aneurysm

A nurse is preparing a client for a transesophageal echocardiography to visualize a thoracic aneurysm. The client asks the nurse to describe the procedure. What is the best response by the​ nurse

"An instrument is inserted into your esophagus so the health care provider can see the​ aneurysm." During transesophageal​ echocardiography, the health care provider inserts an instrument into the esophagus in order to visualize the aneurysm.​ Typically, the client is NPO before the procedure. The client is usually sedated before the instrument is inserted. Transesophageal echocardiography involves the health care provider inserting an instrument down the​ client's esophagus for​ visualization; it is not a type of ultrasonography. The health care provider will inject dye into the artery during​ angiography, not during transesophageal echocardiography. The statement mentioning contrast and an MRI describes a​ contrast-enhanced MRI, not transesophageal echocardiography.

You are preparing to discharge Mr.​ Harrison, who is recovering from a repair of an abdominal aortic aneurysm. You have performed discharge teaching knowing he is returning to his home with his wife. Which statement of Mr. Harrison would indicate to you that further discharge teaching is​ indicated?

"Now that this surgery is behind​ me, I can begin putting a roof on our​ deck." The client should not engage in performing heavy carpentry for a minimum of several weeks after surgical repair of an abdominal aneurysm. It is important that the client looks for signs of bleeding while taking an oral anticoagulant such as warfarin​ (Coumadin). It is important to avoid sitting for prolonged periods and to change positions frequently to reduce the risk of thrombus formation. Smoking cessation is important to reduce the ongoing risk of aneurysm development.

A nurse on the​ medical-surgical unit is providing care for a client newly diagnosed with a femoral aneurysm. The client asks the nurse about risk factors for femoral aneurysms. What is the best response by the​ nurse?

"One of the major risk factors for femoral aneurysms is​ arteriosclerosis." Arteriosclerosis is characterized by loss of elasticity in the vessel walls. Loss of elasticity​ (also called​ elastin) is a primary factor in aneurysm development. The vessels are unable to return to the original shape after blood passes through the vessel with each heartbeat. This causes the affected area to widen and form an aneurysm. The primary risk factors for femoral aneurysm are arteriosclerosis and male gender. Smoking is closely related to aortic aneurysms.​ However, smoking is not a known cause of femoral aneurysms. High cholesterol is not directly associated with femoral aneurysms. Arteriosclerosis is a cause of femoral aneurysms. High cholesterol is a factor in arteriosclerosis

You are caring for Mr. Cooper who is being recovered in the postanesthesia care unit status after graft repair for an aortic abdominal aneurysm. Upon your physical assessment of Mr. Cooper and review of his laboratory​ studies, you suspect graft leakage. Which of the following assessments leads you to this​ conclusion?

An increase in abdominal girth An increase in abdominal girth is consistent with graft​ leakage, which may occur as the blood pools in the abdomen. Although diminished pedal pulses may also indicate a decrease in perfusion of the lower​ extremities, there are many other causes for this finding. A fixed specific gravity indicates that the kidneys are no longer able to respond to changes in the​ body's fluid volume. An increase in BUN and serum creatinine indicates probable renal failure.

A nurse is providing care for a client who had an abdominal aortic aneurysm repair the day before. When assessing the​ client, the nurse notes the​ client's abdomen is considerably larger than earlier in the shift. Based on this​ finding, the nurse would perform what other​ assessments?

Assess the​ client's lower abdomen for bruising. Bruising in the lower​ abdomen, especially on the​ sides, indicates that the​ client's graft is leaking blood into the abdomen. This is a significant finding that must be reported to the health care provider. Clients who had an abdominal surgery less than 3 days ago typically do not have normal bowel sounds. This assessment will not yield information pertinent to the​ client's enlarged abdomen. Nausea and vomiting are common assessment findings in clients who have just had abdominal surgery. An increased central venous pressure indicates that the client is overhydrated. The increasing size of the​ client's abdomen suggests that the graft is leaking blood into the abdomen. This would cause the client to become hypovolemic. Hypovolemia causes the central venous pressure to​ decrease, not increase.

