Abdominal Aortic Aneurysm

  1. General information
    1. Most aneurysms of this type are saccular or dissecting and develop just below the renal arteries but above the iliac bifurcation
    2. Occur most often in men over age 60
    3. Caused by atherosclerosis, hypertension, trauma, syphilis, other types of infectious processes
  2. Medical management: surgical resection of the lesion and replacement with a graft (extracorporeal circulation not needed)
  3. Assessment findings
    1. Severe mid- to low-abdominal pain, low-back pain
    2. Mass in the periumbilical area or slightly to the left of the midline with bruits heard over the mass
    3. Pulsating abdominal mass
    4. Diminished femoral pulses
    5. Diagnostic tests: same as for thoracic aneurysms
  4. Nursing interventions: preoperative
    1. Prepare client for surgery: routine pre-op care.
    2. Assess rate, rhythm, character of the peripheral pulses and mark all distal pulses.
  5. Nursing interventions: postoperative
    1. Provide routine post-op care
    2. Monitor the following parameters
      1. Hourly circulation checks noting rate, rhythm, character of all pulses distal to the graft
      2. CVP/PAP/PCWP
      3. Hourly outputs through Foley catheter (report less than 30 ml/hour)
      4. Daily BUN/creatinine/electrolyte levels
      5. Presence of back pain (may indicate retroperitoneal hemorrhage)
      6. IV fluids
      7. Neuro status including LOC, pupil size and response to light, hand grasp, movement of extremities
      8. Heart rate and rhythm via monitor
    3. Maintain client flat in bed without sharp flexion of hip/knee (avoid pressure on femoral/popliteal arteries).
    4. Auscultate lungs and encourage turning, coughing, and deep breathing.
    5. Assess for signs and symptoms of paralytic ileus (See Intestinal Obstructions).
    6. Prevent thrombophlebitis.
      1. Encourage client to dorsiflex foot while in bed.
      2. Use elastic stockings or sequential compression boots as ordered.
      3. Assess for signs and symptoms (see Thrombophlebitis).
    7. Provide client teaching and discharge planning concerning
      1. Importance of changes in color/temperature of extremities
      2. Avoidance of prolonged sitting, standing, and smoking
      3. Need for a gradual progressive activity regimen
      4. Adherence to low-cholesterol, low-saturated-fat diet

Saturday, May 24, 2008 | Labels: |

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