Aneurysm and Aortic Dissection

  1. Aneurysms
    • local dilation of artery
    • most common cause ***atherosclerosis
    • starts gradually, inc thrombi may form
    • complications- rupture, thrombosis, embolization
  2. Aneurysms- patho
    • arteries that are not supported by skeletal muscle or subjected to repeated bending are most susceptible to factors like shearing forces (HTN)
    • atherosclerosis dec elasticity
    • arterial wall weakens overtime
    • lots of pressure- weak- something has to give
  3. continued path aneurysms
    • vasodilation as compensation
    • blood flow is high and tortuos
    • medial layer damage allows other layers to balloon out
  4. classification aneurysms
    • appearance-
    • - fusiform- localized, uniform
    • - saccular- outpouching
    • - dissecting- hematoma in arterial wall, separates laters of arterial wall
    • - pseudoanerysm or 'false' aneurysm- a sac develops around a hematoma
  5. Abdominal Aortic Aneurysm
    • 4x more common than thoracic aorta
    • 1.5 mill Americans have AAA, most asymptomatic
    • 15,000 deaths/yr
    • greatest risk- men > 50, caucasian
    • most asymtomatic
    • inc risk factors are atherosclerosis, collegan defect, smoking, htn
    • usually occurs below renal artery- kidneys are being perfused
  6. AAA Manifestations
    • small- < 4 cm - no symptoms
    • Av growth- 0.3-0.5 cm/yr
    • as enlarges, may have pulsating abd mass
    • - abd pain/altered bowel function
    • - back pain- compresses on lumbar nerves
    • diagnostic tests- US & CT scan
  7. AAA treatment
    • medical- for asymptomatic
    • </= 5 cm
    • US q6 mos
    • lifestyle modification- no smoking, dec diet, FITT
    • AntiHTN PRN- dec pressure
  8. AAA treatment- surgical
    • Surgical- elective mortality < 5%
    • - Aorta clamped, aneurysm supported with graft or stent- graft
    • > 5 cm
    • growing rapidly
    • symptomatic
  9. Ruptured AAA
    • Medical emergency
    • >/= 6 cm= 20% rupture w/in 1 yr
    • *** abd pain, intense back pain, flank pain
    • *** pulsating abd mass (NEVER palpate)
    • *** shock- dec BP, tachy, inc RR,
    • extreme abd tenderness
  10. Complication of surgery
    • due to worse if preexisting CAD COPD- if we have this- worst recovery
    • endoleak- mesh, leaks, sepsis, shock
    • renal failure- esp if aneurysm is above renal artery
    • emboli
    • spinal cord ischemia- compressing lumbar nerve
  11. nx considerations post op surgery AAA
    • monitor for complications
    • risk for fluid electrolyte imb
    • risk for impaired gas exchx
    • risk for altered tissue perfusion
    • pain
    • risk for bowel ischemia
    • risk for spinal cord ishemia
  12. nx considerations- discharge planning
    • daily foot inspection, podiatrist- perfusion, CSM, pulsing
    • avoid heating pads- vasoconstriction, burn
    • avoid constricting clothing
    • ambulate as tol
    • TEDS/ace wraps if swelling- know how to put this on
    • no heavy lifting for 6-12 weeks
    • avoid pulling/pushing/straining
    • no driving until f/u with MD
  13. Aortic Dissection
    • Intimal tear allows blood into medial layer
    • creation false lumen btwn intima and medial layers- blood flows- just going to bleed, create thrombi b/c stasis
    • - thrombosis
    • with each contraction of heart, inc damage
    • as it progresses, arterial branches block, causing ischemia to organs
    • - brain, kidneys, spinal cord, extremities
    • 70% Aorta acute onset - quick + fast
  14. Aortic Dissection Risk
    • exact cause unknown
    • men 50-70, most with HTN
    • could be genetic, cardiac, cocaine, FH
  15. manifestations of Aortic dissection
    • abrupt excruciating pain
    • - chest/back
    • dec perpherihal pulses
    • BP different in arms
    • Angina, MI murmur
    • changes LOC, snycope- dec arterial blood
    • absent carotids
  16. diagnostic aortic dissection
    • CXR
    • Echo
    • CT/MRI *
  17. complications aortic dissection
    • cardiac tamponade- think beck's triad- hypotension, JVD, muffled heart sounds, tachy etc
    • Ischemia to vital organs
    • - spinal cord, kidneys, abd organs
  18. Management - aortic dissection
    • dec BP to dec shearing forcing
    • - vasodilators
    • - beta blockers
    • if stable- pain control, bld transfusion, HF management
    • if unstable- surgery to resect and repair tear
  19. Raynaud's Phenomenon
    • constriction of small arteries and aterioles
    • Vasospastic- caused by cold, nicotine, caffeine, stress, trauma and unknown
    • - also auto immune component
    • dec perfusion- pallor
    • can appear cyanotic- blue
    • hyperemic response- red
    • - perfusion res-esta
    • Dx based on s/s for 2 yrs
    • -vasospasm affect finger and toes
  20. raynaud's phenomenon- cause
    • typing- constantly using fingers
    • repetitive damage to your finger tips
    • dec perfusion
    • tips become cyanotic
    • fingers thick
    • nails brittle
  21. Raynauds management
    • keep hands and feet warm dry
    • - gloves, warm socks
    • protect body from cold and other triggers
    • - limit time in cold
    • tobacco sensation
    • dec caffeine, chocolate
  22. Management- raynauds
    • biofeedback
    • herbal tx- Ginkgo, ginger, vita E- helps to improve circulation
    • smooth muscle relaxers- ca channel blocker (nifedipine)- dysrythmia, dec BP, H/A, fatigue, helps to dec vasospasm, helps to dec severity and attacks
    • pt teaching- how to recognize attack and dec s/s
Author
Prittyrick
ID
330145
Card Set
Aneurysm and Aortic Dissection
Description
burst
Updated