-
goals with postop pt
- maintaining adequate respiratory function
- fluid and electrolyte balance
- pain control
-
post op AA graft
- Monitor graft patency and renal perfusion
- monitor and intervenes to limit or treat dysrhythmias, infections, and neurologic complications
-
AA graft patency cont. maintain adequate BP
prolonged hypotension
-
prolonged hypotension => fraft thrombsis
- administer IV fluids and blood components (as indicated)
- CVP readings or PA pressuresand urinary output monitored hourly
- -to assess hydration and perfusion
-
AA graft patency cont.
maintain adequate BP
hypertension
- stress onthe arterial anastomoses, resulting in leakage or rupture
- Drug therapy w/
- Diuretics
- antihypertensive - Nipride, corlopam, cardene
-
AA post op
cardiovascular status
- continuous /ecg monitoring
- electrolyte and artrial blood gas
- O2 adm.
- antidysrhythmic meds
- replacement of electrolytes as indicated
- pain control
- resumption of preop cardiac meds
-
AA post op
Infection
- broad spectrum antibiotic
- temp
- labs for elevated WBC (1st indication for infection)
- adequate nutrition
- incision site assessment; clean and dry
- IV,arterial and CVP or PA caths cared for w/ strict asepsis
- peri care for the pt w/ indwelling urinary cath
-
AA post op
GI status
- paralytic ileus may devolp due to anthesia and bowel manipulation
- NG tube on low intermittent suction (decompresses stomach, prvents aspiration, decreases pressure on suture lines)
- -irrigated w/ NS - amnt and character of drainage noted
- assess for absent bowel sounds, fever, abd. distention, diarrhea, and bloody stools
- mouth care for the NPO pt.
-
AA post op
neurologic status
- ASSENDING AORTA INVOLVED - assess LOC, pupil size, response to light, facial symmetyr, tonue deviation, speech, ability to move upper extremities, and hand grasps quality.
- DECENDING AORTA - assess move lower extremities is added
-
AA post op
peripheral perfusion status
- depending location of aneurysm
- all peripheral pulses checked q/hr
- ASCENDING AORTA AND AORTIC ARCH - carotid, radial and temporal
- DESCENDING - femoral, popliteal, posterior tibial, dorsalis pedis
- (mark with pen)
- skin temp and color, cap refill, sensation and movement
- decreased or absent pulse w/ cool, pale, mottled, painful extrmity = embolism of aneurysmal thrombus or plaque, or graft occlusion
-
AA post op
renal perfusion
- urinary cath in place
- hourly urine outputs
- I & O
- daily wts
- CVP and PA for hydration status
- daily blood BUN and creatinine (renal function)
- hypotension, dehydration, prolonged aortic clamping or blood loss can lead to decreased renal perfusion => acute renal failure
-
AA post op
Home Care
- fatigue, poor appetite, irregular bowel habits - expected
- avoid heavy lifting 4-6 wks
- redness, swellin, increased pain, drainage from incisions or fever>100 - call dr.
- teach - color or warmth changes in extremities, palpate peripheral pulses for change in quality
- prophylactic antibiotics before invasive procedures including dental
- sexual dysfunction - common
-
AA post op
evaluation
expected outcomes
- patent arterial graft w/ adequate distal perfusion
- adequate urine output
- normal body temp
- no signs of infection
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