Aortic Aneurysms

A nurse provides discharge instructions to a patient who underwent an aortic surgery. Which statement made by the client indicates understanding of the teaching?

"I will immediately report if the pain or drainage increases." (The patient or caregiver should immediately tell the primary health care provider about increased redness, increased pain, or drainage after surgery. These symptoms can be an indication of endoleak or aneurysm growth below and above the graft. If not treated immediately, severe tissue damage or even death may occur.)

aortic dissection

A tear in the inner layer of the aorta

A patient is diagnosed with an abdominal aortic aneurysm. The patient undergoes minimally invasive aneurysm repair with an endovascular graft and returns to the room on the unit after the procedure. Which is the priority action for the nurse at this time?

Assess the groin area bilaterally (The endovascular graft is placed through the femoral arteries to the area of the aneurysm to prevent further expansion. The nurse first should inspect the groin areas, the femoral artery sites, for bleeding and hematoma.)

The nurse obtains a medical history from a patient with a suspected abdominal aortic aneurysm. To get to the information that is of the highest priority, the nurse should first ask the patient about a history of:

Back pain (Although an abdominal aortic aneurysm is usually asymptomatic, some patients have abdominal or back pain. A pulsating mass in the abdomen, with or without pain, may indicate that the aneurysm is enlarged or dissecting.)

The nurse assesses that a patient with acute ascending aortic dissection has narrow pulse pressure, jugular venous distention, and a diastolic blood pressure of 60 mm Hg. With what does the nurse correlate these findings?

Cardiac tamponade (The patient who has acute ascending aortic dissection is at high risk of cardiac tamponade. Narrow pulse pressure, jugular venous distention, and diastolic blood pressure of 60 mm Hg or hypotension are symptoms of cardiac tamponade. It occurs due to leakage of blood from the dissection into the pericardial sac.)

blood thinner administered to prevent venous thromboembolism

Clopidogrel

The nurse assesses a patient with diaphoresis, weakness, periumbilical pain, pallor, and a pulsating abdominal mass. The patient's heart rate is 120 beats/minute and blood pressure is 90/60 mm Hg. What does the nurse suspect is occurring with this patient?

Dilation of the aorta indicates aortic aneurysms. Diaphoresis, weakness, periumbilical pain, tachycardia, pallor, pulsating abdominal mass, and hypotension are the symptoms of aneurysm rupture.

The nurse assesses a patient postoperatively from a repair of an aortic aneurysm and finds a heart rate of 48, cool, pale, and mottled extremities along with reports of pain. What condition does the nurse suspect is occurring?

Graft occlusion

A male patient was admitted for a possible ruptured aortic aneurysm, but had no back pain. Ten minutes later his assessment includes the following: sinus tachycardia at 138, blood pressure (BP) palpable at 65 mm Hg, increasing waist circumference, and no urine output. How should the nurse interpret this assessment about the patient's aneurysm?

He is bleeding into the abdomen. The lack of back pain indicates the patient most likely is exsanguinating into the abdominal space and the bleeding is likely to continue without surgical repair. A blockade of the blood flow will not occur in the abdominal space as it would in the retroperitoneal space where surrounding anatomic structures may control the bleeding.

A patient has a blood pressure of 180/98 mm Hg after aortic aneurysm surgery. Which drug will the nurse administer to reduce hypertension in this patient?

Hydralazine (an antihypertensive drug that reduces hypertension. It prevents the leakage of blood or rupture at the suture lines after aortic aneurysm surgery.)

A patient has undergone an endovascular aneurysm repair. Which laboratory test should the nurse inform the patient will be required for the duration of the patient's life?

MRI

used to diagnose and assess the location and severity of aneurysms

MRI

A patient has undergone an endovascular aneurysm repair. Which laboratory test should the nurse inform the patient will be required for the duration of the patient's life?

MRI (The magnetic resonance imaging study is required to be performed regularly for rest of a patient's life after endovascular aneurysm repair to monitor for further complications.)

