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”
  • Anxiety
• Assessment: Dissection Objective Cues
  • Signs/Symptoms of Hypovolemic shock
    • ↑Resp ↑Pulse (Weak)
    • ↓BP
    • Narrow pulse pressure
      • Normal 30-40 mmHg

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)

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