ABDOMINAL AORTIC ANEURYSM RESECTION

ABDOMINAL AORTIC ANEURYSM RESECTION:

Excision of the aneurysm and the placement of a synthetic graft (elective or emergency)

ELECTIVE SURGERY FOR AAA:

manage AAA of 5.5 cm diameter or greater (2% - 5% mortality rate).

EMERGENCY SURGERY:

rupturing aneurysm

SURGERY RISKS:

significant blood loss and the consequences of reduced cardiac output and tissue ischemia (MI, AKI, respiratory distress, and paralytic ileus).

NURSING INTERVENTIONS:

● Priority interventions: monitoring the arterial pressure, heart rhythm, and hemodynamic findings, as well as monitoring for evidence of graft occlusion or rupture postoperatively. ● Monitor VS and circulation (pulses distal to graft) q15 min. ● HOB below 45° to prevent flexion of the graft. ● Report evidence of graft occlusion or rupture immediately (changes in pulses, coolness of extremity below graft, white or blue extremities or flanks, severe pain, abdominal distention, decreased urine output). ● Monitor and maintain BP within the prescribed parameters. ** Prolonged hypotension can cause thrombi to form within the graft ** Severe hypertension can cause leakage or rupture at the arterial anastomosis suture line. ● Maintain a warm environment to prevent temperature-induced vasoconstriction. ● Administer IV fluids at prescribed rates to ensure adequate hydration and kidney perfusion. ● Monitor for altered kidney perfusion and acute kidney injury caused by clamping aorta during surgery (urine output < 30 mL/hr, weight gain, elevated BUN or blood creatinine). ● Auscultate lung sounds. Encourage coughing and deep breathing q2hr. -- Encourage splinting c̅ coughing. ● Assess onset, quality, duration, and severity of pain. --Administer pain medication as prescribed. ● Monitor bowel sounds, and observe for abdominal distention. -- Maintain NG suction as prescribed. ● Prevent thromboembolism. --SCDs, early ambulation. ● Monitor for infection. ● Administer antibiotics as prescribed to maintain adequate blood levels of the medication.