LP 4. Disorders of the Aorta (Exam 2)

Aortic aneurysms: diagnostic studies

X-rays: -chest: demonstrate mediastinal silhoulette & any abnormal widening of thoracic aorta -abdomen: may show calcification within wall of AAA ECG: -to rule out MI since symptoms mimic angina Echo: -assists in diagnosis of aortic valve insufficiency Ultrasonography: -useful in screening for aneurysms -monitors aneurysm size CT Scan: -most accurate test to determine* -anterior to posterior length -cross sectional diameter -presence of thrombus -best type of surgical repair MRI: -diagnose and assess location and severity Angiography: -anatomic mapping of aortic system using contrast -not reliable method of determining diameter or length -can provide accurate info about involvement of intestinal, renal, or distal vessels *angiography is also useful if a suprarenal or thoracoabdominal aneurysm is suspected

Thoracic Endovascular Aortic Repair (TEVAR)

a temporary lumbar drain may be inserted for cerebrospinal fluid removal to reduce spinal cord edema and help prevent paralysis -if a lumbar drain is used, strict aseptic techniques are essential to avoid introducing infection *standard to treat acute and chronic Type B aortic dissections with complications -similar to EVAR

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment, the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? a. Notify the surgeon and anesthesiologist. b. Wrap both the legs in a warming blanket. c. Document the findings and recheck in 15 minutes. d. Compare findings to the preoperative assessment of the pulses.

a. Notify the surgeon and anesthesiologist.

true aneurysm

wall of artery forms aneurysm -further subdivided into fusiform and Saccular

Thoracic Aortic Aneurysm (TAA)

widening or bulging of the upper portion of the aorta that may occur in the descending thoracic aorta, the ascending aorta, or the aortic arch.

AAA resection

*autotransfusion reduces need for blood transfusion during surgery -requires cross clamping of aorta proximal and distal to aneurysm -can be completed in 30-45 mins -clamps are removed and blood flow to lower extremities is restored

Aortic Dissection Classification

*classified based on the location of the dissection and duration of onset Type A: affects the Ascending aorta (A for ascending) Type B: affects the descending aorta acute- first 14 days subacute- 14-90 days chronic- greater than 90 days

Aortic dissection: clinical manifestations

*depend on location of intimal tear and extent of dissection Acute Type A: abrupt onset of excruciating anterior chest pain Acute Type B: more likely to report pain located in their back, abd, or legs *often described as "sharp" and "worst ever", or as "tearing", "ripping", or "stabbing". -may mimic that of MI *differentiated from MI pain that is more gradual in onset and has increasing intensity. -as the dissection progresses, pain may migrate and follow the path of the dissection -older pts are less likely to present w/ abrupt onset of chest or back pain and are more likely to present w/ hypotension and vague symps.

Surgical therapy

*emergency surgery for acute Type A aortic dissection -when drug therapy is ineffective or when complications of aortic dissection are present -surgery is delayed to allow edema to decrease and permit clotting of blood *mortality rate is 50% within 48 hrs of symptom onset -involves resection of aortic segment and replacement w/ synthetic graft material -in hospital mortality and neurologic complications are high -open surgical repair is recommended for pts with a chronic dissection that have a connective tissue disorder, and a descending thoracic aortic diameter greater than 5.5 cm *causes of death include aortic rupture, mesenteric ischemia, MI, sepsis, stroke, and multiorgan failure

Aortic Aneurysms Genetic link

*familial tendency is r/t a number of congenital abnormalies -bicuspid aortic valve -coarctation of the aorta's -Turner's syndrome -autosomal dominant polycystic kidney disease -specific collagen defects (Ehlers-Danlos syndrome) -premature breakdown of vascular elastic tissure (loeys-Dietz syndrome, Marfan's syndrome)

IAH treatment

*goals include control of situations that lead to IAH -open surgical compression -percutaneous drainage (combined w/ tPA infusion) -intubation, ventilation, pt positioning, gastric decompression, cautious fluid resuscitation, pain mgmt, and temp hemofiltratrion are used

Postop: Peripheral perfusion status (Pulse asessment)

*hourly at first! -pulse assessment -mark pulse locations with felt tip pen -when the ascending aorta and the aortic arch are involved, assess the carotid, radial, and temporal artery pulses -for surgery of the ascending aorta, assess the femoral, popliteal, posterior tibial, and dorsalis pedis pulses

