Overview
This lecture covers aneurysms, including their types, risk factors, clinical manifestations, diagnosis, treatment, nursing care, and post-op management.
Aneurysm Basics
- An aneurysm is a localized dilation at a weak point in an artery wall.
- Formed due to damage of the vessel's media layer.
- Classified by shape: false, true, fusiform, saccular, and dissecting.
- Saccular and fusiform are the most common types.
- Risk of rupture increases with aneurysm size; rupture can cause fatal hemorrhage.
Risk Factors and Causes
- Major risk factors: smoking, hyperlipidemia, male gender, family history.
- Causes include congenital connective tissue disorders (e.g., Marfan, Turner syndrome), hypertension, trauma, infection, and atherosclerosis.
Thoracic Aortic Aneurysms
- Most commonly caused by atherosclerosis, especially in men aged 50–70.
- High risk for dissection and has high mortality.
- Pre-dissection symptoms: often asymptomatic, can include dyspnea, cough, hoarse voice, dysphagia, or discomfort in chest/back/jaw/neck.
- Dissection symptoms: tearing pain, cyanosis, hypotension, tachycardia, unequal arm blood pressures.
- Diagnosed by chest X-ray or CT angiography.
Abdominal Aortic Aneurysms
- Also mainly caused by atherosclerosis; more common in men, Caucasians, and those over 65.
- Untreated, most will rupture and cause death.
- 60% asymptomatic, 40% have symptoms like a throbbing abdomen or pulsatile mass.
- Signs of rupture: severe back or abdominal pain, hypotension, increasing abdominal girth, scrotal/flank hematomas.
- Hallmark: pulsatile mass in mid-upper abdomen; abdominal bruit heard on auscultation; CT/ultrasound for size/location.
Nursing Considerations
- Never palpate an abdominal pulsatile mass to avoid rupture.
- Monitor blood pressure and CBC; teach patient to avoid bending, lifting, or constipation.
Treatment & Management
- Manage blood pressure to slow aneurysm growth and prevent dissection.
- For dissection/rupture: emergency BP control (IV beta blockers, nitroprusside), target systolic BP 90–120 mmHg, MAP 65–75.
- Calm, bed rest, oxygen, blood transfusion, and emergency surgery if ruptured.
Surgical and Postoperative Care
- Main treatment is resection and grafting via minimally invasive artery approach.
- Post-op: patient supine for 6 hours, then HOB up to 45° after 2 hours; keep affected leg straight.
- Frequent vitals and Doppler pulse checks; assess insertion site for bleeding/hematoma.
- Report to provider: bleeding, swelling, pain, cyanosis, systolic BP >180 mmHg, persistent cough/sneeze/vomit.
- Monitor temp every 4 hours; watch for post-manipulation syndrome (fever, leukocytosis).
- Encourage fluids, normal diet, monitor renal function (risk of contrast-induced injury).
Key Terms & Definitions
- Aneurysm — Localized dilation of an artery due to vessel wall weakness.
- Dissection — Separation of the arterial wall layers, leading to rupture risk.
- Atherosclerosis — Plaque buildup in arteries causing vessel narrowing and weakening.
- Pulsatile Mass — A rhythmic bulge, usually in the abdomen, suggestive of aneurysm.
- Bruit — Turbulent blood flow sound heard over an artery with a stethoscope.
Action Items / Next Steps
- Review aneurysm types, risk factors, and clinical signs.
- Study aneurysm management protocols and post-op care.
- Prepare for upcoming exam questions on aneurysms and related emergencies.