Mastering Open Aneurysm Repair
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Questions and Answers

What type of graft is used to replace the entire diseased segment in iliac artery aneurysms?

  • Autogenous graft
  • Synthetic graft
  • Patch graft
  • Bifurcated graft (correct)

    • In OAR, what is the purpose of aortic cross-clamping?

  • To suture the synthetic graft to the aorta
  • To temporarily stop blood flow (correct)
  • To remove any thrombus or plaque
  • To repair the artery by primary closure

    • How long does it typically take to perform most resections in OAR?

  • 30 to 45 minutes (correct)
  • 45 to 60 minutes
  • Less than 30 minutes
  • More than 60 minutes

    • What is the main risk postoperative in OAR?

    <p>Acute kidney injury</p> Signup and view all the answers

    What type of aneurysms may be repaired by primary closure or patch graft?

    <p>Saccular aneurysms</p> Signup and view all the answers

    When are the aortic clamps removed in OAR?

    <p>After blood flow is restored</p> Signup and view all the answers

    Which of the following is NOT one of the 4 steps of Open aneurysm repair (OAR)?

    <p>Removing any thrombus or plaque</p> Signup and view all the answers

    What is the purpose of a synthetic graft in Open aneurysm repair (OAR)?

    <p>To replace the diseased segment of the aorta</p> Signup and view all the answers

    In Open aneurysm repair (OAR), what is the role of the native aortic wall?

    <p>To act as a protective cover around the graft</p> Signup and view all the answers

    Which of the following is the first step in Open aneurysm repair (OAR)?

    <p>Cutting into the diseased aortic segment</p> Signup and view all the answers

    What is the purpose of suturing a synthetic graft to the aorta proximal and distal to the aneurysm in OAR?

    <p>To act as a protective cover</p> Signup and view all the answers

    What is the final step in Open aneurysm repair (OAR)?

    <p>Suturing the native aortic wall around the graft</p> Signup and view all the answers

    Which of the following is a key eligibility criteria for minimally invasive endovascular aneurysm repair (EVAR)?

    <p>Adequate iliofemoral vessels</p> Signup and view all the answers

    What is the main advantage of EVAR over OAR?

    <p>Shorter hospital stay</p> Signup and view all the answers

    What is the most common complication of AAA repair?

    <p>Endoleak</p> Signup and view all the answers

    What is the purpose of coil embolization in AAA repair?

    <p>Hemostasis</p> Signup and view all the answers

    What is the purpose of periodic imaging in patients undergoing EVAR?

    <p>Monitoring for endoleak</p> Signup and view all the answers

    What is the most common material used for EVAR grafts?

    <p>Dacron</p> Signup and view all the answers

    What is the purpose of flexible wire rings in EVAR grafts?

    <p>Supporting the graft</p> Signup and view all the answers

    What is the main complication associated with OAR?

    <p>Paraplegia</p> Signup and view all the answers

    What may cause endoleak in AAA repair?

    <p>Inadequate seal at graft ends</p> Signup and view all the answers

    What is the purpose of graft insertion in EVAR?

    <p>Replacing the aneurysm</p> Signup and view all the answers

    Which of the following is a potential complication of emergency repair of a ruptured AAA?

    <p>Intraabdominal hypertension</p> Signup and view all the answers

    What is a sign of compartment syndrome in the context of AAA repair?

    <p>Pain that worsens with stretching</p> Signup and view all the answers

    What does IAH (Intra-abdominal hypertension) reduce in the body?

    <p>Blood flow to the viscera</p> Signup and view all the answers

    How is IAH confirmed?

    <p>By measuring intraabdominal pressure indirectly</p> Signup and view all the answers

    What are the treatment goals for IAH?

    <p>Control of situations that lead to IAH</p> Signup and view all the answers

    What are the interventions for IAH?

    <p>All of the above</p> Signup and view all the answers

    What are some conservative measures used for IAH?

    <p>All of the above</p> Signup and view all the answers

    How is IAH associated with abdominal compartment syndrome?

    <p>It impairs organ perfusion</p> Signup and view all the answers

    What is the purpose of pain management in IAH treatment?

    <p>To relieve pain</p> Signup and view all the answers

    Which of the following is a potential complication of emergency repair of a ruptured AAA?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is a key sign of compartment syndrome?

    <p>Deep and constant pain</p> Signup and view all the answers

    What is the purpose of monitoring the 6 P's in emergency repair of a ruptured AAA?

    <p>To identify potential complications</p> Signup and view all the answers

    Which of the following interventions is NOT used for the treatment of IAH?

    <p>Temporary hemofiltration</p> Signup and view all the answers

    What are the treatment goals for IAH?

