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Exam #3 - Aneurysms

What is an aneurysm? Outpouchings or dilations that occur within arteries
What aorta branch off of the aortic artery? Thoracic aorta (arch, ascending, descending) and abdominal aorta
What is the inner-most layer of a vessel called? The intima; it is lined with endothelial cells
What is the muscular middle layer of a vessel called? Media
What is the outer layer of a vessel that contains connective tissue called? Adventitia
What three ways can an aneurysm be classified? True aneurysm, pseudoaneurysm, and aortic dissection
On what basis are aneurysms classified? By the number of layers of the vessel wall that are affected
What is the most common location for aneurysms? The abdominal aorta
What is the most common cause of aneurysms? Atherosclerosis
Besides atherosclerosis, what are other causes of aneurysms? Congenital, mechanical, inflammatory and infectious
What is the most serious complication related to an untreated aneurysm? Rupture and bleeding
What is the goal of managing an aneurysm? To prevent rupture
How is a true aneurysm characterized? Arterial wall forms the shape of the aneurysm or dilation; can be fusiform or sacculated
How is a pseudoaneurysm characterized? All layers are disrupted and blood flows outside the vessel wall; bleeding is contained by surrounding structures
How is an aortic dissection characterized? False lumen created from tear in the intima; blood flows in vessel but also in between vessel layers
What are risk factors associated with aneurysms? Males > females, increasing age, smoking, CAD, HTN, elevated cholesterol
What are the signs/symptoms of a thoracic aneurysm? Often asymptomatic; most common are deep, diffuse chest pain, angina, hoarseness, dysphagia, JVD, and upper extremity and facial edema
What are signs/symptoms of an abdominal aneurysm? Often asymptomatic; epigastric pain, back pain, constipation, "blue toe syndrome," pulsatile mass, bruit
What diagnostic test is the gold standard for imaging an aneurysm? CT scan
Besides the CT scan, what other diagnostic tests can be used for aneurysms? CXR, TEE, ECG, Echocardiogram, US, and angiography
What information does angiography provide? Anatomic mapping of the vessels
What information can a transesophageal echocardiogram provide? Can identify dissections that are near the aortic root
How can an ultrasound be used in regards to an aneurysm? Can be used as a screening tool or monitoring the size of the aneurysm over time
How can an echocardiogram be used in regards to an aneurysm? To evaluate the aortic valves for insufficiency related to dilation of the aorta or left ventricular hypertrophy
What is the best way to prevent extension, dissection and rupture of an aneurysm? Control blood pressure
What guides treatment of an aneurysm? Size
Besides prevention of extension, dissection and rupture, what is another treatment goal in regards to aneurysms? Early detection
How is an aneurysm less than 4 cm managed? Blood pressure control and routine follow-up
How is an aneurysm greater than 5 cm managed? Surgical repair
What percentage of people die from an aneurysm rupture? 90%
What are the signs/symptoms of a ruptured anterior aneurysm? Massive hemorrhage, hypovolemic shock (tachycardia, decreased BP), pulsatile mass, back or flank pain, cardiopulmonary arrest
What are the signs/symptoms of a ruptured posterior aneurysm? Severe back pain, back or flank ecchymosis (Grey Turner's sign)
Signs and symptoms of an aneurysm are based on lack of perfusion where? Lack of perfusion distal to the site of occlusion
What does a bruit indicate? Turbulent blood flow
What blood pressure medications are used in the treatment of an aneurysm? Beta-blockers; decrease HR and contractility; decreases stress on arterial wall
What are general signs of aneurysm rupture? Pain in chest or abdomen, diaphoresis, tachycardia, hypotension, delayed capillary refill, cool, clammy skin
What nursing interventions are carried-out preoperatively? Hydration, maximize hematocrit, correct coagulation and electrolyte abnormalities, control pain, anxiety and blood pressure, establish baseline data, mark pedal pulse locations, monitor for signs of rupture
What medication is given preoperatively for anxiety? Versed (Midazolam) a benzodiazepine
What pedal pulses should be marked preoperatively? Dorsal pedis and posterior tibial
What is involved in the open technique of surgical repair of an aneurysm? An incision is made into the aneurysm to remove the plaque or thrombi, then a synthetic graft is inserted and the aortic wall is sutured over the graft
What is involved in endovascular stent grafting surgical repair of an aneurysm? A catheter is thread-up through the femoral artery and a graft or stent is inserted over the catheter
What are the benefits of endovascular stent grafting? Decreased length of stay in the hospital, decreased anesthesia time and discomfort, decreased blood loss, faster recovery
Where would a patient who has undergone surgical repair of an aneurysm be postoperatively? In ICU to be monitored closely and frequently
What nursing interventions are carried-out postoperatively? Maintain graft patency by preventing blood pressure extremes and perform focused assessments
What classes of medications are administered by IV postoperatively? Diuretics and antihypertensives
What beta-blocker is administered by IV postoperatively? Esmolol (Brevibloc)
What vasodilator is administered by IV postoperatively? Nitroprusside (Nipride)
If blood pressure got too high postoperatively, what would that cause? It would put stress on the sutures
If blood pressure got too low postoperatively, what would that cause? Poor perfusion distal to the site
What is performed in a focused cardiovascular postoperative assessment? Continuously monitor ECG; invasive arterial line for BP monitoring and ABGs
What is performed in a focused distal perfusion postoperative assessment? Check pedal pulses and temperature of the extremities
What is performed in a focused renal postoperative assessment? Hourly urine outputs, look for signs of acute tubular necrosis (tea or cola-colored urine)
What is performed in a focused gastrointestinal postoperative assessment? Swelling of intestines, monitor for bowel sounds, patient will have NG tube in place
What is performed in a focused neurologic postoperative assessment? LOC, pupils, signs of CVA (facial symmetry); looking for emboli that were released and could go to the brain
Created by: ssbourbon