-
Aneurysms
- local dilation of artery
- most common cause ***atherosclerosis
- starts gradually, inc thrombi may form
- complications- rupture, thrombosis, embolization
-
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
-
continued path aneurysms
- vasodilation as compensation
- blood flow is high and tortuos
- medial layer damage allows other layers to balloon out
-
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
-
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
-
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
-
AAA treatment
- medical- for asymptomatic
- </= 5 cm
- US q6 mos
- lifestyle modification- no smoking, dec diet, FITT
- AntiHTN PRN- dec pressure
-
AAA treatment- surgical
- Surgical- elective mortality < 5%
- - Aorta clamped, aneurysm supported with graft or stent- graft
- > 5 cm
- growing rapidly
- symptomatic
-
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
-
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
-
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
-
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
-
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
-
Aortic Dissection Risk
- exact cause unknown
- men 50-70, most with HTN
- could be genetic, cardiac, cocaine, FH
-
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
-
diagnostic aortic dissection
-
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
-
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
-
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
-
raynaud's phenomenon- cause
- typing- constantly using fingers
- repetitive damage to your finger tips
- dec perfusion
- tips become cyanotic
- fingers thick
- nails brittle
-
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
-
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
|
|