    <p>Control of situations that lead to IAH</p> Signup and view all the answers

    Which of the following is NOT a measure used in the conservative treatment of IAH?

    <p>Temporary hemofiltration</p> Signup and view all the answers

    Interventions for IAH include ______, percutaneous drainage, and percutaneous drainage combined with a thrombolytic infusion.

    <p>open (surgical) decompression</p> Signup and view all the answers

    Conservative measures for IAH include intubation, ventilation, patient positioning, gastric decompression, cautious fluid resuscitation, pain management, and temporary ______.

    <p>hemofiltration</p> Signup and view all the answers

    Treatment goals for IAH include control of situations that lead to IAH and ______.

    <p>conservative measures</p> Signup and view all the answers

    Which of the following is NOT a sign of aneurysm rupture?

    <p>Peripheral pules changes</p> Signup and view all the answers

    What is the purpose of marking pedal pulse sites before surgery?

    <p>To ensure accurate postoperative assessment</p> Signup and view all the answers

    What should the nurse pay special attention to in the patient's assessment for aortic aneurysms?

    <p>Neurologic status</p> Signup and view all the answers

    Which of the following is a key component of nursing management for aortic aneurysms?

    <p>Assessing peripheral pulses</p> Signup and view all the answers

    What is the purpose of establishing baseline data in nursing management for aortic aneurysms?

    <p>To compare with later assessments</p> Signup and view all the answers

    Which of the following is a potential complication of aortic aneurysms?

    <p>Aneurysm rupture</p> Signup and view all the answers

    Which of the following signs is NOT associated with aneurysm rupture?

    <p>Hypotension</p> Signup and view all the answers

    Which of the following signs is NOT commonly associated with aneurysm rupture?

    <p>Altered level of consciousness</p> Signup and view all the answers

    Which of the following signs is commonly associated with aneurysm rupture?

    <p>Pallor</p> Signup and view all the answers

    Which of the following signs is NOT a sign of aneurysm rupture?

    <p>Hypotension</p> Signup and view all the answers

    Which of the following signs should the nurse monitor for in a patient with aneurysm rupture?

    <p>Back pain</p> Signup and view all the answers

    Which of the following signs is commonly associated with aneurysm rupture?

    <p>Diaphoresis</p> Signup and view all the answers

    Which of the following signs is NOT associated with aneurysm rupture?

    <p>Pallor</p> Signup and view all the answers

    Which of the following signs should the nurse monitor for in a patient with aneurysm rupture?

    <p>Periumbilical pain</p> Signup and view all the answers

    Which of the following assessments should the nurse prioritize in the management of aortic aneurysms?

    <p>Monitoring peripheral pulses</p> Signup and view all the answers

    What is the purpose of marking pedal pulse sites before aortic aneurysm surgery?

    <p>To ensure accurate postoperative assessment</p> Signup and view all the answers

    What should the nurse establish before surgery to guide future assessments in aortic aneurysm management?

    <p>Baseline data</p> Signup and view all the answers

    Which of the following assessments should the nurse pay special attention to in the management of aortic aneurysms?

    <p>Peripheral pulses and neurologic status</p> Signup and view all the answers

    What should the nurse do before surgery in the management of aortic aneurysms?

    <p>Document any skin lesions</p> Signup and view all the answers

    What is the purpose of establishing baseline data in nursing management for aortic aneurysms?

    <p>To compare with later assessments</p> Signup and view all the answers

    Which position is recommended for a patient post op AAA surgery?

    <p>Semi fowlers position</p> Signup and view all the answers

    What is the purpose of monitoring arterial blood pressure every 2-3 minutes until stable post op AAA surgery?

    <p>To evaluate for potential complications</p> Signup and view all the answers

    Which medication is used for pain management post op AAA surgery?

    <p>Opioids</p> Signup and view all the answers

    What should the nurse assess when checking pulses and the 6 P's post op AAA surgery?

    <p>Neurological status</p> Signup and view all the answers

    Which layer of the arterial wall is involved in aortic dissection?

    <p>Media</p> Signup and view all the answers

    Which type of aortic dissection affects the ascending aorta and arch, requiring emergency surgery?

    <p>Type A dissection</p> Signup and view all the answers

    How is aortic dissection classified based on symptom onset?

    <p>Acute, subacute, chronic</p> Signup and view all the answers

    Is aortic dissection considered a type of aneurysm?

    <p>No</p> Signup and view all the answers

    Which of the following is a classification of aortic dissection based on symptom onset?

    <p>Acute aortic dissection</p> Signup and view all the answers

    When does subacute aortic dissection occur?

    <p>Between 14 to 90 days</p> Signup and view all the answers

    What is the classification of aortic dissection that occurs after 90 days of symptom onset?

