Abdominal Aortic Aneurysm

clinical manifestations; AAA

- 75% asymptomatic - Any type abdominal, flank or back pain - Early satiety, N and V - Decreased distal perfusion - if pressure against superior vena cava, edema of the hands may be present - pressure against the esophagus or trachael nerve causes stridor, hoarseness, and dysphagia - Turner's sign - *widening pulse pressure* - diagnosed via x-ray

Endovascular surgical technique

- Insertion of a stent-graft ( a polyester tube within a metal cylinder), causing the aneurysm to shrink over time with a 90% success rate - less recovery time of the two

Classification; aneurysm

- Shape - Location along aorta - The process that leads to the formation

diagnosis; AAA

- a viewable mass halfway between the xyphoid process and umbilicus - bruit may be heard over the abdominal aorta, femoral, renal, or poplietal arteries - weak or absent pulses - cool skin - sluggish capillary refill - decreased HCT and Hgb with increased WBC - increased BUN and creatanine - proteinuria and hemouria due to compromised kidneys - increased chest diameter with trachieal deviation

nursing care; AAA

- cardiac and/or hemodynamic monitoring - monitor for hemorrhage from surgical site - maintain a pressure dressing to prevent hematomas - graft viable? check for bruit - peripheral pulses; color, motion, sensation & capillary refill - BP; edema and avoid HTN to avoid graft destruction - pain control - assess CBC, ABGs, chemistries, and I&O - allay anxiety- client and family

clinical manifestations; dissection

- life threatening emergency - can occur anywhere along aorta - type A dissection (proximal) - type B dissection (distal) - severe and instantaneous chest pain radiating to the back, neck, jaw, or abdomen with associated absence of central pulses - "ripping" or "tearing" sensation

clinical manifestations; thoracic aneurysm

- sudden, tearing chest pain radiating to the shoulders, neck, and back

clinical manifestations; dissection

- syncope - paralysis - numbness - aphasia - arm pain - weakness - dyspnea

Open medium sternotomy

- traditional method - Insertion of Dacron graft to replace aneurysm

pathophysiology; AAA

1. atherosclerotic plaques are deposited into the inner most layer (intima) of the arteries wall 2. degenerative changes 3. decreased elasticity

true

a dissection aneurysm is a type of aneurysm, not a rupture

aorta

aneurysms develop in different shapes and locations along this

treatment; AAA

goal of this is to prevent rupture of aneurysm • Elective surgery > 5cm • If < 4cm, watch and wait with ultrasounds q6-12months • Beta blockers • 20% chance it will rupture in the first year if >6 cm • many ruptures die before they reach the hospital • antihypertensives

Morphin syndrome

individuals with this are more prone to AAAs. It is a disorder affecting the vessels and tissues - very tall in stature - very long arms - abnormal breast bone - eye problems

true

most aortic aneurysms are small, slow in growth and rarely rupture - the larger, the higher risk for rupture

abdominal aortic aneurysms

these are the most common type of aneurysms - they form in the abdominal area of the aorta - 90% develop below the level of renal arteries - once formed, it will increase in size at an unpredictable growth rate until treated by surgery - may extend to proxmial end of illiac artery- causing thrombosis formation

saccular

these types of aneurysms are shaped like a small outpouching - shaped like a small blister on a portion of the vessel wall - AKA false aneurysms; they are caused by a traumatic break in the vessel wall, instead of a weakening of the vessel wall

fusiform

these types of aneurysms are spindle shaped, and taper at both ends - true aneurysm; actual weakening of the vessel wall - involves circumferential aorta

complications; surgery

this includes; - blood leaking from the graph - infection

clinical manifestations; rupture

this is a common complication of AAA; the larger the aneurysm the greater the risk of this happening • Life threatening internal bleeding • Sudden, intense and persistent abdominal, chest or back pain • Sweatiness, Clamminess, Dizziness • Hypotension • Tachycardia • Loss of consciousness • Shortness of breath

aneurysm

this is a weakened and bulging area along the aorta and develop when there is a weak spot along the aortic wall - this is described as a permanent outpouching or dilatation of the arterial wall

circumferential

this means that the aneurysm covers the entire diameter of the aorta

dissecting aneurysms

this occurs when a tear in the inner lining of the aorta extends into the middle zone of connective tissue, causing blood to flow into the layers of the vessel wall - less common

Turner's sign

this refers to ecchomyosis of the back or flank

type A (proximal)

this type of dissection affects the ascending aorta

type B (distal)

this type of dissection affects the descending aorta

incidence; aortic aneurysm

• 5-8% population • 10th major cause of death in men over 60 • Men > women - seen after 60 • Strong familial tendency • 75% all aneurysms are in abdomen • 10% of aneurysms are thoracic

diagnostic studies; AAA

• Abdominal Assessment • CBC, BUN, Creatinine • Chest X-ray, Flat Plate Abdomen • CAT Scan, MRI (measurement) • Abdominal Ultrasound • Transesophageal Echocardiography (location) • Angiography (size, location)

nursing diagnosis; AAA

• Increased risk for infection r/t invasive monitoring, incision and insertion tubes • Alteration in comfort r/t incision • Alteration in tissue perfusion r/t compromised peripheral circulation • Anxiety • Risk for hypovolemic shock r/t compromised hemodynamics

nursing diagnosis; surgical repair of AAA

• Increased risk for infection r/t invasive monitoring, incision and insertion tubes • Alteration in comfort r/t incision • Alteration in tissue perfusion r/t compromised peripheral circulation • Anxiety r/t urgent nature of the disorder • Risk for hypovolemic shock r/t compromised hemodynamics

risk factors; AAA

• Smoking • Hypertension • Vascular disease (Atherosclerosis) • Trauma • Infection • Congenital Disease (Morphin syndrome)

teaching; AAA

• Smoking cessation - refer to sources for help • Reduction other cardiac risks • Daily ASA • Exercise program (rehab) • Control BP