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 36 Cardiovascular system CAUSES • Atherosclerosis Congenital defect • Hypertension • Infection Marfan syndrome • Syphilis • Trauma ASSESSMENT FINDINGS Abdominal mass to th e left o f the mi dline Abdominal pulsations Bruits ov er the site of the aneury sm Commonly asymptomatic Diminished femoral pulses Lower abdominal pain • Lower back pain Systolic bl ood press ure in the legs that’s lower than that in the arms DIAGNOSTIC TEST RESULTS Abdominal computed tomography scan shows aneurysm. Abdominal ultrasound shows aneurysm. Arteriography shows aneurysm. Chest X-ray shows aneurysm. ECG differenti ates aneurysm from MI. NURSING DIAGNOSES • Acute pain • Anxiety Ineffective tissue p erfusion: Peripheral Risk for deficient fluid volume TREATMENT • Abdominal aortic aneurysm resection Bed rest Drug therapy Analgesic: oxycodone (OxyContin ) Antihypertensives: prazosin (Minipress), nitroprusside (Nitropress), nitroglycerin Beta-adrenergi c blo cker: propranolo l (Inderal), metoprolol (Lopressor) INTERVENTIONS AND RATIONALES • Assess cardiovascular status and monitor and record vital signs. Tachycardia, dyspnea or hypotension may indicate fluid volume deficit caused by rupture of aneurysm. Monitor intake and output and laboratory studies.  Low urine output and high specific  gravity indicate hypovolemia. Observe the client fo r signs of hypovo- lemic shock from aneurysm rupture, such as anxiety, restlessness, severe back pain, decreased pulse pressure, increased thready pulse, and pale, cool, moist, clammy skin, to detect early signs of compromise. Gently p alpate the abdomen fo r distention.  Increasing distention may signify imp ending rupture. Check peripheral circulation: pulses, temperature, color, and complaints of abnormal sensations to detect poor arterial blood flow. Assess pain to detect enlarging aneurysm or rupture. Administer medications , as prescribed, to reduce hypertension and control pain. Encourage the client to express feelings such as a fear of dying to reduce anxiety. • Maintain a qui et environment to control blood pressure and reduce risk of rupture. Teaching topics Explanatio n of the disorder and treatment plan Medications and possible adverse effects Signs and symptoms of dec reased peripheral circulati on, such as change in skin color or temperature, complaints of numbness or tingling, and absent pulses Activity limitations, including alternating rest periods with activity, and adhering to pre- scribed exercise and diet regimen Angina  Angina is ches t pain caused by inadequate myocardial oxygen supply. It’s usually caused by narrowing of the coronary arteries, which results from plaque accumulation in the intimal lining.  Angina is gen erally catego rized a s one of three main forms: stable, unstable (an acute coronary syndrome), or Prinzmetal’s (variant). • In stable angina, symptoms a re consistent and pain is relieved by rest. In unstable angina, pa in is marked by increasing severity, duration, and frequency. Pain from unstable angina responds slowly to nitroglycerin and isn’t relieved by rest. In Prinzmet al’s angina, pain is unpredict- able and may occur at rest. Angina isn’t hard to understand. If I don’t get enough oxygen, it hurts.

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• Abdominal pulsations
• Commonly asymptomatic
lower than that in the arms
DIAGNOSTIC TEST RESULTS
NURSING DIAGNOSES
• Acute pain
TREATMENT 
and record vital signs. Tachycardia, dyspnea
or hypotension may indicate fluid volume
deficit caused by rupture of aneurysm.
• Monitor intake and output and laboratory
studies. Low urine output and high specific
 gravity indicate hypovolemia.
lemic shock from aneurysm rupture, such
as anxiety, restlessness, severe back pain,
decreased pulse pressure, increased thready
pulse, and pale, cool, moist, clammy skin, to
detect early signs of compromise.
• Gently palpate the abdomen for distention.
 Increasing distention may signify impending
rupture.
abnormal sensations to detect poor arterial
blood flow.
rupture.
• Encourage the client to express feelings
such as a fear of dying to reduce anxiety.
• Maintain a quiet environment to control
blood pressure and reduce risk of rupture.
Teaching topics 
plan
peripheral circulation, such as change in skin
color or temperature, complaints of numbness
or tingling, and absent pulses
• Activity limitations, including alternating
scribed exercise and diet regimen
Angina
results from plaque accumulation in the
intimal lining.
coronary syndrome), or Prinzmetal’s (variant).
• In stable angina, symptoms are consistent
and pain is relieved by rest.
• In unstable angina, pain is marked by
increasing severity, duration, and frequency.
Pain from unstable angina responds slowly to
nitroglycerin and isn’t relieved by rest.
• In Prinzmetal’s angina, pain is unpredict-
able and may occur at rest.
Angina isn’t hard to understand. If I don’t get
enough oxygen, it hurts.