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Nur-354
Exam #3 - Aneurysms
| Term | Definition |
|---|---|
| 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
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