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Aneurysms
| Question | Answer |
|---|---|
| Aneurysms | An aneruuysm is a permananent localized dilation of an artery, which enlarges the artery to at least two time its normal diameter. It is the distention at the site of a weakness in the arterial wall |
| Fusiform | entire circimference of the artery wall is dilated |
| Saccular | pouchlike projection at one side of the artery |
| Dissecting | tear in the inner linning of an arteriosclerotic aortic wall causes blood to form a hematoma between layers of the artery compressing the lumen. |
| True | the arterial wall is weakened by acquired or congenital problems, vessle wall remains intact |
| False | occur as the result of vessel injury or trauma to all three layers of the arterial wall |
| Pathophysiology of aneurysm | Aneurysms form when the middle layer (media ) of the artery is weakend, producing a stretchingeffect in the inner layer (intima) and the outer layer ( adventia) of the artery. May be caused bycongenitaly weakness, syphillis, trauma, atherosclerosis. |
| Abdominal Aortic Aneurysm | lower back or abdominal pain (epigastric area), tends to move (severe if aneurysm is leaking) and is unaffected by movementpulsatile mass in the periumbilical area slightly to the left of the midline+ bruitHTNmottling of the lower extremeities if |
| Thoracic Aneurysm | may be asymtomaticdyspneadysphagia (difficulty swallowing)pain resulting from pressure agianst the nerves or vertebrahoarsenesscoughunequal pulses and arterial pressure in upper extremetiesdisplaced tracheaS & S of rupture include: hyp |
| CT Scan | used to assess size and location ( most definitive for AAA) |
| Aortography | is a rdiographic process in which the aorta is injected with contrast media for suspected arterial occlusive disease local anesthesia apply pressure dressing 20 minutes after procedure Assess distal pulses Monitor I & O Encourage fluids |
| Abdominal X ray or lateral film of the spine for AAA | shows eggshell appearance of the aneurysm |
| Chest X ray | dx throacic aneurysm |
| Ultrasonography | noninvasisve techinique provides an accurate diagnosis as well as information about the size and location |
| Therapeutic management and surgical interventions of aortic aneurysms | The size of the aneurysm and the presence of symptoms are the most important parameter in thedetermination of treatment. Non surgical management maintian BP to decrease the risk of rupture frequent CT scans to monitor growth follow-up with HC |
| Altered tissue perfusion: peripheral r/t impaired arterial circulation | Perform neurovascular asessment of extremities Q2-4HMonitor hemodynamic statusRecord I&OAdminister narcotocs as order to alleviate painEncourage splinting of abdomen when coughingPrevent flexion of hip and knees to eliminate pressure on the arte |
| Risk for impaired tissue perfusion (renal) | monitor urine output < 50ml/hr notify physicicanmonitor BUN/Cr QDmaintain foley cath |
| Risk for Impaired tissue perfusion (peripheral) | asses vital signs and circulation Q15 min. for the 1st H, then hourly assessments of pulses distal to the graft sitereport signs of graft occlusion of rupture:white or blue extremeities or flankssevere painabdominal distentionchanges in pulses |
| Risk for injury ( paralytic ileus) | expected for 2-3 daysNG tube to low suction until BS returnbowel sounds Q8H, report return to physicianassess for prolonged absence of bowel sounds and distention |
| Risk for Sensory and Perceptual alterations | assess LOC Q15min then Q1h, then q4h |
| PRBC’s | given for moderate blood loss because they replenish the red cell deficit and improve the o2 carrying cap without adding excessive fluid volume |
| IV of LR at 150 cc/hr | to provide isotonic hydration |
| CBC | provide baseline , H&H, WBC’s |
| SMA | baseline electrolytes |
| PT/PTT | assess risk for bleeding |
| Kefzol 1 gm, IV q6 | prophylactic antibiotic |
| Betadine bath this evening and in A.M. | pre-op surgical scrub to prevent infection |
| Defining characteristics of rupure include | - sudden drop in BP 80/50- low MAP = 65- HR 138, rapid and theady- pale, cold and clammy skin- increased cap refill = >5sec- restless & agitated |
| AAA repair complications include | Renal failure may occur due to clamping of the artery during surgery - monitor urine output, BUN/Cr |
| MI | hemodynamic and cardiac monitoring |
| Graft occlusion or rupture causing hemorrhage | changes in pulses, cool to cold extremities below the graft,white or blue extremities or flankssevere painabdominal distentionHOB limited to 45* to avoid flexion on the graft |
| Hypovolemia and/or renal failure | monitor urine output < 50ml/hr notify physicianBUN/Cr |
| Respiratory distress | RR & depth Q1Hauscultates lung sounds Q4hpositions, turns, deep breathes prn Q2hsplinting |
| Paralytic ileus expected for 2-3 days | NG tube to low suction until BS returnbowel sounds Q8Hdistention |
Created by:
littlemina
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