Podcast
Questions and Answers
Which of the following best defines an abdominal aortic aneurysm (AAA)?
Which of the following best defines an abdominal aortic aneurysm (AAA)?
- A local dilation of the abdominal artery (correct)
- A narrowing of the abdominal aorta
- A clot formation in the abdominal artery
- A rupture of the inferior vena cava
What is the most common cause of AAA?
What is the most common cause of AAA?
- Smoking
- Diabetes mellitus
- Hypertension
- Atherosclerosis (correct)
Which patient is at highest risk for developing an AAA?
Which patient is at highest risk for developing an AAA?
- 45-year-old male smoker
- 65-year-old female with hypothyroidism
- 50-year-old male with type 2 diabetes
- 70-year-old male with hypertension and smoking history (correct)
Which of the following are risk factors for AAA? (Select all that apply)
Which of the following are risk factors for AAA? (Select all that apply)
Which of the following diagnostic tools is most commonly used to detect an AAA?
Which of the following diagnostic tools is most commonly used to detect an AAA?
What are common symptoms of AAA before rupture? (Select all that apply)
What are common symptoms of AAA before rupture? (Select all that apply)
Which of the following is considered a surgical emergency in AAA?
Which of the following is considered a surgical emergency in AAA?
What is a true aneurysm?
What is a true aneurysm?
What types of true aneurysms exist? (Select all that apply)
What types of true aneurysms exist? (Select all that apply)
What is the minimal urine output goal post-AAA repair to assess renal perfusion?
What is the minimal urine output goal post-AAA repair to assess renal perfusion?
Why is uncontrolled hypertension dangerous in AAA patients?
Why is uncontrolled hypertension dangerous in AAA patients?
What is the purpose of performing an angiogram before AAA surgery?
What is the purpose of performing an angiogram before AAA surgery?
What is the most appropriate intervention for a patient with a suspected ruptured AAA?
What is the most appropriate intervention for a patient with a suspected ruptured AAA?
Which lab values are most critical to monitor for renal function after AAA surgery?
Which lab values are most critical to monitor for renal function after AAA surgery?
Which are signs of ineffective tissue perfusion in the lower extremities post-AAA repair? (Select all that apply)
Which are signs of ineffective tissue perfusion in the lower extremities post-AAA repair? (Select all that apply)
Paralytic ileus after AAA surgery is most likely due to:
Paralytic ileus after AAA surgery is most likely due to:
The nurse notices a sudden drop in hemoglobin post-op AAA repair. What should be suspected?
The nurse notices a sudden drop in hemoglobin post-op AAA repair. What should be suspected?
Which post-op sign may suggest a graft thrombosis?
Which post-op sign may suggest a graft thrombosis?
Which symptom is consistent with bowel ischemia after AAA repair?
Which symptom is consistent with bowel ischemia after AAA repair?
Why is pain control important in post-AAA patients?
Why is pain control important in post-AAA patients?
A patient is post-op from an open AAA repair. The nurse notes the following: BP 88/60, HR 122, urine output 15 mL/hr. What is the priority action?
A patient is post-op from an open AAA repair. The nurse notes the following: BP 88/60, HR 122, urine output 15 mL/hr. What is the priority action?
What should a nurse assess after an endovascular aortic repair (EVAR)? (Select all that apply)
What should a nurse assess after an endovascular aortic repair (EVAR)? (Select all that apply)
A nurse is caring for a post-op AAA patient. The patient reports new, severe abdominal pain. What is the best initial action?
A nurse is caring for a post-op AAA patient. The patient reports new, severe abdominal pain. What is the best initial action?
A patient with AAA is on post-op day 2. Bowel sounds are absent, and the abdomen is distended. What should the nurse do?
A patient with AAA is on post-op day 2. Bowel sounds are absent, and the abdomen is distended. What should the nurse do?
Which nursing interventions support renal perfusion post-AAA surgery? (Select all that apply)
Which nursing interventions support renal perfusion post-AAA surgery? (Select all that apply)
After AAA repair, a patient's BP is 190/100. What is the nurse's best response?
