By the end of the presentation listeners must be able to:(a) know the definition of aortic aneurysm(b) describe Etiology Classification Pathophysiology Clinical manifestations Nursing management Medical Management Complications
An aneurysm is an abnormal dilation of a blood vessel commonly at a site of a weakness or tear in the vessel . Aneurysm mostly affects the aorta and peripheral arteries because of increased pressure in these vessels Aneurysm occur more often in men than women and their incidence increases with age.
Aneurysm is divided into two types and these are(a)True : this is where aneurysm forms with atleast one layer of vessel still intact. Trueaneurysm can be farther divided into Fusiform- circumferential and relatively uniform in shape Saccular- pouch-like with a narrow neck(b)False (pseudoaneurysm) : is not aneurysm buta disruption of all layers of the arterial wallresulting in rupture.
In normal cases the aorta is made up of structural proteins called collagen and elastin. Collagen provides tensile strength while elastin recoils after systole. Aneurysm form due to the weakness of the arterial wall. Destruction of elastin and collagen in the wall of the aorta leads to abnormal dilation and rapture of the aorta respectively, and this result into aneurysm (Wung & Aouizerat, 2004.) Aneurysm also occur due to hypertension and long-term eroding atherosclerosis.
Dyspnea Hoarseness and dysphagia Edema of the face and the neck Distended neck veins Back, neck or substernal pains Mild to severe mid-abdominal and lumbar back pains.
Diagnostic studies Chest X-ray to visualize thoracic aortic aneurysm Abdominal Ultrasonography to diagnose abdominal aortic aneurysm Contrast –enhanced CT that allows precise measurement of the aneurysm ECG may be performed to rule out evidence of myocardial infarction.
medications Medications that are administered to patients with aneurysm include: Beta –blockers e.g. propranolol, that control the myocardial contractility Anti-hypertensives e.g. nifedipine, Surgery
Nursing assessment Thorough history and physical assessment should be performed. The nurse should watch for signs of cardiac, pulmonary, cerebral, and lower extremity vascular problems The nurse should monitor the patient for indications of aneurysm rupture such as diaphoresis, paleness, weakness, tachycardia, hypotension and abdominal pain
Altered comfort; pain related to inflammatory processes Risk for ineffective tissue perfusion related to aneurysm rupture as evidenced by hemorrhage and lack of blood flow to tissues. Risk for injury related to pressure on the aneurysm Anxiety related to the nature of the disorder
Acute interventions It is seen in two ways (a) preoperative (b) post operative
Nurse the patient in the supine position to relieve pain Brief explanation of the disease process Teaching the patient and family about the procedure that is to take place on the patient Provide support for the patient and the family with careful assessment of all body systems Assess the patient ready for the planned surgery. Pre-surgical assessment include giving IV fluids, Sample collection, vital signs and dressing the patient with theatre clothes
In most cases such patients are nursed in ICU for close monitoring The nurse inserts the following: Urinary indwelling catheter Endotracheal tube Nasogastric tube
The nurse should monitor BP, administer IV fluids and blood components which are important for adequate blood flow to the graft. The nurse should monitor urinary input and output which help in assessing the patient’s hydration and perfusion status ECG monitoring, ABG determination, administration of oxygen and IV anti- dysrhythmc medications as needed.
Health promotion Teaching patient measures of health promotion with special attention to patients with family history of aneurysm. The patient should encouraged to reduce cardiovascular risk factors such as BP control, smoking cessation, increasing physical activity and
Ambulatory and home care Encourage the patient to express any concerns and assure the patient that you are available. Assure the patient that normal activities of daily living will be resume soon. The patient should be instructed of increase gradually in activities such as fatigue, poor appetite and regular habits should be expected Heavy lifting should be avoided. Any increased pain, drainage from incision, increased fever of greater than 38⁰c should be reported to the hospital.
Expected outcomes Adequate tissue perfusion Normal body temperature No sign of infection
Lewis, Heitkemper, Dirksen (2007) Medical Surgical, Nursing; 7th edition, Mosby Elsevier, USA. Priscilla Lemone and Karen Burk(2008) Medical Surgical Nursing, Fourth Edition, Pearson Education Inc. New Jersey, USA
DEFINITION It the inflammation of the vein (Brunner & Suddarth’s, 2007 ) The term is used clinically to indicate a superficial and localized condition that can be treated with application of heat (Lippincott Manual of Nursing)
ETIOLOGY Phlebitis is caused by the following:(a) bacterial: stimulates inflammation(b) Chemical: irritating solutions(c) Mechanical: physical trauma; skin puncture; movement of the cannula of the vein during insertion(d) Medications; e.g. Celecoxib(e) Genetic; pass from one generation to another(f) Alcohol abuse
CLINICAL MANIFESTATION Redness and warmth with a temperature elevation of a degree above the baseline Pain or burning along the length of the vein Swelling Vein being hard and cord-like Fever
OCCURENCE The incidence of phlebitis increases with the length of time the I.V. is in place, the composition of fluid or medication infused, the size of the cannula inserted, inadequate anchoring of the line and introduction of microorganism at the site of insertion
NURSING DIAGNOSIS Altered thermoregulation; hyperthermia related to inflammatory processes secondary to infections. Altered comfort; pain related to inflammatory process Risk for skin integrity due skin puncture
Nursing Interventions Apply warm compresses immediately to relieve pain and inflammation. Follow with moist, warm compresses to stimulate circulation and promote absorption. Administer analgesic to relieve pain and fever Document interventions and assessments.
Preventive Measures Anchor the needle or catheter securely at the insertion site. Change the insertion site at least every 72 hours. If the facility phlebitis rate goes above 5%, insertion sites should be changed every 48 hours Use large veins for irritating fluid because of higher blood flow, which rapidly dilutes the irritant. Sufficiently dilute irritating agents before infusion.