    <p>Chronic aortic dissection</p> Signup and view all the answers

    Which type of aortic dissection is more likely to present with pain in the back, abdomen, or legs?

    <p>Type B aortic dissection</p> Signup and view all the answers

    What percentage of patients with an acute Type A aortic dissection report an abrupt onset of severe anterior chest or back pain?

    <p>80%</p> Signup and view all the answers

    How may the pain associated with aortic dissection be described?

    <p>Sharp and worst ever</p> Signup and view all the answers

    Which of the following is a distinguishing feature between dissection pain and MI pain?

    <p>Dissection pain follows the path of the dissection</p> Signup and view all the answers

    Which of the following is more likely to be experienced by older patients with aortic dissection?

    <p>Hypotension</p> Signup and view all the answers

    Which of the following emphasizes the importance of physical examination in diagnosing aortic dissection?

    <p>Painless aortic dissection</p> Signup and view all the answers

    Which of the following is a characteristic of dissection pain compared to MI pain?

    <p>Dissection pain has a more gradual onset</p> Signup and view all the answers

    Which of the following is a symptom of aortic arch dissection?

    <p>Weakened or absent carotid and temporal pulses</p> Signup and view all the answers

    Which type of aortic dissection is more likely to cause disruption of blood flow in the coronary arteries and aortic valve insufficiency?

    <p>Type A aortic dissection</p> Signup and view all the answers

    Which of the following is NOT a symptom of aortic arch dissection?

    <p>Abdominal organ dysfunction</p> Signup and view all the answers

    In aortic dissection, if the aortic arch is involved, what symptom may the patient have?

    <p>Neurologic deficits</p> Signup and view all the answers

    Which of the following is a potential symptom of aortic dissection in older patients?

    <p>Hypotension</p> Signup and view all the answers

    What may be different between the left and right arms in aortic dissection involving the subclavian artery?

    <p>Radial, ulnar, and brachial pulse quality</p> Signup and view all the answers

    As the aortic dissection progresses down the aorta, which areas may show evidence of decreased tissue perfusion?

    <p>Abdominal organs and lower extremities</p> Signup and view all the answers

    Which of the following is the main cause of nontraumatic aortic dissection?

    <p>Weakened elastic fibers in the arterial wall</p> Signup and view all the answers

    What is the consequence of a tear developing in the inner layer of the aorta in aortic dissection?

    <p>The inner layer separates from the outer layer of the aorta</p> Signup and view all the answers

    What is the outcome when the blood-filled channel in aortic dissection ruptures through the outside aortic wall?

    <p>The aortic dissection becomes fatal</p> Signup and view all the answers

    Which of the following is the most important risk factor for aortic dissection?

    <p>Hypertension</p> Signup and view all the answers

    Which gender is at a higher risk for developing aortic dissection?

    <p>Men</p> Signup and view all the answers

    What is the severe and life-threatening complication of an acute ascending aortic dissection called?

    <p>Cardiac tamponade</p> Signup and view all the answers

    Which of the following organs may experience occlusion of blood supply due to aortic dissection?

    <p>Brain, kidneys, spinal cord, and extremities</p> Signup and view all the answers

    What is the manifestation of tamponade associated with cardiac tamponade?

    <p>Hypotension, narrowed pulse pressure, jugular venous distention, muffled heart sounds, and pulsus paradoxus</p> Signup and view all the answers

    What can happen to the false lumen in aortic dissection?

    <p>It ruptures</p> Signup and view all the answers

    What is a potential complication of emergency repair of a ruptured AAA?

    <p>Hemorrhage</p> Signup and view all the answers

    Which of the following is NOT a predisposing factor for aortic dissection?

    <p>Gender</p> Signup and view all the answers

    What is the potential complication of an aorta weakened by dissection?

    <p>Aortic rupture</p> Signup and view all the answers

    What is the potential complication of aortic dissection that can lead to renal failure?

    <p>Renal ischemia</p> Signup and view all the answers

    Which diagnostic study is preferred in very unstable patients or those with contraindications to CT or MRI?

    <p>TEE</p> Signup and view all the answers

    Which diagnostic study can provide more detailed information on the severity of the aortic dissection and related complications?

    <p>3-D CT scanning</p> Signup and view all the answers

    Which diagnostic study may show a widening of the mediastinum and pleural effusion?

    <p>Chest x-ray</p> Signup and view all the answers

    Which diagnostic study utilizes 3-D technology to visualize the aortic dissection?

    <p>3-D CT scanning</p> Signup and view all the answers

    Which diagnostic study can help rule out cardiac ischemia?

    <p>ECG</p> Signup and view all the answers

    Which diagnostic study is commonly used to detect aortic dissection and suspected aneurysms?