Conservative therapy

*if no symptoms: can be treated conservatively for a period of time -pain relief, HR, and BP control -CVD risk factor modification -close surveillance with CT or MRI *the pt with an acute or chronic type B aortic dissection without complications can be treated conservatively

Aortic aneurysm surgical therapy

*if ruptured: emergent surgical intervention is required -90% mortality w/ruptured AAAs -for elective surgery, the pt needs to be well hydrated, and any electrolyte, coagulation, and hematocrit abnormalities are corrected preop

Causes of aortic aneurysm

*most common cause of descending AAAs is atherosclerosis -degenerative, congenital, mechanical (penetrating/blunt trauma), inflammatory, infectious -male gender/tobacco use are major risk -other risks include presence of coronary or peripheral artery disease, high BP, and high cholesterol

Clinical manifestations of thoracic aorta aneurysm

*often asymptomatic -most common manifestations: -deep diffuse chest pain -pain may extend to interscapular area -difficulty swallowing r/t pressure on esophagus

Intraabdominal hypertension (IAH)

*potentially lethal complication is an emergency repair -assoscited w/ abd compartment syndrome (ACS) -reduces blood flow to viscera -end organ perfusion impaired (results in multisystem organ failure)

Aortic aneurysm complications

*rupture (more common in people who smoke tobacco) *rupture into retroperitoneal space: -bleeding may be tamponaded by surrounding structures, thus preventing exsanguination & death -Severe back pain -may/may not have back/flank ecchymosis (Grey Turner's sign) *rupture into thoracic or abd cavity -massive hemorrhage -most do not survive long enough to get to hospital -pt who reaches hospital will be in hypovolemic shock w/ tachycardia, hypotension, pale clammy skin, decreased urine output, altered LOC, and abd tenderness *in this situation, simultaneous resuscitation and immediate surgical repair are necessary

Benefits to Endovascular graft procedure:

-Decreased anesthesia and operative time -limited blood loss -decreased morbidity and mortality risks -small bilateral groin incisions -more rapid resumption of physical activity -shortened length of stay in hospital -quicker recovery -higher patient satisfaction -reduction in overall costs

Diagnostic studies

-ECG to rule out MI -Chest x-ray (must show a widening of the mediastinum and pleural effusion) -3-D CT scan -MRI -transesophageal echo (TEE) *3D CT scan and TEE have become standard of care for the diagnosis of acute aortic dissection *a CT scan or MRI can provide more detailed info on the severity of the dissection and related complications (pericardial effusions, carotid dissection) *TEE is preferred in very unstable pts or those w/contraindications to CT or MRI (those w/metal implants, allergies to contrast material)

Postop

-ICU monitoring 24-48 hrs post aortic surgery pts -arterial line -CVP or PA cath -mechanical ventilation -Peripheral IV lines -Urinary cath -NG tube -ECG -pulse ox -pain meds

Postop: neurologic status

-LOC -pupil size and response to light -facial symmetry -speech -ability to move upper extremities -quality of hand grasps *when the ascending aorta is involved, neurovascular assessment of the lower extremities is important -check skin temp and color, capillary refill time, and sensation and movement of the extremeties

Aortic aneursym: interprofessional care

-a careful review of body systems is necessary to identify any co-morbidities, especially of the lungs, heart, or kidney because they may influence the pts surgical risk goal: to prevent aneurysm from rupturing -early detection/treatment once detected: studies done to determine size and location

Aortic dissection: predisposing factors

-age -aortic diseases (aortitis, coarctation, arch hypoplasia) -athersclerosis -blunt or iatrogenic trauma -tobacco use, cocaine, or methamphetamine use -cogenital heart disease (bicuspid ao

Aortic aneurysm risk factors

-age -male gender -High BP -CAD -family history -high cholesterol -lower extremity PAD -CAD -previous stroke -tobacco use (most modifiable risk factor) -obese/overweight

Aortic dissection: predisposing factors

-age, aortic disease (aortitis, coarctation, arch hypoplasia), atherosclerosis, blunt or iatrogenic trauma, tobacco use, cocaine or methamphetamine use, congenital heart disease (bicuspid aortic valve), connective tissue disorders (Marfan's or Ehlers-Danlos syndrome), family history, history of heart surgery, male gender, pregnancy, and poorly controlled hypertension *nearly half of all acute aortic dissections in pts younger than 40 occur in pts w/ Marfan's syndrome

