Aneurysm Lecture Notes PDF

NEUROLOGICAL AND CARDIOVASCULAR LECTURE: ANEURYSMS BASIC MEDICAL SURGICAL NURSING, NUR 1210C 1  ANEURYSMS Weakening of vessels causing permanent dilation of an artery Found typical...

NEUROLOGICAL AND CARDIOVASCULAR LECTURE: ANEURYSMS BASIC MEDICAL SURGICAL NURSING, NUR 1210C 1  ANEURYSMS Weakening of vessels causing permanent dilation of an artery Found typically at specific sites: Cerebral, abdominal, thoracic, peripheral Occur at points with no support Not attached to skeletal muscle or at bends/curvature in artery Cerebral aneurysm – occurs in the brain Aortic aneurysm – occurs in aorta Thoracic or peripheral – named depending on where it is Triple AAA – abdominal, aortic aneurysm Aneurysm – weakening of vessels at a part of artery and causes a pouch Worry – rupturing of weak aneurysms Problem with bifurcation aneurysm – can weaken all vessels and make it easier to rupture 2  TYPES OF ANEURYSMS FUSIFORM SACCULAR ANEURYSM Dilation affecting entire Outpouching of only a circumference of the specific portion of the artery artery Fusiform – circles around artery, ballooning of entire vessel Saccular – outpouching like a pimple, only one side 3  CHARACTERISTICS OF ANEURYSMS TRUE VS FALSE DISSECTING True Blood leaks into Weakened by congenital or and fills the wall of acquired problems the artery False Causes separation Weakening of all 3 muscle of the layers of the layers resulting from artery trauma or injury Blood flow is decreased to distal organs True aneurysm – created by genetics, created when born false aneurysm – from trauma or injury ○ example – hit in the neck, carotid started to develop aneurysm ○ whatever hit person in the neck weakened muscles of the vessel dissecting aneurysm ○ when blood leaks into intima or between media of our blood vessels ○ this causes → ballooning effect pulls apart vessel blood fills into balloon/internal pocket overtime = blood balloon makes huge pocket ○ blood going into pocket leads to lessened blood flow to organs ○ especially concerning for huge arteries like aorta – distal organs like legs, knees, etc have decreased perfusion ○ will keep dissecting until it ruptures 4  RISK FACTORS MODIFIABLE NON-MODIFIABLE Atherosclerosis Age Hypertension Gender Illicit drug use Family history Hyperlipidemia Smoking Alcohol abuse atherosclerosis – plaque that builds up in arterial walls, damaging the vasculature hypertension – causes constant pressure in arteries cocaine – causes sudden changes in pressure in body, can lead to hypertensive crisis smoking – damages vessels non-modifiable being older men are more likely to have aneurysms family history  DIAGNOSTICS Computed tomography (CT) scan with contrast Ultrasonography/Ultrasound (US) Medical Exam Patient history outpouching can use ultrasound CT scan w contrast – highlights vessel of concern, abdominal aortic aneurysm – sometimes seen in abdomen from pulsating mass ○ IMPORTANT NOT TO TOUCH IT – pressure on weak vessel could cause rupture patient history ○ have they been smoking for a long time? ○ have they been drinking alcohol for a long time? ○ do they have risk factors? ○ for cerebral aneurysms – have they had headaches, recent strokes, neuro changes typically no symptoms due to just weakening of vessels  SIGNS AND SYMPTOMS Initially asymptomatic Thoracic aortic aneurysm (TAA) Back pain Symptoms typically related to site Shortness of breath, hoarseness, of aneurysm difficulty swallowing Abdominal aortic aneurysm (AAA) Brain aneurysm May have abdominal, flank or back Headaches pain Vision changes Pain may be gnawing, unaffected by mobility, lasting for hours to days Numbness or tingling to head/face Pulsing mass near umbilicus Seizures Difficulty concentrating abdominal aneurysm ○ may have pain ○ may have a mass thoracic aortic aneurysm (TAA) ○ can cause difficulty breathing if big enough and pushing on organs (if large) pressing on lungs ○ could press on back and cause back pain ○ symptoms depend on where aneurysm typically is brain aneurysm ○ large enough and pressing on brain → seizures ○ difficulty concentrating  RUPTURED ANEURYSM: AAA Most severe