After AAA repair, a patient's BP is 190/100. What is the nurse's best response?
A nurse finds diminished pedal pulses in a post-op AAA patient. What should the nurse do first?
A nurse finds diminished pedal pulses in a post-op AAA patient. What should the nurse do first?
A client is 12 hours post-endovascular AAA repair. Which finding should be reported immediately?
A client is 12 hours post-endovascular AAA repair. Which finding should be reported immediately?
Which intervention helps prevent thrombus formation at the graft site post-op?
Which intervention helps prevent thrombus formation at the graft site post-op?
A patient with AAA repair is at risk for bowel ischemia. Which nursing assessments are appropriate? (Select all that apply)
A patient with AAA repair is at risk for bowel ischemia. Which nursing assessments are appropriate? (Select all that apply)
A nurse notices a patient is restless and diaphoretic with sudden back pain post AAA repair. What's the immediate action?
A nurse notices a patient is restless and diaphoretic with sudden back pain post AAA repair. What's the immediate action?
What post-op medication is most appropriate to prevent increased pressure on the graft?
What post-op medication is most appropriate to prevent increased pressure on the graft?
A patient has urine output of 20 mL/hr and rising creatinine post-op AAA. What is this likely due to?
A patient has urine output of 20 mL/hr and rising creatinine post-op AAA. What is this likely due to?
What post-op findings support adequate fluid balance? (Select all that apply)
What post-op findings support adequate fluid balance? (Select all that apply)
After AAA repair, the nurse notes an increase in abdominal girth and hypoactive bowel sounds. What complication is suspected?
After AAA repair, the nurse notes an increase in abdominal girth and hypoactive bowel sounds. What complication is suspected?
A client with AAA repair has these labs: Hgb 8.0 g/dL (↓), HR 118, BP 88/60. What does the nurse suspect?
A client with AAA repair has these labs: Hgb 8.0 g/dL (↓), HR 118, BP 88/60. What does the nurse suspect?
A patient develops a sudden fever and elevated WBCs 3 days after open AAA repair. Which assessments support infection? (Select all that apply)
A patient develops a sudden fever and elevated WBCs 3 days after open AAA repair. Which assessments support infection? (Select all that apply)
A patient post-AAA reports severe groin pain and numbness in the foot. What complication is most likely?
A patient post-AAA reports severe groin pain and numbness in the foot. What complication is most likely?
A nurse reviews this trend: BP ↓, HR ↑, urine output ↓, H&H ↓. What should be the next nursing action?
A nurse reviews this trend: BP ↓, HR ↑, urine output ↓, H&H ↓. What should be the next nursing action?
Which patient would be most appropriate for discharge post-endovascular AAA repair?
Which patient would be most appropriate for discharge post-endovascular AAA repair?
A nurse sees cloudy dressing drainage and low-grade fever 5 days post-AAA repair. What should the nurse do?
A nurse sees cloudy dressing drainage and low-grade fever 5 days post-AAA repair. What should the nurse do?
What findings suggest that endovascular repair was successful and the patient is stable? (Select all that apply)
What findings suggest that endovascular repair was successful and the patient is stable? (Select all that apply)
What trend would alert the nurse to worsening renal function after AAA repair?
What trend would alert the nurse to worsening renal function after AAA repair?
A patient with a history of AAA repair presents with pulsatile abdominal mass and hypotension. What is the suspected diagnosis?
A patient with a history of AAA repair presents with pulsatile abdominal mass and hypotension. What is the suspected diagnosis?
Which post-op changes would warrant immediate notification of the provider? (Select all that apply)
Which post-op changes would warrant immediate notification of the provider? (Select all that apply)
Flashcards
Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm (AAA)
Localized dilation or ballooning of the abdominal aorta due to weakening.
Most Common Cause of AAA
Most Common Cause of AAA
Atherosclerosis, weakens arterial walls.
Key AAA Risk Factors
Key AAA Risk Factors
Advanced age, male, hypertension, and smoking.
