NURS 424 - Exam #4

What is an aneurysm? abnormal dilation of an artery resulting in a weakened wall Complications of atherosclerosis Can be genetic, connective tissue disorder, traumatic injury, or infection Manifestations of aneurysms Can be asymptomatic without complications How do you diagnoses an aneurysm - Radiograph - CT - TEE - MRI (not as common) - Visualization and palpation are not reliable How do you manage aneurysms? - Closely monitor through imaging and track the size - Aggressive blood pressure control When do you want to intervene for aneurysms? When it is greater than 5-5.5 cm What are the interventions for a aneursym? - Open surgical repair (high risk but a graft is placed) - Endovascular aneurysm repair (aka EVAR) - Keep blood pressure under control What is an endovascular aneurysm repair? - Prevents rupture from happening - Less invasive - Done in the cath lab using guidewire to place the endograft - Stent is placed (loos like a pair of pants)Aortic Rupture - Similar to a balloon rupture - High mortality! It is almost certain Manifestations of an Aortic Rupture - Rapid severe pain in chest, back, abdomen, or flank - Syncope - Hypotension - Rapid shock and hemorrhage - Need to be at the right place at the right time for this patient to maybe survive. Management of an Aortic Rupture - Rapid stabilization - Decrease stress - Pain control - Fluid management Nursing considerations for an Aortic Rupture - Pain control - Ventilator therapy - Tight BP control - Monitor peripheral sensation and pulses to extremities - Kidney function - Neuro status Dissection - Separation of the lining of the vessels allowing blood to enter (think a pair of pantyhose that have been ripped) Dissection considerations - High mortality rate but able to be repaired - Typically extends forward from the point of origin Dissection manifestations - Acute onset of severe pain that does not change but location may migrate - Described as "ripping, stabbing, tearing, burning" - Hypertension is more common but hypotension is more ominousDissection management - BP control - Fluid management - Anticoagulation - Surgical vs medical based on type Aortic dissection types Stanford type A and Stanford type B Stanford type A aortic dissection - Goes to surgery - Mortality rate is 1-2% per hour - Proximal aortic surgery Stanford Type B dissection - Does NOT go to surgery - Keep BP 120 A patient presents to the emergency department (ED) with sudden severe back pain that is extending forward from where it started. The patient has a history of hypertension, hypercholesterolemia, and an abdominal aortic aneurysm. Which of the following describe goals of management for this patient? (Select all that apply) A: Pain control B: Control hypertension C: Fluid management D: Oral nutrition E: Anticoagulation A, B, and C Types of burns thermal, chemical, electrical, radiation, and extreme cold