Health promotion

-alert for opportunities to teach health promotion to pts and their caregivers -encourage pt to reduce cardiovascular risk factors -BP control, smoking cessation, increasing physical activity, and maintaining normal body weight and serum lipid levels. *these measures help ensure graft patency after surgery

endovascular graft procedure

-alt to conventional surgical repair -involves placement of sutureless aortic graft into abdominal aorta inside aneurysm *minimally invasive -done through femoral artery cutdown -constructed from dacron cylinder -surface supported w/ rings of flexible wire -delivered through sheath to predetermined point -delivered through a femoral artery catheter -deployed against vessel wall by balloon inflation -anchored to vessel by series of small hooks -blood then flows through graft, preventing expansion of aneurysm -aneurysm wall will begin to shrink over time *must meet strict eligibility criteria to be a candidate (iliofemoral vessels that will alow for safe graft insetion and vessels of sufficient length and width to support the graft)

Most common disorders of the aorta

-aneurysms -aortoiliac occlusive disease -aortic dissection

Clinical manifestions of Ascending aorta/aortic arch aneurysm

-angina (from decreased blood flow to the coronary arteries) -TIA (from decreased blood flow to the carotid arteries) -coughing and shortness of breath -hoarseness and/or dysphagia (from pressure on the laryngeal nerve) *if it presses on superior vena cava: -decreased venous return -distended neck veins -edema of face and arms

Postop: Infection

-antibiotic admin -assessment of body temp -monitoring of WBC -adequate nutrition -observe surgical incision for signs of infection *all IV, arterial, and CVP or PA cath insertion sites should be cared for by using strict aseptic technique because they are ports of entry for bacteria -meticulous perineal care for the pt with an indwelling urinary cath is essential to minimize the risk of urinary tract infection. Keep surgical incisions clean and dry.

Aortic Dissection complications

-aorta may rupture (resulting in exsanguination and death) -hemorrhage may occur in mediastinal, pleural, or abd cavities -occlusion of arterial supply to vital organs *symptoms of spinal cord ischemia: range from weakness and decreased sensation and rarely to complete lower extreme paralysis *renal ischemia can lead to renal failure -manifestations of abd (mesenteric) ischemia can occur and cause abd pain, decreased bowel sounds, altered bowel func, and bowel necrosis

Preop Teaching

-brief explanation of disease process -planned surgical procedre *preop routines -bowel prep -NPO -shower -IV antibiotics right before incision is made

Clinical manifestations con'td

-cardiovascular, neurologic, and resp signs may be present -Type A: disruption of blood flow in coronary arteries and aortic valve insufficiency *if aortic arch involved: neurologic deficiencies may be present (altered LOC, weakened or absent carotid and temporal pulses, dizziness, syncope) -pt may develop angina, MI, and a new high pitched heart murmur. In severe cases, these complications can result in left heart failure, cardiogenic shock, and death

If it extends aboce the renal arteries or if cross clamp must be applied ABOVE renal arteries:

-check for adequate renal perfusion after clamp removal and before closure of incision *risk of postop renal complications increase when repair is ABOVE renal arteries

Preop nursing management cont'd

-continuous ECG and intra arterial pressure monitoring -observation of changes in quality of peripheral pulses -frequent vital signs- sometimes 2-3 mins until target BP is maintained *if the arteries branching off the aortic arch are involved, monitor the pts LOC, cranial nerve functions, and limb movement, sensation, and strength

Postop: Cardiovascular status

-continuous ECG monitoring-risk for MI -electrolyte monitoring -arterial blood gas monitoring -O2 admin -antidysrhythmic and antihypertensive meds -pain control -resume heart meds *myocardial ischemia or infarction may occur in the periop period due to decreased myocardial O2 demands -cardiac dysrhythmias may occur due to electrolyte imbalances, hypoxemia, hypothermia, or myocardial ischemia

Post op: acue care

-decreased renal perfusion can occur from the embolization of the aortic thrombus/plaque to one or both of the renal arteries *this causes ischemia of one or both kidneys. Hypotension, dehydration, prolonged aortic clamping during surgery, or blood loss can also lead to decreased renal perfusion -renal perfusion status -urinary output: record hourly outputs (decreased UOP notify MD) may require increased IVF) -fluid intake -daily weight -CVP/PA pressure -blood urea nitrogen/creatinine