In performing a physical assessment of a client with an​ aneurysm, which assessments would you​ include?

Assessment of sensation and movement of the extremities Palpation of the abdomen for the presence of masses Measurement of blood pressure in the upper and lower extremities Palpation of peripheral pulses

A client is admitted to the​ medical-surgical unit with a diagnosis of popliteal aneurysm. What manifestations would the nurse expect to find when assessing this​ client?

Client report of numbness in the affected foot and leg Client report of cramping pain with exercise Cramping pain with exercise is a common finding in a client with popliteal aneurysm. This client will experience decreased blood flow to the lower leg and foot because of impaired blood flow. The tissues in the lower leg need additional blood flow during exercise. When the blood flow is not​ available, the client experiences pain that is relieved with rest. A mass such as an aneurysm can cause pressure on a​ nerve, which will cause numbness in the affected foot and leg. A pulsating mass in the groin area is characteristic of a femoral aneurysm. A popliteal aneurysm causes a pulsating mass behind the knee in the popliteal space. A popliteal aneurysm can cause emboli that cause diminished circulation to the degree that a nonhealing ulcer develops. The blood stagnates in the aneurysm and forms clots. This is not an expected finding. This is a complication of the popliteal aneurysm. Swelling in the affected leg is characteristic of deep venous thrombosis. The swelling occurs because of poor blood return caused by an obstructed vein.

Which of the following treatment goals are appropriate for a client with an aneurysm that will be monitored and not surgically repaired at this​ time?

Control hypertension Stop smoking

A nurse is assessing a client with a thoracic aortic aneurysm. What manifestations would the nurse observe if the client developed thoracic aortic​ dissection?

Dyspnea Syncope Sudden, severe, tearing pain A client with aortic dissection will develop sudden intense pain that is often described as a tearing pain. The pain is located in the vicinity of the tear in the aorta. The client will develop syncope because of blood loss. Aortic dissection causes significant blood loss over a short period of time. The client will develop dyspnea if the aneurysm is pressing on the​ client's trachea. This pressure will affect air moving through the trachea into the lungs. The client with aortic dissection will develop dyspnea as the body attempts to maintain homeostasis. Respiratory rate will increase in an effort to bring in more oxygen. The​ client's pedal pulses will become faint and difficult to palpate because of loss of blood volume. Intermittent claudication is cramping pain in the legs with exercise caused by impaired blood flow. The client with aortic dissection is in an emergency situation. This client would not experience intermittent claudication.

A client with a diagnosis of true aortic aneurysm asks the nurse about the cause of the aneurysm. What is the most accurate response by the​ nurse?

High blood pressure and plaque weaken the walls of the artery and cause the vessel to​ bulge." The medial layer of the artery weakens with stretching from hypertension. The arterial wall contains elastin that stretches. Hypertension causes excess wear on the elastin and causes it to break down. When the elastin breaks​ down, the artery​ dilates, causing an aneurysm. Atherosclerosis causes the artery wall to weaken and finally bulge. Berry aneurysms are a form of pseudoaneurysm caused by a congenital weakness in the wall of an artery. A tear in the wall of the artery is called dissecting aneurysm. The tear allows blood to leak out between the layers of the artery.

A client who had an abdominal aneurysm repair 4 days ago is scheduled for discharge in 2 days. What would the nurse include in discharge teaching for this​ client?

Increase your fiber and fluid intake to help with constipation and straining during bowel​ movements." ​The nurse would instruct the client to increase fiber and fluid intake to minimize constipation. If the client strains to have a bowel​ movement, intrathoracic pressure will increase. This will increase the risk of the aneurysm​ graft's leaking. Antihypertensives are used to maintain a normal blood pressure. Hypertension is a risk factor for aneurysm. This client has had an aneurysm and could potentially develop another aneurysm. The client will need to maintain normal blood pressure to avoid another aneurysm in addition to other potential complications of hypertension. The client needs to be cleared by the health care provider before resuming sexual intercourse. The client will usually be cleared to have sexual intercourse in 6 to 12 weeks. The client must be instructed to not sit for prolonged periods of time. Sitting with the legs down increases the risk of deep venous thrombosis.

