Aortic Aneurysm

  • aortic aneurysm Is the distention of an artery caused by structural  weakening of the arterial wall. Under hemodynamic pressure, the weakened area enlarges, causing serious complications by compressing surrounding structures.
  • It result from degeneration of the medial wall, which occurs as a normal part of the aging process as well as with hypertension, atherosclerosis, trauma or infection, immunologic conditions, and as a complication of Marfan Syndrome.
  • Thoracoabdominal aortic aneurysm may originate in the ascending aorta and aortic arch (frequent site of dissection) or in the lower descending thoracic aorta and upper abdominal aorta.
  • Abdominal aneurysms originate in the abdominal aorta, typically between the renal arteries and iliac branches. Most of the male patients are asymptomatic.
  • Complications includes fatal hemorrhage, paraplegia caused by interruption of anterior spinal artery, abdominal ischemia stroke, myocardial ischemia, lower extremity ischemia, renal failure, impotence, and cardiac tamponade.

Assessment:

 aneurysm_aortic1. Thoracoabdominal Aortic Aneurysm

  • Constant, boring pain or pressure in chest.
  • Intermittent neuralgic pain caused by nerve compression.
  • Dyspnea, cough, and hoarseness because of pressure against trachea and recurrent laryngeal nerve.
  • Dysphagia because of pressure on esophagus.
  • Dilated superficial veins of chest and cyanosis  caused by compression of chest vessels.
  • Ipsilateral dilation of pupils caused by pressure against cervical sympathetic chain.
  • Pulse or blood pressure variations between arms caused by interference with circulation in left subclavian artery.

2. Abdominal Aneurysm

  • Persistent or intermittent abdominal pain, often localized to middle or lower left side of abdomen.
  • Pulsating mass with bruit.
  • Blood pressure elevated in arm more than in thigh.

3. Predisposing factors

  • Local infection, pyogenic or fungal (mycotic aneurysm)
  • Congenital weakness of vessels
  • Arteriosclerosis
  • Trauma
  • Syphilis

Diagnostic Evaluation:

  1. Abdominal or chest X-rays may show calcification that outlines the aneurysm.
  2. CT scan and ultrasonography are used to detect and monitor size of aneurysm.
  3. MRI or magnetic resonance angiography further evaluate circulation.
  4. Arteriography allows visualization of aneurysm and vessel.

aneurysm surgerySurgical Interventions:

  1. Surgery may be required to remove the aneurysm and restore vascular continuity with a bypass graft. Complications of surgery include arterial occlusion, graft hemorrhage, infection, ischemic colon, and impotence.
  2. Endovascular grafting using stent inserted via catheter through the femoral artery may be warranted.

Nursing Interventions:

  1. Monitor for signs and symptoms of spinal cord ischemia such as pain, numbness, paresthesia, and weakness caused by dissection.
  2. Monitor for signs of stroke or cardiac tamponade caused by dissection.
  3. Postoperatively, monitor vital signs continuously.
  4. Check extremities for sensation, temperature, pulses, color, capillary refill, and petechiae.
  5. Monitor for bleeding from the wound and for signs of hemorrhage, hypotension, tachycardia, pallor, and diaphoresis.
  6. Monitor temperature and incision for signs of infection.
  7. Monitor urinary output hourly.
  8. Administer antibiotics, if ordered, to prevent infection.
  9. Administer pain medication, as ordered, or monitor patient-controlled analgesia.
  10. Elevate the head of the bed no more than 45 degrees for first 3 days postoperatively to prevent pressure on the repair graft site.
  11. Warn patient not to cross legs or sit for long periods to prevent thrombus formation.
  12. Teach the patient about blood pressure medications and the importance of taking them as prescribed.
  13. Teach the patient to recognize and report signs and symptoms of an expanding aneurysm or rupture.
  14. Encourage adequate nutritional intake to enhance wound healing.
  15. Teach the patient to maintain a postoperative exercise regimen.

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