CARDIOVASCULAR MODULE: AORTIC ANEURYSM Adult Medical-Surgical Nursing

Aneurysm: Description An aneurysm is a weakening and dilatation of part of an arterial wall which may rupture if large enough Aneurysm mainly affects the aorta: Abdominal aorta 75% Thoracic aorta 25%

Aneurysm : Classification Types of aneurysm: Fusiform: Ballooning of the whole arterial circumference Saccular: Ballooning as a sac from one side

Aneurysm: Pre-disposing risk factors Hypertension Smoking Atherosclerosis

Aortic Aneurysm: Pathophysiology The arterial lining consists of the inner intima, the media and the outer adventitia Atherosclerotic plaques (lipid/ fibrous tissue) develop below the intima of the aorta This leads to: Loss of elasticity, weakening of the media and dilatation (ballooning) May lead to rupture Thrombi are deposited around the aneurysm Emboli may break off causing occlusion distally

Aortic Aneurysm: Complications Rupture: If a posterior rupture, the surrounding structures tamponade (there may be signs of shock, severe backache and bruising) If an anterior rupture, massive haemorrhage occurs and death is probable

Clinical Manifestations (Thoracic) Chest pain Hoarseness (pressure on recurrent laryngeal nerve) Dyspnoea Dysphagia All symptoms are related to increased pressure

Clinical Manifestations (Abdominal) Asymptomatic Detected on routine examination Pulsatile mass in periumbilical region May be associated with hypotension May have patchy mottling of feet from mini-emboli in capillaries: “blue toe syndrome”

Aortic Aneurysm: Diagnosis Patient history if symptoms Thoracic and abdominal Xray: shows calcification and aortic arch outline Ultrasound CT scan MRI These tests reveal the size and position of the aneurysm

Aortic Aneurysm: Management If small (<5cm in diameter): Monitor growth frequently by Ultrasound, CT or MRI scans Anticoagulant/ antiplatelet therapy to prevent emboli If >5cm in diameter: Surgery is required

Aortic Aneurysm: Surgery Surgery if > 5cm diameter as there is risk of rupture: Surgery involves: Resection of diseased area Arterial graft / stent (Dacron) Anticoagulant cover to prevent thrombi and emboli

Nursing Responsibilities Patient education about the condition Awareness about risks related to anticoagulant therapy

Surgical Nursing Responsibilities If surgery: nursing care in ICU Vital signs and nursing records: Maintain normal BP to prevent stasis and clotting and to reduce the risk of haemorrhage Monitor temperature (risk of infection) Monitor for dysrhythmias Note peripheral pulses, neuro status, renal perfusion Observe for paralytic ileus (NG tube) Observe dressings, drains ABG, electrolytes