AAA Risk Factors
AAA Risk Factors
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AAA Diagnostic Tool
AAA Diagnostic Tool
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AAA Before Rupture Symptoms
AAA Before Rupture Symptoms
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AAA Surgical Emergency
AAA Surgical Emergency
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True Aneurysm
True Aneurysm
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Types of True Aneurysms
Types of True Aneurysms
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Post-AAA Minimal Urine Output
Post-AAA Minimal Urine Output
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Why is Hypertension Dangerous in AAA
Why is Hypertension Dangerous in AAA
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Purpose of Angiogram
Purpose of Angiogram
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Intervention for Ruptured AAA
Intervention for Ruptured AAA
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Labs to Monitor Renal Function After AAA
Labs to Monitor Renal Function After AAA
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Signs of Ineffective Tissue Perfusion Post AAA
Signs of Ineffective Tissue Perfusion Post AAA
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Paralytic Ileus Cause
Paralytic Ileus Cause
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Sudden Drop in Hemoglobin Post-AAA Repair
Sudden Drop in Hemoglobin Post-AAA Repair
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Sign of Graft Thrombosis
Sign of Graft Thrombosis
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Symptom Consistent with Bowel Ischemia
Symptom Consistent with Bowel Ischemia
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Pain Control in Post-AAA
Pain Control in Post-AAA
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Study Notes
Abdominal Aortic Aneurysm (AAA) Definition
- Abdominal Aortic Aneurysm (AAA) is defined as a localized dilation or ballooning of the abdominal aorta.
- AAA is often due to weakening of the vessel wall, typically from atherosclerosis.
Common Cause of AAA
- Atherosclerosis causes weakening of arterial walls.
- Atherosclerosis is the most common underlying cause of AAA.
Risk Factors for AAA
- Advanced age, male sex, hypertension, and smoking are key risk factors associated with AAA.
- Other risk factors include obesity and family history.
- Low blood pressure is not a risk factor, but can indicate rupture.
Diagnostic Tool
- Ultrasound is a non-invasive and effective initial imaging tool for detecting and monitoring AAA.
Common Symptoms Before Rupture
- Many AAAs are asymptomatic
- If symptomatic, a pulsating abdominal mass or back pain may be present.
Surgical Emergency
- Sudden severe back or abdominal pain can indicate dissection or rupture, requiring immediate surgical intervention.
True Aneurysm
- A true aneurysm involves dilation of all three vessel layers: intima, media, and adventitia.
Types of True Aneurysms
- Fusiform and saccular aneurysms are types of true aneurysms.
- Dissecting aneurysms and false aneurysms differ structurally.
Renal Perfusion Post-AAA Repair
- Minimum acceptable urine output to indicate adequate renal perfusion is 30 mL/hr.
Uncontrolled Hypertension
- High BP can increase tension on the weakened aneurysm wall, leading to rupture.
Angiogram Before AAA Surgery
- An angiogram provides a detailed image of blood vessels to plan surgical intervention.
Suspected Ruptured AAA Intervention
- Ruptured AAAs are medical emergencies that require immediate surgical intervention.
Lab Values to Monitor for Renal Function
- BUN and creatinine levels help assess kidney function, which can be impaired post-surgery.
Signs of Ineffective Tissue Perfusion Post-AAA Repair
- Absent pulses, cool/pale legs, and paresthesia suggest inadequate blood flow.
- Redness and warmth suggest infection, not perfusion deficit.
Paralytic Ileus After AAA
- Surgical manipulation of the intestines during open AAA repair can result in paralytic ileus.
Sudden Drop in Hemoglobin Post-Op
- A decrease in hemoglobin post-operatively could indicate internal hemorrhage.
Post-op Sign Suggesting Graft Thrombosis
- A lack of peripheral pulses post-operatively can suggest that the graft has clotted.
Symptom Consistent with Bowel Ischemia
- Clamping of the aorta during repair can reduce bowel perfusion, causing distention and decreased sounds.
Importance of Pain Control
- Uncontrolled pain increases BP and HR, which can stress the graft and increase bleeding risk.
Immediate Nursing Action
- Hypotension, tachycardia, and low urine output suggest hypovolemia or hemorrhage.