A nurse is preparing a client for​ contrast-enhanced MRI to visualize and measure an aneurysm. What interventions would the nurse use when preparing this client for the​ MRI?

Instruct the client that an MRI is used to obtain measurements of an aneurysm. A​ contrast-enhanced MRI is used to obtain accurate dimensions and the location of an aneurysm. All transdermal patches must be removed before MRI is performed. The nurse must notify the health care provider to be certain the health care provider is aware that the client has a pacemaker. A notation in the client records does not guarantee that the health care provider will see the notation. The client would be sedated for an MRI if the client is claustrophobic. The nurse would not sedate the client unless there are circumstances warranting sedation.

Which medication would likely be prescribed to treat a client with an aortic​ dissection?

Metoprolol​ (Lopressor) It is important to treat a thoracic aortic aneurysm with​ beta-blocker therapy and antihypertensive medications to control the heart rate and blood pressure. Diazoxide​ (Hyperstat) and hydralazine​ (Apresoline) would be avoided because using these medications may worsen the dissection. Anticoagulation therapy will be prescribed after a surgical repair of an aneurysm to prevent thrombus and emboli formation.​ Initially, injectable anticoagulation will be initiated with conversion to an oral​ anticoagulant, such as​ low-dose aspirin.

In caring for a client with an​ aneurysm, which interventions would address the​ client's increased risk for ineffective tissue​ perfusion?

Monitoring the​ client's diet to enhance fiber intake Monitoring the​ client's fiber intake prevents straining during​ defecation, which would increase​ intra-abdominal pressure. The​ client's legs should be flat and not elevated while the client is in bed. Elevation of legs would increase​ intra-abdominal pressure. Increasing​ intra-abdominal pressure may lead to aneurysm rupture. The resulting hemorrhage would not effectively perfuse the tissues. Anticoagulant therapy is only prescribed after a surgical repair of an aneurysm. Holding​ one's breath during movement increases​ intra-abdominal pressure, which increases the risk of aneurysm rupture.

Mr. Gleason is a​ 72-year-old man who is seeking treatment for pain in his lower legs when at rest. He has been treated for hypertension with a vasodilator and diuretic for the past 10​ years, maintaining a blood pressure between​ 112/60 and​ 128/76 mmHg. He leads an active life and lives independently in his apartment. Which additional assessment would you seek that would support a diagnosis of a popliteal​ aneurysm?

Numbness of the lower extremity The priority assessments for a popliteal aneurysm include intermittent​ claudication, pain at​ rest, numbness of a lower​ extremity, and a pulsating mass behind the knee. Lumbar pain is not a presenting factor but may occur with an abdominal aortic aneurysm. Absence of pedal pulses and a foot that is cool to touch may be indicative of an obstruction in circulation to the lower extremity.

A nurse is providing care for a client with a large abdominal aortic aneurysm. The client is on bed rest with the legs flat. The client reports feeling anxious and afraid of dying. What is the initial intervention the nurse would use in the care of this​ client?

Offer to stay at the bedside with the client. Offering oneself is a powerful intervention when a client is anxious and afraid. This intervention demonstrates caring and allows the client to verbalize his or her fears to the nurse. The nurse is present in the room if the client does experience a condition change. A sedative will reduce the​ client's anxiety, but it will not alleviate the​ client's fears. In​ addition, the sedative could mask symptoms such as changes in level of consciousness. Calling a family member is a good strategy.​ However, the client is anxious at the present and needs support. The nurse could call the family members from the​ client's room, but this would not be the initial intervention. A quiet environment will help calm the client but will not alleviate the​ client's fears.

A nurse is participating in a health screening fair at a senior citizens center. What group would the nurse identify as potentially needing priority ultrasound screening for abdominal aortic​ aneurysm?

