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 (C)</p> Signup and view all the answers

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

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

When are the aortic clamps removed in OAR?

<p>After blood flow is restored (D)</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 (A)</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 (B)</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 (D)</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 (A)</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 (A)</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 (B)</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 (D)</p> Signup and view all the answers

What is the main advantage of EVAR over OAR?

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

What is the most common complication of AAA repair?

<p>Endoleak (C)</p> Signup and view all the answers

What is the purpose of coil embolization in AAA repair?

<p>Hemostasis (A)</p> Signup and view all the answers

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

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

What is the most common material used for EVAR grafts?

<p>Dacron (D)</p> Signup and view all the answers

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

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

What is the main complication associated with OAR?

<p>Paraplegia (D)</p> Signup and view all the answers

What may cause endoleak in AAA repair?

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

What is the purpose of graft insertion in EVAR?

<p>Replacing the aneurysm (C)</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 (B)</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 (A)</p> Signup and view all the answers

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

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

How is IAH confirmed?

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

What are the treatment goals for IAH?

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

What are the interventions for IAH?

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

What are some conservative measures used for IAH?

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

How is IAH associated with abdominal compartment syndrome?

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

What is the purpose of pain management in IAH treatment?

<p>To relieve pain (D)</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 (C)</p> Signup and view all the answers

What is a key sign of compartment syndrome?

<p>Deep and constant pain (C)</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 (A)</p> Signup and view all the answers

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

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

What are the treatment goals for IAH?

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

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

<p>To ensure accurate postoperative assessment (C)</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 (D)</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 (C)</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 (B)</p> Signup and view all the answers

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

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

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

<p>Hypotension (D)</p> Signup and view all the answers

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

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

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

<p>Pallor (C)</p> Signup and view all the answers

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

<p>Hypotension (D)</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 (D)</p> Signup and view all the answers

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

<p>Diaphoresis (C)</p> Signup and view all the answers

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

<p>Pallor (D)</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 (B)</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 (C)</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 (B)</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 (C)</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 (A)</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 (D)</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 (B)</p> Signup and view all the answers

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

<p>Semi fowlers position (B)</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 (D)</p> Signup and view all the answers

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

<p>Opioids (B)</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 (C)</p> Signup and view all the answers

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

<p>Media (A)</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 (D)</p> Signup and view all the answers

How is aortic dissection classified based on symptom onset?

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

Is aortic dissection considered a type of aneurysm?

<p>No (A)</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 (A)</p> Signup and view all the answers

When does subacute aortic dissection occur?

<p>Between 14 to 90 days (A)</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 (C)</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 (A)</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% (C)</p> Signup and view all the answers

How may the pain associated with aortic dissection be described?

<p>Sharp and worst ever (B)</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 (C)</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 (D)</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 (D)</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 (C)</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 (B)</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 (D)</p> Signup and view all the answers

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

<p>Abdominal organ dysfunction (B)</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 (D)</p> Signup and view all the answers

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

<p>Hypotension (C)</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 (B)</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 (A)</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 (B)</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 (C)</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 (D)</p> Signup and view all the answers

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

<p>Hypertension (C)</p> Signup and view all the answers

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

<p>Men (D)</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 (B)</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 (C)</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 (B)</p> Signup and view all the answers

What can happen to the false lumen in aortic dissection?

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

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

<p>Hemorrhage (B)</p> Signup and view all the answers

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

<p>Gender (A)</p> Signup and view all the answers

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

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

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

<p>Renal ischemia (A)</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 (C)</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 (A)</p> Signup and view all the answers

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

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

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

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

Which diagnostic study can help rule out cardiac ischemia?

<p>ECG (C)</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 (A)</p> Signup and view all the answers

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

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

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

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

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

<p>Diltiazem (C)</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 (C)</p> Signup and view all the answers

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

<p>Relieves pain (B)</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 (B)</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 (D)</p> Signup and view all the answers

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

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

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

<p>Endovascular dissection repair (C)</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 (C)</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 (C)</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 (D)</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 (B)</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 (C)</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 (B)</p> Signup and view all the answers

Which type of aortic dissection requires emergency surgery?

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

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

<p>When complications occur (B)</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 (B)</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 (C)</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 (A)</p> Signup and view all the answers

What are some causes of death in aortic dissection?

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

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

<p>Bleeding (B)</p> Signup and view all the answers

What is the most important risk factor for aortic dissection?

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

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

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

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

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

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

<p>Hematoma (D)</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 (C)</p> Signup and view all the answers

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

<p>Catheter and transducer (B)</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 (C)</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 (B)</p> Signup and view all the answers

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

<p>EVAR (A)</p> Signup and view all the answers

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