CARDIOVASCULAR MODULE:

AORTIC ANEURYSM

Adult Medical-Surgical Nursing

Aneurysm: Description

An aneurysm is a weakening and dilatation of part of an arterial wall which may rupture if large enough

Aneurysm mainly affects the aorta:Abdominal aorta 75%Thoracic aorta 25%

Aneurysm: Classification

Types of aneurysm:

Fusiform: Ballooning of the whole arterial

circumference

Saccular: Ballooning as a sac from one side

Aneurysm: Pre-disposing risk factors

Hypertension

Smoking

Atherosclerosis

Aortic Aneurysm: Pathophysiology

The arterial lining consists of the inner intima, the media and the outer adventitia

Atherosclerotic plaques (lipid/ fibrous tissue) develop below the intima of the aorta

This leads to: Loss of elasticity, weakening of the media and

dilatation (ballooning) May lead to ruptureThrombi are deposited around the aneurysmEmboli may break off causing occlusion

distally

Aortic Aneurysm: Complications

Rupture:

If a posterior rupture, the surrounding structures tamponade (there may be signs of shock, severe backache and bruising)

If an anterior rupture, massive haemorrhage occurs and death is probable

Clinical Manifestations (Thoracic)

Chest painHoarseness (pressure on recurrent laryngeal

nerve)DyspnoeaDysphagia

All symptoms are related to increased pressure

Clinical Manifestations (Abdominal)

AsymptomaticDetected on routine examinationPulsatile mass in periumbilical regionMay be associated with hypotension

May have patchy mottling of feet from mini-emboli in capillaries: “blue toe syndrome”

Aortic Aneurysm: Diagnosis

Patient history if symptomsThoracic and abdominal Xray: shows

calcification and aortic arch outlineUltrasoundCT scanMRIThese tests reveal the size and position of the

aneurysm

Aortic Aneurysm: Management

If small (<5cm in diameter):Monitor growth frequently by Ultrasound, CT

or MRI scansAnticoagulant/ antiplatelet therapy to prevent

emboli

If >5cm in diameter:Surgery is required

Aortic Aneurysm: Surgery

Surgery if > 5cm diameter as there is risk of rupture:

Surgery involves:

Resection of diseased area

Arterial graft / stent (Dacron)

Anticoagulant cover to prevent thrombi and emboli

Nursing Responsibilities

Patient education about the condition

Awareness about risks related to anticoagulant therapy

Surgical Nursing Responsibilities

If surgery: nursing care in ICUVital signs and nursing records: Maintain normal BP to prevent stasis and

clotting and to reduce the risk of haemorrhage Monitor temperature (risk of infection)Monitor for dysrhythmias Note peripheral pulses, neuro status, renal

perfusion Observe for paralytic ileus (NG tube)Observe dressings, drainsABG, electrolytes