The nurse assesses an absence of bowel sounds in a patient that had aortic surgery. The patient reports severe abdominal pain. What nursing action is a priority with this patient?

Prepare the patient for reoperation (Bowel infarction may result from restricted blood flow to the bowel due to occlusion of the mesenteric arteries. Therefore, immediate reoperation is necessary to restore the blood flow. )

Which nursing action would be beneficial for a patient who underwent an abdominal aortic aneurysm repair and develops endoleak?

Preparing the patient for coil embolization Endoleak is characterized by seepage of blood back into the old aneurysm and disturbed hemostasis of the body. Coil embolization is used after abdominal aortic aneurysm repair to maintain hemostasis.

Which finding causes the nurse to suspect a risk for graft thrombosis in a patient who has undergone an endovascular graft procedure?

Prolonged low blood pressure (Adequate blood pressure is important for maintaining graft patency. Prolonged low blood pressure hampers the blood circulation and may increase the risk of graft thrombosis.)

Bluish fingers and toes, pallor, pain, and numbness are symptoms of

Raynaud's phenomenon

Which patient is at high risk for developing irreversible renal failure after an aortic aneurysm surgery?

The patient with diabetes may have decreased renal perfusion from embolization of the aortic thrombus or plaque in one or both of the renal arteries. This can cause renal ischemia and can result in permanent renal failure.

The nurse is preparing a patient for an open aneurysm repair. What nursing actions can assist with decreasing the risk for bowel complications?

The retroperitoneal surgical approach should be used while performing open aneurysm repair because it minimizes the risk of bowel complications.

A patient has a graft occlusion from a repair of an aortic aneurysm. About what treatment will the nurse educate the patient?

Thrombolytic therapy

The nurse is caring for a patient who had insertion of a temporary lumbar drain after an endovascular dissection repair. What does the nurse explain to the patient that the benefit of the drain is?

To prevent paralysis Repair of endovascular dissection may cause accumulation of cerebrospinal fluid, resulting in spinal cord edema. Temporary insertion of a lumbar drain helps remove the cerebrospinal fluid and reduce spinal cord edema, thus preventing paralysis.

The nurse is admitting a 68-year-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication?

Vitamin K

warfarin

a vitamin K antagonist anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, vitamin K is given as the antidote for warfarin.

esmolol

a β-adrenergic blocker and is titrated to a target a heart rate of 60 beats/minute or less

The nurse is assessing a patient with patchy mottling of the feet and toes. What complication should the nurse assess for in this patient?

abdominal aortic aneurysm

Tachycardia, an altered level of consciousness, clammy skin, abdominal tenderness, and decreased urine output are symptoms of

aneurysm rupture

Which test is used to map the entire aortic system?

angiography

fusiform aneurysm

circumferential and relatively uniform in shape

used to determine the presence of thrombus in the aneurysm

computed tomography scan

Calcium channel blockers such as _______ should be administered if β-adrenergic blockers are contraindicated.

diltiazem

used to assess the function of the aortic valve

echocardiography

A patient reports chest pain and is found to be diaphoretic and pale. Which diagnostic test can the nurse assess to rule out cardiac ischemia? used to assess the function of the aortic valve

electrocardiogram

A patient is being treated for intraabdominal hypertension. What nursing action would be a priority in the care of this patient?

elevating HOB

A patient is postoperative after having aortic surgery. Which medication does the nurse prepare to administer to this patient to prevent complications?

furosemide (Severe hypertension should be prevented in the patient after an aortic surgery because it may cause stress on the arterial anastomoses)

true aneurysm

involves formation of the aneurysm with at least one vessel layer still intact

used as an analgesic after acute aortic dissection because it decreases sympathetic nervous system stimulation and helps in relieving pain

morphine

false aneurysm

occur due to peripheral artery bypass graft surgery

saccular aneurysm

pouchlike and has a narrow neck that connects the bulge to one side of the arterial wall

this study is used to monitor the aneurysm size

ultrasound

antidote for warfarin

vitamin k

this study shows calcification within the aortic wall

x-ray