complication of aneurysms Critically ill patients Risk for hypovolemic shock due to hemorrhage Interventions for ruptured Signs and Symptoms aneurysm: Severe hypotension If suspected, call RRT and MD Diaphoresis Large bore IV Decreased level of consciousness (LOC) Emergency surgery performed Oliguria (scant urine output) Frequent assessments Loss of distal pulses Dysrhythmias Frequent vital signs Retroperitoneal (aka flank or lower back) bruising/hematoma Abdominal distention all aneurysms can rupture rupture → worst thing that can happen ○ once ruptured – blood leaves vessels AAA – blood flow for kidneys, legs, pelvic organs, GI tract = patient gets acutely ill and could die quickly hypovolemic shock due to severe hemorrhage → severely drops BP not enough circulating oxygen critically ill patients – can lead to death quickly not enough blood volume sweating kidneys stop working – oliguria decreased consciousness no distal pulses dysrhythmias – due to heart being ischemic retroperitoneal bleeding – lot of blood pooling and settling in abs large enough rupture = can lead to distended abdomen if you see this – call doc, RRT IMMEDIATELY large bore 18 gauge IV needed to give a lot of blood back ○ many fluids given as well  surgery is needed ASAP – typically rapid response is called and they’re rushed off to surgery simultaneously teamwork needed for this: someone getting fluid, someone getting IV, someone getting bed ready to roll them, vital signs constantly vitals ○ done every 5 minutes, every 10 minutes, every 30 seconds = all dependent on how fast  TREATMENT OF UNRUPTURED ANEURYSMS: AAA Non-surgical management Surgical Management Do NOT palpate Resection or repair Monitor for signs and symptoms of Stent grafts rupture Post-op care like other Maintain normal blood pressure angiographies Manage hypertension to prevent rupture Complications of stent Frequent US or CT grafts: Educate patients on signs and symptoms Rupture of rupture and importance of strict blood Infection pressure management Bleeding Stop smoking, illicit drug use or alcohol Peripheral abuse embolisms do NOT touch need to maintain normal pressure – need systolic of 90 or less ultrasound, CTs – making sure its not getting bigger if it’s getting bigger we need to intervene stent graft – prevents blood flow into damage area ○ very difficult to treat ○ can end up still having blood loss important to recognize modifiable s/s bleeding – internal blood loss  AORTIC DISSECTION Life-threatening Signs and Symptoms Sharp, ripping, tearing, stabbing Causes: pain Hypertension Diaphoresis Connective tissue Nausea/vomiting disorders (Marfan Syndrome) Fainting Gender Pallor Age Rapid, weak pulse Apprehension CTA to confirm BP elevated (unless ruptured) TEE at bedside if unable to transport aortic arch is affected blood is going into intima and media hypertension – most common cause martin syndrome – elongated connected tissue, very tall and lanky in nature ○ typically die from aneurysms males – at risk middle aged adults – when we see aortic dissections forming CTA – to confirm blood fills into pocket → distal organs need oxygen → HR increases due to body demanding more oxygen hypertension will occur unless already ruptured BP elevated with hypertensive patients 10  TREATMENT OF AORTIC DISSECTION Hospital Management Long Term Management Maintain SBP of 100-120 mm hg Maintain BP less than 120/80 mm IV BP medications hg Large bore IVs for fluids and IV Educate on strict BP control medication administration Beta blockers or calcium channel IV Morphine blockers Indwelling catheter may be indicated Potential Surgical repair maintain BP IV fluids for pain – IV morphine for strict I/O monitoring – may need catheter may or MAY NOT get repaired – sometimes with managing BP, body repairs itself long-term – patients need to control BP after d/c ○ check BP every couple of hours keep a log, take medicine as described typically on calcium channel blockers or beta blockers – decreases workload of heart ○ beta blockers – decreases workload of heart, less pressure ○ calcium channel blocker – dilates vessels and takes off pressure