Monitor for indications of Rupture

-diaphoresis -pallor -weakness -tachycardia -hypotension -abd, back, groin, or periumbilical pain -changes in level of conciousness -pulsating abd mass

Aortic aneurysms: etiology/pathophysiology

-dilated aortic wall becomes lined w/ thrombi that can embolize -leads to acute ischemic symps in distal branches

Aortic dissection: Etiology and pathophysiology

-due to degeneration of the elastic fibers in the arterial wall -chronic hypertension hastens the process -tear in inner layer allows blood to "track" between inner and middle layer *blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect) -if the blood filled channel ruptures through the outside aortic wall, aortic dissection is often fatal *as heart contracts, each systolic pulsation increases pressure on damaged area -further increases dissection -may occlude major branches of aorta -cutting off blood supply to brain, abd organs, kidneys, spinal cord, and extremities

Ambulatory care

-encourage pt to express concerns -instruct pt to gradually to increase activities -no heavy lifting -fatigue, poor appetite, and irregular bowel habits are common -sexual dysfunction in male pts is common after aortic surgery (urology consult) -teach about signs and symptoms of complications: -infection -neurovascular changes

Potential complications of endovascular graft procedure

-endoleak (seepage of blood back into the old aneurysm) -aneurysm growth -aneurysm rupture -aortic dissection -bleeding -stent migration -renal artery occlusion (stent migration) -graft thrombosis -incisional site hematoma -site infection *may be due to an inadequate seal at either graft end, a tear through the graft fabrick, or leakage between the overlapping graft segments, and may require coil embolization (insertion of beads) for hemostasis *graft dysfunction may require traditional surgical repair -need for long term follow up to monitor for an andoleak, document stability of the aneurysm sac, and determine the need for surgical repair

open aneurysm repair (OAR)

-inserting synthetic graft (dacron or polytetrafluoroethylene (PTFE) -suturing native aortic wall around graft:acts as protective cover *if the iliac arteries are also aneursymal, a bifurcated graft replaces the entired diseased segment -with saccular aneurysms, it may be possible to excise only the bylbous lesion, repairing the artery by primary closure (suturing the artery together)or by application of an autogenous or synthetic patch graft

Clinical manifestations of AAA Cont'd

-may mimic pain associated w/ abd or back disorders -may cause back pain, epigastric discomfort, flank pain -gnawing constant feeling in abd -altered bowel elimination, intermitten claudication *may spontaneously embolize plaque causing "blue toe syndrome" (patchy mottling of the feet and toes in the presence of palpable pedal pulses) -compression of nearby anatomic structures and nerves may cause back pain, epigastric discomfort, alt bowel elimination, intermitten claudication

false aneurysm

-may result from trauma or infection, or may occur after peripheral artery bypass graft surgery at the site of the graft-to-artery anastomosis -may result from arterial leakage after removal of cannulae (lower extremity arterial caths, IABP devices)

Postop: maintain graft patency

-normal BP *prolonged low BP may result in graft thrombosis -IV fluids and blood components -CVP or PA pressure monitoring -urinary output monitoring *decreased urine output suggests perfusion and monitoring of renal func is needed -avoid severe hypertension (drug therapy may be indicated-IV diuretics or IV antihypertensive agents)

Overall goals

-normal tissue perfusion -intact motor and sensory function -no complications r/t surgical repair such as thrombosis, infection, rupture

Clinical manifestations of abdominal aortic aneurysms (AAA)

-often asymptomatic *frequently detected by: -routine physical exam (a pulsatile mass in the periumbilical area slightly to the left of the midline may be present. *DO NOT PALPATE! May cause rupture -bruit over aneurysm -when pt examined for unrelated problems (CT scan, abd x-ray) *physical findings may be more difficult to detect in obese individuals

Surgical techniques

-open aneurysm repair (OAR) -incising diseased segment of aorta -removing intraluminal thrombus or plaque

Aortic aneurysyms

-outpouching or dilation of arterial wall -occur in men more oftehn than in women and in whites more than african americans -incidence increases w/age -aneurysyms may occur in more than one location -peripheral artery aneurysms can also develop but are not common

