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Abdominal Aortic Aneurysm (Patho (Pathophysiology, • due to…
Abdominal Aortic Aneurysm
Patho
Pathophysiology
• due to degenerative changes allows the tunica intima and tunica adventitia layers to stretch outward.
• blood pressure within the aorta progressively weakens vessel walls and enlarges the aneurysm
• Rupture occurs when vessel wall tension exceeds the wall’s ability
• risk increases with a diameter greater than 5.5 cm
Incidence
Incidence
• five times more common in men than in women
• three times more common in white men
• increases after age 50 for men and after age 60 for women
Nursing Diagnosis
Nursing diagnosis
• Risk for Decreased Cardiac Output r/t Rupture of the aorta
• Risk for Ineffective Tissue Perfusion r/t increase stress on arterial wall (hypertension)
• Anxiety r/t Sudden onset of illness AEB Restlessness
Diagnostics
CBC
Electrolyte panel
Ultrasounds
CT
electrocardiogram
Medical Surgical Managment
Smoking cessation
VTE prophylaxis
Low fat low salt low caffeine diet
Activity as tolerated
Progressive ambulation
Antihypertensives
Analgesics
statins
Etiology
Advanced age (usually over age 65)
Male gender
Caucasian
Positive family history
Smoking (strongest risk factor associated with formation, expansion, and rupture of aneurysm)
Hypertension
Atherosclerosis or peripheral vascular disease
Connective tissue disorder
Chronic obstructive pulmonary disease
History of other large-artery aneurysms
Obesity
nursing assessment
Intact aneurysm
• Fever, malaise
• Gnawing, generalized, steady abdominal or flank pain
• Lower back pain unaffected by movement
• Gastric or abdominal fullness
• Pulsating mass in the periumbilical or epigastric area
• Abdominal bruit
• Lower-extremity ischemia
possibly asymptomatic
dissecting aneurysm
Sudden severe abdominal or lumbar pain radiating to flank
• change in mental status
• Weak pulse and decreasing blood pressure
ruptured aneurysm
• GI bleeding with hematemesis and melena (duodenal rupture)
• Mottled skin; poor distal perfusion
• Absent peripheral pulses distally
• decreased LOC
• Diaphoresis
• Hypotension
• Tachycardia
• Oliguria
• Distended abdomen
• Ecchymosis or hematoma in the abdominal, flank, or groin area
• Paraplegia (if spine is affected)
• Systolic bruit over the aorta
• Tenderness over the affected area
severe, persistant abdominal and back pain (peritoneal rup.)
medications
Fluid and blood replacement (if rupture)
Beta-andrenergic blockers
Anithypertensives
Analgesics
Aspirin
Statins