Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)

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Outline

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

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!

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: 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)

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

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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).