Expected outcomes

-pt arterial graft with adequate distal perfusion -adequate urine output -no signs of infection

Post op: GI status

-record amount and character of NG tube output -abd assessment -passing of flatus= return of bowel func (the intestines may become swollen and bruised, and peristalsis ceases for variable intervals) -assess for signs of bowel ischemia or infarction (report immediately). Include absent bowel sounds, fever, abd distention, diarrhea, and bloody (maroon colored) stools, pt may need an emergency bowel resection -after open abd aortic surgery, paralytic ileus may develop as a result of anesthesia and handling of the bowel during surgery

Preop nursing management

-semi fowler's position -maintain a quiet environment -anxiety and pain management (opioids and tranquilizers as ordered) -continuous IV admin of antihypertensive agents *these measures help to keep the HR and systolic BP at the lowest possible level that maintains vital organ perfusion (typically HR less than 60, Systolic between 110-120 mm Hg) -to prevent the extension of the dissection, manage pain and anxiety because they can cause elevations in the HR and systolic BP

Complications: Cardiac Tamponade

-severe, life threatening complication *occurs when blood escapes from dissection into pericardial sac CLINICAL MANIFESTATIONS: -hypotension -narrowed pulse pressure -distended neck veins -muffled heart sounds -pulsus paradoxus

5.5 cm is threshold for repair!

-surgival intervention may occur sooner if: -the pt has a genetic disorder (Marfan's, Ehlers-Danlos syndrome) -the aneursym expands rapidly -if it becomes symptomatic -if risk of rupture is high *correction of existing carotid and/or coronary artery blockages may be needed before the aneurysm is repaired

Post op: peripheral perfusion status (extemity assessment)

-temp, color, capillary refill time, sensation, and movement of extremeties -may need to use a doppler to assess -occasionally, lower extremity pulses may be absent for a short time after surgery as the result of vasospasm and hypothermia *a decreased or absent pulse together with a cool, pale, mottled, or painful extremity may include embolization or graft occlusion. Report these findings immediately

Assessment

-throrough history and physical exam -watch for signs of cardiac, pul, cerebral, and lower extremity vascular problems -establish baseline date to compare postop -note quality and character of peripheral pulses and neurologic status -document pedal pulse sites and any skin lesions on lower extremities before surgery

Aortic Aneurysms classification

2 basic classifications: true and false

Small Aneurysm treatment

4-5.4 cm -conservative therapy consists of risk factor modification: tobacco cessation, decreasing BP, optimizing lipid profile, and annual monitoring or aneurysm size using ultrasound, CT, or MRI (every 6-12 months) -growth rates may be lowered w/ B-adrenergic blocking agents, ACE inhibitors, and angiotensin II receptor blockers, statins, antibiotics *monitor by ultrasound every 2-3 years for pts with AAAs smaller than 4.0 cm in diameter

Abdominal Aortic Aneurysm (AAA)

A condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge. -may involve the aortic arch & thoracic and/or abdominal aorta -3/4 occur in abd aorta -1/4 occur in thoracic aorta -most occur BELOW renal arteries -the larger the aneurysm, the greater risk of rupture

A patient has a 6-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining an admission history from the patient, it will be most important for the nurse to ask about a. low back pain. b. trouble swallowing. c. abdominal tenderness. d. changes in bowel habits.

ANS: B Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms.

Question: In which of the following areas is an abdominal aortic aneurysms most commonly located? A. distal to the iliac arteries B. Distal to the renal arteries C. Adjacent to the aortic branch D. Proximal to the renal arteries

B. distal to the renal arteries

Which nursing action should be included in the plan of care after endovascular graft repair of an AAA? A. record hourly chest tube drainage B. monitor strict I&Os C. check the abd incision for redness D. auscultate heart sounds Q2 hrs

B. monitor strict I&Os (renal artery occlusion can occur)

Question: A pt has a 6-cm thoracic aortic aneurysm that was discovered during routine chest x-ray. When obtaining an admission history from the pt, it will be most important for the nurse to talk about A. low back pain B. trouble swallowing C. abd tenderness D. changes in bowel habits