    <p>3-D CT scanning</p> Signup and view all the answers

    Which diagnostic study is considered the gold standard for diagnosing aortic dissection?

    <p>3-D CT scanning</p> Signup and view all the answers

    Which of the following is the initial goal of therapy for acute aortic dissection without complications?

    <p>All of the above</p> Signup and view all the answers

    What is the target heart rate for acute aortic dissection management?

    <p>Under 60 beats/min</p> Signup and view all the answers

    Which medication can be used to lower heart rate if a β-blocker is contraindicated?

    <p>Diltiazem</p> Signup and view all the answers

    What is the purpose of HR and BP control in acute aortic dissection management?

    <p>To reduce aortic wall stress</p> Signup and view all the answers

    What does morphine do in the management of acute aortic dissection?

    <p>Relieves pain</p> Signup and view all the answers

    What is the role of supportive treatment in acute aortic dissection management?

    <p>To serve as a bridge to surgery</p> Signup and view all the answers

    Which of the following is NOT a goal of therapy for acute aortic dissection without complications?

    <p>Surgical intervention</p> Signup and view all the answers

    Which type of aortic dissection is typically treated conservatively without complications?

    <p>Chronic Type B aortic dissection</p> Signup and view all the answers

    What is the treatment option for acute Type B aortic dissections with complications?

    <p>Endovascular dissection repair</p> Signup and view all the answers

    Which procedure is similar to EVAR and has fewer postsurgical complications in the treatment of aortic dissection?

    <p>Thoracic endovascular aortic repair</p> Signup and view all the answers

    What are the potential complications that TEVAR does not prevent in the treatment of aortic dissection?

    <p>Renal failure, paraplegia, and stroke</p> Signup and view all the answers

    What may be inserted during Thoracic endovascular aortic repair to help decrease or prevent neurologic complications?

    <p>Lumbar spinal drain</p> Signup and view all the answers

    What is the essential technique to prevent infection when using a lumbar drain during Thoracic endovascular aortic repair?

    <p>Strict aseptic technique</p> Signup and view all the answers

    What is the treatment goal for chronic Type B aortic dissection with complications, such as peripheral ischemia?

    <p>Endovascular dissection repair</p> Signup and view all the answers

    What is the purpose of surveillance imaging with CT or MRI in the conservative therapy of aortic dissection?

    <p>To detect complications</p> Signup and view all the answers

    Which type of aortic dissection requires emergency surgery?

    <p>Type A aortic dissection</p> Signup and view all the answers

    What is the mortality rate within 48 hours of symptom onset for surgical therapy in acute Type A aortic dissection?

    <p>50%</p> Signup and view all the answers

    When is surgical therapy indicated in acute Type A aortic dissection?

    <p>When complications occur</p> Signup and view all the answers

    What is the recommended treatment for patients with a chronic dissection and a connective tissue disorder or an aneurysm greater than 5.5 cm?

    <p>Open surgical repair</p> Signup and view all the answers

    What is the purpose of delaying surgery in aortic dissection when possible?

    <p>To allow time for edema to decrease</p> Signup and view all the answers

    What is involved in aortic dissection surgery?

    <p>Resection of the aortic segment with the intimal tear and replacement with a synthetic graft</p> Signup and view all the answers

    What are some causes of death in aortic dissection?

    <p>Myocardial infarction, stroke, multiorgan failure</p> Signup and view all the answers

    Which of the following is NOT a potential complication of aortic aneurysms?

    <p>Bleeding</p> Signup and view all the answers

    What is the most important risk factor for aortic dissection?

    <p>High blood pressure</p> Signup and view all the answers

    Which of the following is a potential complication of aortic dissection?

    <p>Distal ischemia</p> Signup and view all the answers

    What is the purpose of periodic imaging in patients undergoing EVAR?

    <p>To assess graft migration</p> Signup and view all the answers

    Which of the following is a symptom of aortic arch dissection?

    <p>Hematoma</p> Signup and view all the answers

    What is the severe and life-threatening complication of an acute ascending aortic dissection called?

    <p>Rupture graft</p> Signup and view all the answers

    What are some conservative measures used for Intrabdominal Hypertension (IAH)?

    <p>Catheter and transducer</p> Signup and view all the answers

    Which of the following assessments should the nurse prioritize in the management of aortic aneurysms?

    <p>Site and distal pulses assessment</p> Signup and view all the answers

    What is the outcome when the blood-filled channel in aortic dissection ruptures through the outside aortic wall?

    <p>Endo leak</p> Signup and view all the answers

    Which diagnostic study may show a widening of the mediastinum and pleural effusion?

    <p>EVAR</p> Signup and view all the answers

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