- Increasing fluids helps support perfusion in this case.
Assessments After Endovascular Aortic Repair
- Groin access sites must be assessed for bleeding.
- Distal perfusion must be monitored with BP and pulse checks.
New Severe Abdominal Pain
- Sudden abdominal pain may indicate a graft leak or rupture and is a medical emergency, notify the provider immediately.
Absent Bowel Sounds, Distended Abdomen
- These are signs of paralytic ileus, which is a potential post-op complication due to decreased perfusion or bowel manipulation, notify the provider.
Interventions to Support Renal Perfusion
- Monitor urine output hourly, monitor BUN and creatinine, provide IV fluids as ordered, and monitor for flank pain.
- Maintaining kidney perfusion requires close monitoring of renal function and adequate circulating volume.
Elevated Post-Op Blood Pressure
- High BP post-op can stress the graft and lead to rupture or leakage, the provider must be notified.
Diminished Pedal Pulses Post-Op
- Confirm the absence or change in pulses before escalating.
- A doppler can help ensure accurate assessment.
Finding to Report Immediately Post-Endovascular Repair
- Swelling and pain at the access site could indicate a hematoma or retroperitoneal bleeding.
Post-Op Intervention to Prevent Thrombus Formation
- Early ambulation promotes circulation and reduces risk of thrombosis and DVT.
Nursing Assessments for Bowel Ischemia Risk
- Bowel perfusion is monitored through GI function and physical signs of distention or ileus.
- Monitor abdominal girth, assess for flatus, bowel sounds, and nausea.
Sudden Back Pain Post-AAA Repair
- Restlessness and diaphoresis with sudden back pain are classic signs of rupture that require immediate emergency response via rapid response team.
Appropriate Post-Op Medication
- Antihypertensives prevent excessive pressure on the surgical site, reducing risk of rupture.
Low Urine Output, Rising Creatinine
- Low urine output and rising creatinine suggest impaired renal perfusion, possibly from graft complications or hypotension.
Post-Op Findings Supporting Adequate Fluid Balance
- Stable BP, clear lungs, output > 30 mL/hr, and warm extremities are indicators of stable fluid status and tissue perfusion.
- A drop in Hct may suggest bleeding.
Increased Abdominal Girth, Hypoactive Bowel Sounds
- Increased girth and decreased bowel activity suggest impaired blood flow to the intestines.
Critical Post-Op Labs
- Low Hgb, hypotension, and tachycardia post-op suggest internal bleeding/hypovolemia.
Findings Supporting Infection Post-Op
- Purulent drainage, decreased appetite, elevated HR, and new pain point to post-op infection.
- Clear urine is not indicative.
Severe Groin Pain, Numbness in Food Post-Op
- Numbness and pain can indicate decreased distal perfusion due to occlusion or thrombosis at the graft.
Reviewing Trends- BP ↓, HR ↑, urine output ↓, H&H↓
- This pattern reflects ongoing hemorrhage and hypoperfusion and needs immediate intervention via notification of the provider with preparation for blood transfusion.
Appropriate Post-Endovascular AAA Repair Discharge
- Incision site dry, pulses present, and ambulating independently indicates good healing, perfusion, and mobility making this patient safe for discharge.
Cloudy Dressing Drainage, Low-Grade Fever
- Possible wound infection requires medical evaluation and antibiotic therapy from the provider.
Findings Suggesting Successful Endovascular Repair
- Distal pulses present, normal bowel sounds, dry incision, and urine output reflect effective circulation, healing, and renal perfusion.
- Elevated BP indicated this is not ideal.
Trend Alerting to Worsening Renal Function
- Increased BUN and creatinine with decreased urine output signal renal hypoperfusion and injury.
Suspected Diagnosis
A pulsatile mass and hypotension strongly suggest aneurysm rupture which is life-threatening.
Post-Op Changes Warranting Immediate Notification
- Absent distal pulses, severe abdominal pain, Hgb drop, and decreased urine output signal impaired perfusion, bleeding, or complication.
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