Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)
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Outline
Aneurysm (Dissecting, Repair)
Definition/Etiology:
- Aneurysm: abnormal dilation of an artery due to a weakened vessel wall
- Types
- Thoracic vs Abdominal
- PCCN focuses on AAA
- Located just below renal arteries
- Caused by Atherosclerosis
- Risk Factors: HTN & Smoking
- Most common in men >60 years old
- Danger
- Risk for Dissection: Separation of wall layers
- Usually asymptomatic – until they are NOT
Pathophysiology:
- Aneurysm
- Inflammation and breakdown of the inside of the vessel wall
- .Weak Wall = loss of structure integrity
- Wide Wall -bulge (balloon) blowing up
- Dissection (Life Threatening)
- Tear in the artery at Tunica Intima
- Blood pools between layers
- Blood spills in up and down beside original lumen
- Cause Ischemia/Lack of Perfusion
- AVOID Rupture
- An aneurysm is a bulge in the artery that behaves like a balloon. Ever blow up a balloon?
- At first blowing it up is easy, but eventually there is more pressure, and if you continue to blow on that balloon – POP!
Noticing: Assessment & Recognizing Cues:
- Assessment: Abdominal Aortic Aneurysm Cues
- Most Individuals are asymptomatic
- Observe: Pulsatile abdominal mass lower abdomen (left of midline)
- Usually non-tender on palpation
- Vague, nonspecific abdominal pain
- Advanced Auscultation: Bruits below renal arteries
- Assessment: Dissection Subjective Cues
- PAIN
- Unrelenting lower back pain (flank)
- “Sudden, tearing, ripping”
- Unrelenting lower back pain (flank)
- Anxiety
- PAIN
- Assessment: Dissection Objective Cues
- Signs/Symptoms of Hypovolemic shock
- ↑Resp ↑Pulse (Weak)
- ↓BP
- Narrow pulse pressure
- Normal 30-40 mmHg
- Signs/Symptoms of Hypovolemic shock
Interpreting: Analyzing & Planning:
- Interpreting: Labs
- CBC – H/H for anemia/hemorrhage
- ↑ BUN/Creatinine – Kidney involvement
- Interpreting:Diagnostics
- Ultrasound
- Non-specific abdominal pain = Find AAA accidently
- CT
- Know patient has a AAA
- Gold Standard for stable patient
- Surgery planning
- TEE
- Intra-Operative (Plan as we go)
- Patient is Unstable
- Rupture (CCRN material)
- Ultrasound
Responding: Patient Interventions & Taking Action:
- General
- ABCs
- Pain management
- Prepare Patient for surgical intervention
- Pharmacological Interventions
- Beta Blockers – Lower BP/Lower
- ASA – Once Dissection is fixed – ischemia
- Statins – Lower Inflammation
- Non-Pharmacological Interventions
- Establish IV access
- ECG/Telemetry
- Medical Management
- AAA over 5.5cm -Endovascular Stent
- Dissection –Emergent Surgery
Reflecting: Evaluating Patient Outcomes:
- Wean from Vent (surgery)
- Monitor airway
- Monitor for bleeding
- ↓BP
- ↓Pulses
- Monitor Urine Output
- Monitor BUN & Creatinine
- Pain Management
Linchpins (Key Points):
- Notice
- Interpret
- Respond
- Reflect
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Transcript
References
- Fernando, S. M., Tran, A., Cheng, W., Rochwerg, B., Strauss, S. A., Mutter, E., … & Perry, J. J. (2022). Accuracy of presenting symptoms, physical examination, and imaging for diagnosis of ruptured abdominal aortic aneurysm: Systematic review and meta‐analysis. Academic Emergency Medicine, 29(4), 486-496.
- Kohlman-Trigoboff, D., Rich, K., Foley, A., Fitzgerald, K., Arizmendi, D., Robinson, C., … & Treat-Jacobson, D. (2020). Society for Vascular Nursing Endovascular Repair of Abdominal Aortic Aneurysm (AAA) Updated Nursing Clinical Practice Guideline. Journal of vascular nursing: official publication of the Society for Peripheral Vascular Nursing, 38(2), 36.
