MSN-I. VASCULAR DISORDER

1. ANUERYSMS
MRS. C. MARY LALITHA KALA
ASSOCIATE PROFESSOR
AMERICAN NRI COLLEGE OF NURSING

2. DEFINITION
 “An aneurysm is a localized sac or dilation formed
at a weak point in the wall of an artery.”
-- Brunner and suddharth

3. CLASSIFICATION ACC TO SHAPE AND FORM
SL NO TYPE
1. FALSE ANEURYSM Actually a pulsating hematoma. The clot and connective
tissue are outside the arterial wall.
2. TRUE ANEURYSM One, two or all three layers are involved.
3. FUSIFORM ANEURYSM Symmetric, spindle shaped expansion of entire
circumference of involved vessel.
4. SACCULAR ANEURYSM A bulbous protrusion of one side of arterial wall.
5. DISSECTING ANEURYSM This usually is hematoma that splits the layers of the
arterial wall.

5. CLASSIFICATION ACC TO ETIOLOGY
SL NO TYPE
1. CONGENITAL Primary connective tissue disorders. Ex: marfan
syndrome, turners syndrome.
2. MECHANICAL
(HEMODYNAMIC)
Post stenotic and arteriovenous fistula and amputation
related.
3. TRAUMATIC ( PSUEDO
ANEURYSM)
Penetrating arterial injuries, blunt injuries, psuedo
aneurysms.
4. INFLAMMATORY(NON
INFECTIUOS)
Associated with arteritis and periarterial inflammation.
5. INFECTIOUS( MYCOTIC) Bacterial, fungal and spirochetal infections
6. PREGNANCY RELATED
DEGENERATIVE
Non specific inflammatory variant.
7. ANASTOMOTIC AND GRAFT
ANEURYSM
Infection, arterial wall failure, suture failure, graft failure.

6. SACCULAR ANEURYSMS( BERRY ANUERYSMS)
OF THE CIRCLE OF WILLIS

7. I. THORACIC AORTA ANEURYSM

9. INCIDENCE & ETIOLOGY
1. 70% of all cases are caused by atherosclerosis.
2. More frequently in men between the ages of 50
and 70 years.
3. Affects 10 of every 100,000 older adults.
4. Thoracic area is most common site for dissecting
aneurysm.
5. Associated with high mortality and morbidity rates.

10. CLINICAL MANIFESTATIONS
--Symptoms depend upon how rapidly the dilation is
occurring.
-- some patients are asymptomatic.
-- pain is the prominent symptom and occurs only
when the patient is supine & is boring in nature.
-- dyspnea ( due to pressure of the aneurysm sac
against the trachea, a main bronchus or the lung
itself)
-- cough, hoarseness, stridor or weakness or
complete loss of voice ( aphonia) ( due to pressure
against the laryngeal nerve.
-- dysphagia ( due to impingement on the
esophagus by the aneurysm.

11. ASSESSMENT AND DIAGNOSTIC FINDINGS
1. History collection & PE: When large veimns in the
chest are compressed ny the aneurysm, the
superficial veins of the chest, neck, or arms
become dilated.
2. Edematous areas on the chest wall and cyanosis
are often evident.
3. Pressure against the cervical sympathetic chain
can result in unequal pupils.
4. Chest X- ray, CT angiography, MRA, TEE

12. MEDICAL MANAGEMENT
1. Beta blockers: Atenolol, Metaprolol,
2. ARB”s : Losartan, valsartan
3. Sodium nitro prusside can be given for controlling
blood pressure pre operatively.
4. Anti HTN medication – Hydralazine.
5. The main goal is to keep the B.P under control

13. SURGICAL MANAGEMENT
 The goal is to repair the aneurysm and restore
vascular continuity with a vascular graft.
 Endovascular grafts with nitinol or titanium stents.

14. II. ABDOMINAL AORTIC ANEURYSM.

16. INCIDENCE & ETIOLOGY
-- Atherosclerosis is the common cause.
-- It affects men 2 to 6 times more often than women.
-- Prevalent in patients older than 65 years of age.
-- If left untreated, it may eventually rupture and lead
to death.

17. RISK FACTORS
1. Genetic predisposition.
2. Tobacco use.
3. Hypertension.

18. PATHOPHYSIOLOGY
All aneurysms
involve a damaged
media layer of the
vessel.
Caused by
weakness, trauma
or disease.
Aneurysm
develops and tends
to enlarge

19. CLINICAL MANIFESTATIONS.
1. Only 40% of patients have symptoms.
2. They feel their heart throbbing when lying down.
3. The person feels an abdominal mass or
abdominal throbbing.
4. If aneurysm is asscociated with thrombus, it may
result in emboli.
5. Emboli can cause cyanosis and mottling of toes.
6. Signs of impending rupture include severe back
pain of abdominal pain( persistent / intermittent),
falling B.P and hematocrit value.

20. 1. Rupture in the peritoneal cavity is fatal.
2. A retro peritoneal rupture may result in hematoma
in scrotum, perineum, flank or penis.
3. Right sided Heart failure can occur if rupture is
into venacava. ( parallel aneurysm and aorta
ruptures into venacava).

21. RUPTURE OF AN ANEURYSM

22. ASSESSMENT AND DIAGNOSTIC FINDINGS.
1. A pulsatile mass in the middle and upper
abdomen.
2. A systolic bruit is heard over the mass.
3. Ultrasonography
4. CTA
5. When the aneurysm is small, USG is done at 6
month interval until the aneurysm reaches a size
for surgery.

23. MEDICAL MANAGEMENT
 Antihypertensive drugs---
..Diuretics,
..ARB’s
..Beta blockers
..ACE inhibitors
.. Calcium channel blockers.

24. SURGICAL MANAGEMENT
 When an aneurysm is reaching at least 5.5cm (
2in) , the standard treatment is open surgical repair
by resecting the vessel and sewing a bypass graft
in place.
 The next best treatment is endograft repair.

25. ENDOVASCULAR STENT GRAFT

26. COMPLICATIONS OF ANEURYSM

27. NURSING DIAGNOSIS
1. Pain
2. Risk for fluid volume deficit related to hemorrhage.