Older men with a history of smoking Male gender is a risk factor for abdominal aortic aneurysm. Men who have smoked more than 100​ cigarettes, even in the distant​ past, are at highest risk for abdominal aortic aneurysm. This group is priority for ultrasound screening. Hypertension is a risk factor for abdominal aortic aneurysm.​ However, female gender is not a risk factor. Male gender and high cholesterol are both risk factors for abdominal aortic aneurysm.​ However, this group is not the priority referral for ultrasound screening because even though high cholesterol contributes to aneurysm​ formation, it is not directly related. Female gender is not a risk factor for aneurysm. History of diabetes mellitus does not increase the risk for abdominal aortic aneurysm

Postoperative care of a client for repair of an aneurysm would include which of the following​ assessments?

Palpation of bilateral pedal pulses Measurement of urine output Determination of level of consciousness Observation for abdominal distention

Which is the most common complication of an endovascular aneurysm​ repair?

Persistent aneurysm perfusion The most common complication of endovascular aneurysm repair is persistent perfusion of the aneurysm caused by an ineffective seal at the proximal or distal end of the graft. The stent is placed percutaneously via the femoral​ artery, and the inferior vena cava is not entered. Anticoagulation therapy is started to prevent the development of thrombus and emboli formation. Paraplegia is not a complication of the procedure.

A nurse is providing care for a client with a large thoracic aneurysm. The​ client's urine output has decreased rapidly to less than 20​ mL/hr. The client reports flank pain. The nurse is concerned the client is experiencing what complication of thoracic​ aneurysm?

Renal ischemia from embolus A thrombus can form in a thoracic aneurysm. The thrombus can break​ off, causing an embolus that obstructs blood flow into the kidneys. A thoracic aneurysm is situated above the renal arteries. This allows the embolus to migrate to the renal arteries and cause renal ischemia. The thoracic aneurysm is in the chest and abdomen. It is not situated in a position to affect the bladder. The aneurysm is located in the chest and extending downward. The ureters are located in the pelvis. The aneurysm is not situated in a position to press on the ureters. The aneurysm is located well above the renal arteries and cannot cause pressure on the renal arteries

A nurse on the​ medical-surgical unit is assessing a client. The client has a pulsating mass in the abdomen. When the nurse auscultates the​ mass, the nurse hears a swishing sound. There is no history on the​ client's chart of a mass in the abdomen. Based on this assessment​ data, the nurse would use what priority nursing diagnosis when planning care for this​ client?

Risk for ineffective tissue perfusion The client has the manifestations of an abdominal aortic aneurysm. This client is at risk for rupture or poor perfusion in the area below the aneurysm. The nurse would provide care aimed at promoting effective perfusion. The client is at risk for aneurysm rupture if the client strains when having a bowel movement. Interventions used to treat constipation are also used to protect tissue perfusion.​ Therefore, risk for constipation is a lower priority. The client would be positioned on bed rest with the legs flat. Mobility at this point in the​ client's care is not a priority. After the aneurysm is​ treated, either with medications or a surgical​ procedure, the client will resume activities. The client will be anxious because of the​ nurse's assessment finding. The nurse would approach the client in a calm manner and answer the​ client's questions. While dealing with the​ client's anxiety is​ important, it is not the most urgent issue. The nurse would use interventions to protect tissue perfusion before proceeding with other interventions.

Which is the most likely presentation of a femoral​ aneurysm?

Severe, tearing pain in the femoral area Pulsating femoral mass A pulsating femoral mass is the most likely symptom seen with a femoral aneurysm.​ Abrupt, severe, tearing pain is an indication that the aneurysm may have dissected. This is especially true if it is preceded with hypertension followed by weak or absent pulses and blood pressures in the upper extremities. Midabdominal or lumbar back pain and circulatory impairment of the lower extremities may be seen with an abdominal aortic aneurysm.

A nurse on the​ medical-surgical unit is providing care for a client thoracic aortic aneurysm. The nurse is assessing the client for signs of pressure on the trachea. What assessment finding would suggest that the thoracic aneurysm is pressing on the​ trachea?

