Abdominal Aortic Aneurysm (AAA) Quiz 1

Pathophysiology & Risk Factors

• An abdominal aortic aneurysm (AAA) is a localized dilation of the abdominal aorta
• Atherosclerosis is the most common cause of AAA due to vessel wall weakening
• Sudden severe back or abdominal pain in a patient with known AAA is concerning, may indicate dissection or rupture which is a medical emergency
• Awareness of a pulsating mass in the abdomen can be a classic symptom of AAA.
• Risk factors for AAA include age >65, male sex, smoking, hypertension, and atherosclerosis
• Risk factors are family history, obesity, and smoking; male sex and hypertension also increase risk
• Fusiform aneurysms involve circumferential dilation, while saccular aneurysms are localized bulges on one side.
• AAA can be diagnosed using ultrasound, CT scan, MRI, and abdominal X-ray
• Arterial wall weakening, typically from atherosclerosis, is directly involved in the development of an AAA
• Symptoms that could mean a possible rupture of an AAA: sudden pain, distention, hypotension, and loss of pulses from poor perfusion

Diagnosis & Medical Management

• The primary goal of surveillance in small, asymptomatic AAAs is to monitor aneurysm growth to determine when intervention is needed
• Quitting smoking is the most important teaching point for a patient with a 3.5 cm AAA being managed medically because it is a key modifiable risk factor, and cessation is essential to slow aneurysm growth
• Appropriate nursing interventions for managing a patient undergoing surveillance for AAA include regular BP monitoring, educating about rupture symptoms, and promoting smoking cessation
• Surgical intervention is likely if a CT scan shows an AAA is 6 cm in diameter; an aneurysm >5 cm typically warrants surgical repair due to rupture risk
• Beta blockers are most important to manage an AAA; they help reduce BP and stress on the aneurysm

Surgical Management

• Surgical repair of an AAA is indicated if aneurysm is symptomatic, >5 cm, or growing rapidly
• Endovascular Aortic Repair (EVAR) involves the insertion of a graft via a femoral artery catheter
• Advantages of EVAR over open AAA repair includes faster recovery time, it's less invasive, reduces hospital stays and does not require large incision
• A primary concern following open AAA repair is acute renal failure because open repair involves clamping the aorta, which can reduce renal perfusion
• Essential post-EVAR assessments focus on hemodynamic stability, perfusion to extremities, and the groin access site including groin site for bleeding, bilateral lower extremity pulses, and blood pressure trends
• With a post-op AAA patient that had a sudden BP drop and reports back pain, calling the provider is the first action the nurse should take
• After open AAA repair, lab values to monitor closely for renal function include BUN and creatinine levels may be compromised due to aortic clamping during surgery.
• Assessing for bowel ischemia in a post-op AAA patient includes: assessing abdominal girth and bowel sounds, monitoring for flatus, maintaining the NG tube.
• Diminished pedal pulses post-op AAA repair is interpreted as possible graft thrombosis
• Renal ischemia is the most likely complication due to clamping of the aorta during AAA repair

Postoperative Nursing Diagnoses & Interventions

• A patient with no flatus 3 days post-op is most appropriately diagnosed with Risk for paralytic ileus because bowel manipulation and decreased perfusion increase that risk post AAA repair.

• Adequate renal perfusion indicated after surgery include urine output > 30 mL/hr, systolic BP > 100 mmHg, and stable renal labs (BUN/Creatinine in normal range)

• Decreased hemoglobin and hematocrit can suggest a fluid volume deficit in a post-op AAA patient because it can signal bleeding or fluid volume loss.

• After AAA surgery, increasing abdominal girth and absent bowel sounds require the nurse to notify the surgeon because they are signs of bowel ischemia or ileus.

• Nursing interventions to promote graft integrity after AAA surgery include maintaining normotension, providing adequate pain control, avoiding sudden position changes, and administering vasopressors as needed

• Pain control is important after AAA repair because pain increases sympathetic stimulation, raising BP and HR, which can stress the graft site.

• Elevated WBC, red, warm incision site, tachycardia, and fever may indicate post-op infection in an AAA patient

• Cloudy wound drainage and fever indicate infection, so the nursing diagnosis is infection.

• Monitoring hematocrit levels helps detect internal bleeding post-AAA repair because a declining hematocrit can indicate internal bleeding or hemorrhage.

• The most appropriate pain management strategy for a post-op AAA patient is PCA because it allows the patient to control pain and is commonly used after major surgeries like AAA repair.

Postoperative Outcomes & Evaluation

• Findings indicating successful pain management in a post-op AAA patient: patient states pain is at a 2/10 and is ambulating
• Adequate tissue perfusion in a post-op AAA patient is achieved with strong, palpable pedal pulses
• Effective post-op fluid balance includes urine output >30 mL/hr, moist mucous membranes, and stable vital signs
• Bowel function returning after open AAA repair is indicated by passing flatus and audible bowel sounds
• Surgical recovery in a patient post-AAA repair: absence of wound infection, BP within normal range, strong peripheral pulses and bowel movement within 3 days