B. trouble swallowing

Question: A nurse is caring for a pt with a descending aortic dissection. Which assessment finding is most important to report to the HCP? A. weak pedal pulses B. absent bowel sounds C. Blood pressure of 138/88 mm Hg D. 25 mL of urine output over the past hour

C. Blood pressure of 138/88 (to prevent extension of the dissection, manage pain and anxiety because they can cause elevations in HR and systolic BP)

Question: Following an aortic aneurysm repair, the pt suddenly develops severe pain in the right lower extremity. The right pedal pulse is decreased and the right foot is cool and pale. Which complication should the nurse suspect? A. Hypothermia B. Wound Infection C. Bleeding from the graft site D. Embolization or graft occlusion

D. Embolization or graft occlusion

Question: Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an AAA? A. abd pain B. absent pedal pulses C. chest pain D. lower back pain

D. lower back pain

Question: Your pt has a 5cm abdominal aortic aneurysm. The nurse needs to focus teaching on risk factor for which risk factor? A. male gender B. Turney syndrome C. Abdominal trauma history D. Uncontrolled hypertension

D. uncontrolled hypertension

Drug therapy

IV B-adrenergic blocker (titrated to target HR of 60 bpm or less or to a systolic BP between 100-110 mm HG) -Esmolol Other antihypertensive agents: -calcium channel blockers can be used to lower HR if a B-adrenergic blocker is contraindicated -Nitroprusside -Angiotensin-converting enzyme inhibitors (enalaprilat) *Morphine- preferred analgesic as it decreases sympathetic nervous system stimulation as well as relieving pain

Interprofessional Care

Initial goal: HR and BP control- first action should be to determine the hemodynamic status by assessing BP -decreased BP and myocardial contractility to diminish pulsatile forces within aorta *pain management

Discharge teaching

Post op care is the same as aneurysm post op care therapeutic regimen -antihypertensive drugs and side effects (pts must understand that antihypertensive drugs must be taken daily for the rest of their lives) -B-adrenergic blockers are used to control BP and decrease myocardial contractility *if pain returns or symptoms progress, instruct pt to seek immediate help -most common cause of death in long-term survivors is aortic rupture from re-dissection or aneurysm formation

True aneurysm (saccular)

Pouchlike with narrow neck connecting bulge to one side of arterial wall

What is the aorta?

The largest artery in the body -supplies oxygenated blood to vital organs

An 80-year-old patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED) with severe back pain and absent pedal pulses. Which actions should the nurse take first? a. Obtain the blood pressure. b. Obtain blood for laboratory testing. c. Assess for the presence of an abdominal bruit. d. Determine any family history of kidney disease.

a. Obtain the blood pressure.

When discussing risk factor modification for a 63-year-old patient who has a 5-cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor? a. Male gender b. Turner syndrome c. Abdominal trauma history d. Uncontrolled hypertension

d. Uncontrolled hypertension

When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important for the nurse to communicate to the health care provider? a. Presence of flatus b. Loose, bloody stools c. Hypoactive bowel sounds d. Abdominal pain with palpation

b. Loose, bloody stools

Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? a. Record hourly chest tube drainage. b. Monitor fluid intake and urine output. c. Check the abdominal incision for any redness. d. Teach the reason for a prolonged recovery period.

b. Monitor fluid intake and urine output.

Grey Turner's sign

bruising in flank area (lower back area)

True aneurysm (fusiform)

circumferential, relatively uniform in shape

Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Monitor the quality and presence of the pedal pulses. b. Teach the patient the signs of possible wound infection. c. Check the lower extremities for strength and movement. d. Help the patient to use a pillow to splint while coughing.

d. Help the patient to use a pillow to splint while coughing.

Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 40 mL. The nurse notifies the health care provider and anticipates an order for a(n) a. hemoglobin count. b. additional antibiotic. c. decrease in IV infusion rate. d. blood urea nitrogen (BUN) level.

d. blood urea nitrogen (BUN) level.

Aortic Dissection

often misnamed "dissecting aneurysm" -not a type of aneurysm -results of a false lumen through which blood flows *results from the creation of a false lumen between the intima (inner lining) and the media (middle layer) of the arterial wall *classifised based on the location of the dissection and duration of onset *Type A dissection: affects the ascending aorta and arch *Type B dissection: begins in the descending aorta *dissections are also classified as acute (first 14 days), subacute (14-90 days), or chronic (greater than 90 days) based on symptom onset