The client has a​ harsh, high-pitched sound on inspiration. Clients with pressure on the trachea will develop stridor. Stridor causes a​ harsh, high-pitched sound as the lungs attempt to move air through a narrow space. Hoarseness can be caused by a variety of disorders. In this​ client's case, hoarseness could be caused by pressure on the laryngeal nerve.​ However, this is not an indication of pressure on the trachea. Edema in the face and neck suggests that the aneurysm is pressing on the veins in the​ client's upper body. This pressure prevents blood return to the heart. Substernal pain indicates the thoracic aneurysm is causing pressure within the chest. This does not indicate that there is pressure on the trachea.

The nurse is providing care for a client with a circumferential aortic aneurysm. The client asks the nurse if this type of aneurysm is serious. What is the best response by the​ nurse?

This type of aneurysm involves a weak area in the aorta and typically enlarges​ slowly, so you will not need treatment for a long​ time." The circumferential aneurysm involves all three layers of the artery. It enlarges slowly but steadily. This type of aneurysm is caused by weakening in the artery wall. A saccular aneurysm resembles small pouches on the side of the artery wall. This type of aneurysm is usually found in the circle of Willis. A dissecting aneurysm leaks blood between the layers of the artery. False​ (also called​ traumatic) aneurysms are caused by trauma to the artery wall rather than a progressive weakening.

Stroke is a possible complication of which type of​ aneurysm?

Thoracic Stroke is a possible complication of a thoracic aneurysm. Stroke is not associated with an aortic dissecting​ aneurysm, an abdominal​ aneurysm, or a popliteal aneurysm

If a client presents with​ stridor, dysphagia with esophageal​ pressure, and facial​ edema, which type of aneurysm might the client be​ experiencing?

Thoracic aortic A thoracic aortic aneurysm may present with​ back, substernal or neck pain and edema of the face and neck. It may also present with​ dyspnea, stridor, hoarseness or brassy​ cough, and dysphagia if the aneurysm presses on the trachea or esophagus. Abdominal aortic aneurysms present with a pulsating abdominal​ mass, midabdominal or back​ pain, and signs of hypoxia to the lower extremities. A popliteal or femoral aneurysm may present with a pulsating mass at the site. A popliteal aneurysm may also include symptoms of numbness or pain at rest.

A nurse in the intensive care unit is providing care for a client eight hours postoperative from abdominal aneurysm repair. What assessment finding would the nurse urgently call to the health care​ provider?

Urinary output of 20 mL for the past hour This output is too low. The minimal output is 30​ mL/hr. The client is most likely either losing blood or is not receiving sufficient intravenous fluids. In either​ case, the nurse must notify the health care provider for further orders. The normal creatinine is 0.5 to 1.5​ mg/dL. A creatinine level of 1.3​ mg/dL is within normal limits. A hematocrit of​ 47% is within normal limits for a man and slightly elevated for a woman. The hematocrit level is not sufficiently elevated to call to the health care provider. The normal BUN is 5 to 25​ mg/dL. A level of 28​ mg/dL is slightly elevated but is not the priority assessment finding. This level would not require an urgent call to the health care provider.

A nurse is preparing client teaching for a client who had an abdominal aortic aneurysm repair 6 days ago. The client is being discharged on warfarin​ (Coumadin). What would the nurse plan to include in this​ teaching?

Wash hands thoroughly before touching the incision. Notify the health care provider if any bleeding occurs. Notify the health care provider if activity tolerance decreases. Coumadin can cause bleeding even if the prothrombin time​ (PT) and International Normalized Ratio​ (INR) are within normal limits. The client would notify the health care provider for instructions concerning laboratory work and medication changes. The nurse would instruct the client in hand hygiene as part of infection control. Decreasing activity tolerance can indicate numerous​ problems, all of which need to be addressed by the health care provider. The client would notify the health care provider for instructions. The client would continue eating leafy green vegetables if this has been the practice. If the client suddenly starts eating more leafy green​ vegetables, the​ client's PT will decrease. This might require a higher dose of Coumadin. If the client suddenly stopped eating leafy green​ vegetables, the PT would increase. This might require a lower dose of Coumadin. The​ client's exercise tolerance will be low after major surgery. The client can begin exercise when cleared by the health care provider. The client will need periods of rest for several weeks.