LOC pulsating abdominal mass

Question 39

Overall goals - Normal tissue perfusion - Intact motor and sensory function - No complications related to surgical repair Thrombosis Infection Rupture health promotion - Alert for opportunities to teach health promotion to patients and their caregivers - Encourage patient to reduce cardiovascular risk factors (Table 33-2) - These measures help ensure graft patency after surgery

Question 40

preoperative TEST!! - Patient/caregiver teaching about disease, treatment plan, and postoperative care - Providing emotional support for patient/caregiver - Preoperative routines - Bowel prep - NPO - Shower - IV antibiotics right before incision made

Question 41

ICU monitoring 24 to 48 hours postoperative TEST!! - Central lines - Endotracheal tube and mechanical ventilation - Peripheral IV lines - Urinary catheter - NG tube - Chest tube and Lumbar drain possible - Continuous ECG monitoring - Pulse oximetry - Pain medication

Question 42

Acute care Normal blood pressure IV fluids and blood components CVP or PA pressure monitoring Urinary output monitoring - hourly Avoid severe hypertension Drug therapy may be indicated ONGOING MONITORING CV status Infection control GI function Neurologic function Peripheral perfusion Renal function

Question 43

cardiovascular status Continuous ECG monitoring Electrolyte monitoring Arterial blood gas monitoring Oxygen administration Antidysrhythmic and antihypertensive meds Pain control Resume heart medications infection Antibiotic administration Assessment of temperature Monitoring of WBC Adequate nutrition Observe surgical incision for signs of infection Hand hygiene and aseptic technique for all invasive catheters; perineal care to  risk of UTI GI Monitor for paralytic ileus; bowel sounds Passing of flatus = return of bowel function Record amount and character of NG tube output NPO; provide oral care Abdominal assessment Assess for signs of bowel ischemia—absent bowel sounds, fever, abdominal distention, diarrhea, and bloody stools

Question 44

neurologic status - Level of consciousness - Pupil size and response to light - Facial symmetry - Speech - Ability to move upper extremities - Quality of hand grasps - Descending aorta—neurovascular check to lower extremities

Question 45

Frequent pulse assessment —doppler, if needed Ascending aorta and aortic arch-Carotid, radial, and temporal Descending aorta-Femoral, popliteal, posterior tibial, and dorsalis pedis Extremity assessment Temperature, color, capillary refill time, sensation, and movement of extremities Vasospasm and hypothermia can cause absence of lower extremity pulses (temporary) Absent pulses + cool, pale, mottled, or painful extremity means embolization or graft occlusion Report immediately vasospasm is ____ normal

Answer 45

not!!!

Question 46

renal notes - Hourly urinary output (initially) - Accurate I & O - Daily weight - CVP pressure - Blood urea nitrogen/creatinine - Decrease renal perfusion may occur with: embolization of plaque to renal arteries, hypotension, prolonged aortic clamping or blood loss

Question 47

Ambulatory care - Encourage patient to express concerns Fatigue, poor appetite, irregular bowel habits, and male sexual dysfunction are common - Instruct patient to gradually increase activities - No heavy lifting for 6 weeks - Teach about signs and symptoms of complications - Infection - Neurovascular changes

Question 48

Expected outcomes - Patent arterial graft with adequate distal perfusion - Adequate urine output - No signs of infection

Question 49

something I just want to emphasize that I feel like might be on the test, we want patients to gradually increase acitivyt but avoid heavy lifting for about ___weeks

Answer 49

6