Chapter#37_Disorders of the Aorta

Question 1

Aneursym is found

Answer 1

Accidently

Question 2

Slide#19
Common Manifestation of Aneursym

Answer 2

Pain

Interscapular Pain

Question 3

In aneurysm

Answer 3

Inner lining of the artery is destroyed in aneuyrsm. Tear in the inner lining of arterial wall

Only be found accidently:
Brain aneurysm
Thoracic Aneurysm
Abdomen aneurysm

Question 4

3 types of aneurysm

Answer 4

Aortic Dissection
Thoracic
Abdominal

Question 5

In aneurysm

Answer 5

Weakening of the atrial wall

Question 6

Risk Factors for aneuyrsm

Answer 6

Women
Increase in Age

Question 7

Slide#3 Atheroscleorosis
Hardening of arteries

Question 8

Slide#10 Big risk factor for atherosclerosis

Answer 8

the plaque dries up and breaks up

Question 9

Risk factors for atheroscleorosis
Risk factors slide#11 and slide#12

Answer 9

CAD
PAD
HP
Hyperlipedemia
Inflammatory and infections?

Question 10

Risk factors slide#11 and slide#12

Answer 10

Modifiable risk factors are Tobacco and Obesity

Question 11

Slide#15
True or False Aneurysm

Answer 11

A. Fusiform anf Sacculated are true aneursym

B. part is false shows aortic disection = walls leaks.

Question 12

«Test Qn»
In TIA (transient ischemic attack)

Answer 12

You will feel:
Coughing
Obstructing Swallowing
Dysphagia «Test»

Question 13

Slide#21
TIA

Answer 13

Suppress on superior vena cava
Edema of Face and Arms Problem with flow

Question 14

In Aneusrym

Answer 14

Audible pulse or brui detected in brui = Brui Heard

Question 15

Slide #22
s/s Aneuyrsm

Answer 15

Epigatric Pain
Altered Bowel Elimination
Intermittent Claudication

Question 16

AAA Hx what is prohibited

Answer 16

Palpitations is prohibited
Listen to Brui
Abdomen X-Ray/ CT-scan
Never ascultate over top of abdomen

Question 17

Slide #24
Rupture into retroperitoneal space

Question 18

Qn. How do you know with aneurysm pt. is bleeding?

Answer 18

Grey Turners sign
BP drops
Tachycardia
RR increases
Absent pedal pulses when rupture as there is no circulation

Question 19

Aneurysm rupture

Answer 19

Action to be taken: Fluid + Blood Transfusion immediately

Cold and Clammy
Absent pedal pulse = Take BP

Question 20

Slide#26
with aneursym, pedal pulses not felt, BP is very important
Diagnostic: Chest X-ray

Question 21

Chest Pain actions

Answer 21

If not MI, then AA making chest pain

Question 22

Slide#26 #27
Monitor aneurysm size

Answer 22

6 cm or more is serious

Question 23

CT scan for aneursym where is it anterior or posterior

Question 24

Slide#28
Thrombosis

Question 25

Slide#30 Goal of aneursym

Answer 25

Prevent neurysm from rupturing

Question 26

Post-op aneuyrsm

Answer 26

Monitor for bleeding Blood clot SCD

Question 27

Slide#33 Op aneurysm: Doctor determines any kind of comorbidities that will influence pt. surgical risk

Answer 27

Lung, Heart, Kidney Genetic Disorder: Marfan Syndrome = Operate immediately

Question 28

Note:

Answer 28

90% Mortality with AAA rupture

Question 29

Slide#35 Pre-op aneurysm

Answer 29

NPO Pt. wakes up will have tubes coming out from everywhere 8 hours to do surgery Electrolytes K, Na shoudl be goof Type and cross blood match = it is an arterial operation PT/ PTT/ aPTT everything should be good.

Question 30

Slide# 50 Potentially lehtal complication in emergency repair

Answer 30

IAH + ACS Compartment means closed = swollen after surgery Compartment syndrome: Reduces blood flow to viscera Eng-organ perfusion impaired

Question 31

IAH Treatment

Answer 31

Open surgical compression Percutaneous drainage Position dorsal = Intraabdominal decompression = lots of fluid needed

Question 32

Indications of Sneuyrsm rupture

Answer 32

Pale/ Diaphoresis/ Weakness/Tachy/ Hypotension

Question 33

Slide#56 Indications fo ruptured AAA

Answer 33

Pain in abdomen, back, groin, priumblical pain Assess: Take Vital Sign = BP + Tachycardia

Question 34

Slide#63 Post-op care

Answer 34

CVP (Central Venous Pressure) Arterial line monitoring for accurate BP - Give pain med for pt. control BP - Check urine o/p - Accurate urinary o/p > since its abdominal Replace fluid for low urine o/p

Question 35

Slide#68 Avoid injection for septic shock Administer antibiotics Not high = not going for sepsis monitor WBC

Question 36

Slide#73 Renal Perfusion Status

Answer 36

Urinary output low BUN and Creatinine measured

Question 37

Aortic disection = lumen is destroyed is type A or type B (true or false aneuyrsm?) destruction of arterial wall of artery

Question 38

Slide#83 Cause of aterial wall xxxxxxxx called

Answer 38

Aortic dissection

Question 39

Slide #86 Scapular radiating from scapular to spine to lungs

Answer 39

Nitro will not work

Question 40

Sharp and worse pain ever with aneuyrsm mimics

Answer 40

MI

Question 41

But not really MI

Answer 41

Its angina = hear a new high pitch sound called heart murmur

Question 42

With Aneuyrsm / aortic dissection Slide # 87 Tear: causes blood to ooze out

Answer 42

Dyspnea = develop as pain

Question 43

Complication of aortic dissection results in

Answer 43

HF

Question 44

Aortic dissection leads to

Answer 44

Cadiogenic Shock Pt. ray or cyanotic, eventually pt. can die

Question 45

In aorta develops to

Answer 45

Cardiac Tamponade

Question 46

Slide#89 Pericardial sac fluid accumulates = how can your heart expan?

Answer 46

Pericardialcentesis

Question 47

Aortic disection cause

Answer 47

HTN leads to aortic dissection then BP drops

Question 48

Goal with aortic dissection

Answer 48

to decrease the SBP = 120 to minimize injury to arterial wall and destroy inner lining of artery

Question 49

Slide#88 and Slide#89 Cardiac tamponade is resolved by

Answer 49

Pericardialcentesis

Question 50

Pericardial sac is filled with fluid= how can the heart expand

Answer 50

Pericardialcentesis

Question 51

Cardiac Tamponade s/s

Answer 51

Narrowed pulse pressure Distended Neck Veins Muffled Heart Sound

Question 52

Diagnostic Slide#91

Answer 52

CXR CT scan 3D bleeding coming from MRI transection PPE (TTE)

Question 53

Slide#93: Pain Mgmt

Answer 53

Slow heart give beta blockers like Esmolol Morphine = SNS stimulation CC decreases HR Give ACE

Question 54

Slide#95 Temporary Chain TEVAR (Thoracuc Endovascular Aortic Repair)

Answer 54

Prevent Paralysis