tissues from further injury (pressure, further constriction); preventing infection Implementation – encourage blood flow à keep environment and client warm; avoid constricting clothing, bed not raised at knees (legs elevated only if edema present), client is to change position frequently, encourage walking or swimming; if client on bedrest – foot/leg exercises at least once an hour; smoking cessation encouraged; stress relief, light blanket over legs when sitting, weight control Evaluation – assess changes in pulses, skin integrity, pain level; evaluate client compliance with exercise routine; smoking cessation; revise plan as needed Aneurysm Etiology – outpouching of the wall of an artery; atherosclerosis (weakens wall) and HTN (puts additional pressure on the wall) à major factor but also d/t structural defect in a weaker area of arterial wall; genetic predisposition, trauma, surgical procedure, diabetes, high cholesterol; smoking; can occur below the diaphragm (abdominal aneurysm – usually below kidneys) or ascending aorta in chest (thoracic aneurysm) Pathophysiology – blood flow stagnant à clots can form causing occlusion or can break off and lodge elsewhere; once aneurysm develops it continues to grow and may rupture or dissect (more common) if not repaired. Dissection – layers of arterial wall separate, bleeding between layers occurs (puts pressure on surrounding structures); blood flows slows to the organs. If suspecting dissection or rupture à call MD asap Signs, symptoms, and diagnosis Often asymptomatic and found when X-ray or CT scan done d/t something else Abdominal a. – back pain, feeling of pressure (back), can see pulsation of the abdomen Thoracic a. – substernal or tracheal pressure, dyspnea Aortic dissection or rupture – abrupt, excruciating pain that radiates to back, chest, abdomen, extremities; peripheral pulses diminished, hypotensive shock; 65% if clients with ruptured AAA die before reaching hospital Diagnosis – clients with family history – screening and physical exam; x-ray, ultrasound, MRI, CT; males with HTN + smoking à ultrasound screening advised Treatment – asymptomatic - client evaluated every few months to track size of aneurysm; antihypertensives, beta-blockers; symptomatic - surgery à when the risk of rupture exceed the risk of surgery; depends on the size à surgery done when thoracic a. 5.5-6.5 cm and abdominal a. 6-8 cm (or if client experiences symptoms à done to prevent rupture) Graft vs. stent Graft – requires open surgery (abdomen or chest) à aneurysm opened, graft inserted, vessel closed around graft Stent graft (pertcutaneous intravascular insertion) à minimally invasive (via femoral artery through groin); meshed stent placed in area of aneurysm (supports vessel and allows blood flow) Nursing management – assessment, diagnosis and planning, implementation, and evaluation Assessment – history and physical; if pulsation found (abnormal) let MD know; assessment of pain pattern (see S&S of rupture) Diagnosis – main goal is prevention of rupture 4/26/19, 11G44 AM Page 4 of 9
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- Fall '19