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Aneurysm (Diagnostics (Surgical Procedures (Open Aneurysm Repair (The…
Aneurysm
Diagnostics
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cat scan
This is the most accurate test to determine the length and cross-section diameter of the aneurysm.
Also shows the presence of a thrombus within the aneurysm.
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Surgical Procedures
Open Aneurysm Repair
The patient will have a large abdominal incision, through which the surgeon cuts into the diseased aortic segment, removes any thrombus or plaque, sutures a synthetic graft to the aorta proximal and distal to the aneurysm, and then sutures the native aortic wall around the graft to act as a protective cover.
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The most common complication of AAA repair is endoleak (the seepage of blood back into the old aneurysm)
Classifications
True aneurysm :check:
Definition: (arterial wall is weakened by congenital/acquired problems w/ at least 1 wall layer still intact)
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Clinical Manifestations
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Rupture of AAA
S&S:
• Hypotension
• Diaphoresis
• Decreased LOC
• Oliguria (scant urine output)
• Loss of pulses distal to rupture
• Dysrhythmias
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Etiology
Primary Causes
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Infectious
Aortitis (Chlamydia pneumoniae, human immunodeficiency virus)
Risk factors
Male gender, older age, and tobacco use are the most important
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Nursing DIagnoses
Nursing Dx 1
Deficient knowledge R/T new medical problem and unfamiliarity with surgical procedure and hospital care AEB expressed need for information and multiple questions
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Goal
Client or significant others verbalize understanding of disease process, treatment options, and goals of therapy by the time of discharge.
Interventions:
Assess the client’s knowledge of the disease and treatment options. This information provides and important starting point in education.
Instruct medically treated clients about the following:
• Goals of therapy (avoidance of excess BP and strain on the disease arterial wall)
• Importance of follow- up computed tomography scanning
• Signs and symptoms to report
• Side effects of the drugs
• Use of antihypertensive medications as prescribed; importance of compliance
Clients treated medically need to maintain goal BP levels and comply with scheduled CT scans to monitor the size of the aneurysm. Knowledge of early warning signs facilitates rapid treatment. These may include pain in the chest, back, groin, abdomen; decreased urine output; cool, pale extremities.Instruct surgical clients about the following:
• Activity restrictions
• Avoidance activities that are isometric or abruptly can raise BP (lifting and carrying of heavy objects, straining for bowel movements)
• Signs and symptoms to report
• Wound care
Discharge instructions guide clients regarding self-care measures; Heavy lifting of more than 5 to 10 pounds is restricted for 4 to 6 weeks after surgical repair of an aortic aneurysm. These restrictions reduce strain on suture lines until they are completely healed; Clients need to be aware of the warning signs that warrant medical attention.Instruct endograft clients about the need for follow- up CT scans at 1 and 6 months and yearly for the rest of their lives. The endograft may incur a leak; ongoing evaluation is needed so appropriate treatment can be initiated.
Nursing Dx 2
Anxiety r/t the sudden onset of illness AEB restlessness and anxious appearance
Goal: Patient will verbalize ways to reduce anxiety level
Interventions:
--Assess the patient’s anxiety level due to their acute life threatening situation
--Acknowledge the patient’s anxiety to help validate their feelings
--Reduce any unnecessary external stimuli that could further escalate the patient’s anxiety
--Explain all procedures in simple terms so that the client can understand what will be done
--Teach the patient relaxation techniques such as guided imagery, meditation, and deep breathing, to help decrease anxiety levels
Evaluation: Patient was able to verbalize way to reduce their anxiety
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Medications
- B-adrenergic blocking agents (propranolol [Inderal])
- Statins (simvastatin)
- Antibiotics (doxycycline)
- Opioids
Management
Begin by performing a thorough history and physical assessment.
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Establishing baseline data is critical for comparison with
later postoperative assessments.
Because atherosclerosis is a systemic disease, look for
signs of coexisting cardiac, pulmonary, cerebral, and lower
extremity vascular problems.
Pay special attention to the
character and quality of the patient’s peripheral pulses, and
renal and neurologic status. Before surgery, mark pedal pulse
sites (dorsalis pedis and posterior tibial) with a single-use
marker and document any skin lesions on the lower extremities
Monitor the patient for signs of
aneurysm rupture, such as diaphoresis; pallor; weakness tachycardia;
hypotension; abdominal, back, groin, or periumbilical
pain; changes in level of consciousness; or a pulsating abdominal
mass
Definition: Permanent localized dilation of artery, which enlarges artery to at least 2x its normal diameter