- Shaw, P. M., Loree, J., Gibbons, R. C., & McCoy, T. M. (2021). Abdominal Aortic Aneurysm (Nursing).
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Progressive Care Certified Nurse (PCCN)
Course Lessons
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Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Minimally-Invasive Cardiac Surgery (Non-Sternal Approach) for Progressive Care Certified Nurse (PCCN)
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vascular Disease for Progressive Care Certified Nurse (PCCN)
Pulmonary
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
COPD Exacerbation for Progressive Care Certified Nurse (PCCN)
Minimally-Invasive Thoracic Surgery (VATS) for Progressive Care Certified Nurse (PCCN)
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Pleural Space Complications (Pneumothorax, Hemothorax, Pleural Effusion, Empyema, Chylothorax) for Progressive Care Certified Nurse (PCCN)
Pulmonary Embolism for Progressive Care Certified Nurse (PCCN)
Pulmonary Hypertension for Progressive Care Certified Nurse (PCCN)
Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Thoracic Surgery (Lobectomy, Pneumonectomy) for Progressive Care Certified Nurse (PCCN)
Endocrine/Hematology/Neurology/Gastrointestinal/Renal
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Anemia for Progressive Care Certified Nurse (PCCN)
Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)
Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)
Seizure Disorder for Progressive Care Certified Nurse (PCCN)
Stroke for Progressive Care Certified Nurse (PCCN)
Functional GI Disorders (Obstruction, Ileus, Diabetic Gastroparesis, Gastroesophageal Reflux, Irritable Bowel Syndrome) for Progressive Care Certified Nurse (PCCN)
GI Bleed (Upper, Lower) for Progressive Care Certified Nurse (PCCN)
GI Infections (C. difficile) for Progressive Care Certified Nurse (PCCN)
GI Surgeries (Resections, Esophagogastrectomy, Bariatric) for Progressive Care Certified Nurse (PCCN)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Malnutrition (Failure to Thrive, Malabsorption Disorders) for Progressive Care Certified Nurse (PCCN)
Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Musculoskeletal/Multisystem/Psychosocial
Functional Issues (Immobility, Falls, Gait Disorders) for Progressive Care Certified Nurse (PCCN)
End of Life for Progressive Care Certified Nurse (PCCN)
Healthcare-Acquired Infections: Catheter-Associated Bloodstream Infections (CAUTI) for Progressive Care Certified Nurse (PCCN)
Healthcare-Acquired Infections: Central-Line-Associated Infections (CLABSI) for Progressive Care Certified Nurse (PCCN)
Healthcare-Acquired Infections: Surgical Site Infections (SSI) for Progressive Care Certified Nurse (PCCN)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Infectious Diseases: Multidrug-Resistant Organisms (MRSA, VRE, CRE, ESBL) for Progressive Care Certified Nurse (PCCN)
Pain (Acute, Chronic) for Progressive Care Certified Nurse (PCCN)
Palliative Care for Progressive Care Certified Nurse (PCCN)
Pressure Injuries (Ulcers) for Progressive Care Certified Nurse (PCCN)
Rhabdomyolysis for Progressive Care Certified Nurse (PCCN)
Sepsis for Progressive Care Certified Nurse (PCCN)
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)
Wounds (Infectious, Surgical, Trauma) for Progressive Care Certified Nurse (PCCN)
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Professional Caring and Ethical Practice
Advocacy & Moral Judgement for Progressive Care Certified Nurse (PCCN)
Caring Practices for Progressive Care Certified Nurse (PCCN)
Response to Diversity for Progressive Care Certified Nurse (PCCN)
Facilitation of Learning for Progressive Care Certified Nurse (PCCN)
Collaboration for Progressive Care Certified Nurse (PCCN)
Systems Thinking for Progressive Care Certified Nurse (PCCN)
Clinical Inquiry for Progressive Care Certified Nurse (PCCN)
