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Abdominal Aortic Aneurysm Nursing Care

Plan and Management

Description

An aortic aneurysm is an abnormal dilation of the arterial wall caused by localized

weakness and stretching in the medial layer or wall of an artery.

The aneurysm can be located anywhere along the abdominal aorta.

The goal of treatment is to limit the progression of the disease by modifying risk

factors , controlling the BP to prevent strain on the aneurysm, recognizing

symptoms early, and preventing rupture.

Assessment

1. Prominent, pulsating mass in abdomen, at or above the umbilicus

2. Systolic bruit over the aorta

3. Tenderness on deep palpation

4. Abdominal or lower back pain

Diagnostic Evaluation

1. Chest radiograph, angiogram, transesophageal echocardiography, and magnetic

resonance imaging(MRI).

2. Duplex ultrasonography or computed tomography (CT)

Primary Nursing Diagnosis

Risk for fluid volume deficit related to hemorrhage

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Other Diagnoses that may occur in Nursing Care Plans For Abdominal Aortic

Aneurysm

Acute pain related to surgical tissue trauma

Anxiety related to threat to health status

Decreased cardiac output related to:

o changes in intravascular volume

o increased systemic vascular resistance

o third-space fluid shift

Deficient knowledge (preoperative and postoperative care) related to newly

identified need for aortic surgery

Ineffective breathing pattern related to:

o effects of general anesthesia

o endotracheal intubation

o presence of an abdominal incision

Medical Management

Medical or surgical treatment depends on the type of aneurysm. For a rupture aneurysm,

prognosis is poor and surgery is performed immediately. When surgery can be delayed,

medical measures include:

Strict control of blood pressure and reduction in pulsatile flow.

Systolic pressure maintained at 100 to 120 mm Hg with antihypertensive drugs,

such as nitroprusside.

Pulsatile flow reduced by medications that reduce cardiac contractility, such as

propanolol.

Surgical Management

Removal of the aneurysm and restoration of vascular continuity with a graft

(resection and bypass graft or endovascular grafting) is the goal of surgery and the

treatment of choice for abdominal aortic aneurysms larger than 5.5 cm (2 inches)

in diameter or those that are enlarging. Intensive monitoring in the critical care

unit is required.

Nonsurgical Intervention

1. Modify risk factors.

2. Instruct the client regarding the procedure for monitoring BP.

3. Instruct the client on the importance of regular physician visits to follow the size

of the aneurysm.

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4. Instruct the client that if severe back or abdominal pain or fullness, soreness over

the umbilicus, sudden development of discoloration in the extremities, or a

persistent elevation of BP occurs to notify the physician immediately.

5. Instruct the client with a thoracic aneurysm to report immediately the occurrence

of chest or back pain, shortness of breath, difficulty swallowing, or hoarseness.

Pharmacologic Highlights

1. 1-10 mg IV of opioid analgesic (morphine) to relieve surgical pain.

2. 50–100 mcg IV of opioid analgesic (Fentanyl) to relieve surgical pain.

3. Antihypertensives and/or diuretics for rising BP may stress graft suture lines.

4. 80-400 mg/day in divide doses of Beta blocker (propanolol) to use in people with

small aneurysms without risk for rupture; decreases rate of AAA expansion

Nursing Intervention

1. Monitor vital signs.

2. Assess risk factors for the arterial disease process.

3. Obtain information regarding back or abdominal pain.

4. Question the client regarding the sensation of palpation in the abdomen.

5. Inspect the skin for the presence of vascular disease or breakdown.

6. Check peripheral circulation, including pulses,temperature, and color.

7. Observe for signs of rupture.

8. Note any tenderness over the abdomen.

9. Monitor for abdominal distention.

Documentation Guidelines

Location,intensity,and frequency of pain,and the factors that relieve pain

Appearance of abdominal wound (color,temperature,intactness,drainage)

Evidence of stability of vital signs,hydration status,bowel sounds,electrolytes

Presence of complications: Hypotension, hypertension, cardiac dysrhythmias, low

urine out- put,thrombophlebitis,infection,graft occlusion,changes in

consciousness,aneurysm rupture, excessive anxiety,poor wound healing

Discharge and Home Healthcare Guidelines

1. Wound care. Explain the need to keep the surgical wound clean and dry. Teach

the patient to observe the wound and report to the physician any increased

swelling,redness,drainage,odor,or separation of the wound edges. Also instruct the

patient to notify the physician if a fever develops.

2. Activity restriction. Instruct the patient to lift nothing heavier than 5 pounds for

about 6 to 12 weeks and to avoid driving until her or his physician permits.

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Braking while driving may increase intra-abdominal pressure and disrupt the

suture line. Most surgeons temporarily discourage activities that require pulling,

pushing, or stretching—activities such as vacuuming,changing sheets,playing

tennis and golf,mowing grass,and chopping wood.

3. Smoking cessation. Encourage the patient to stop smoking and to attend smoking

cessation classes.

4. Complications following surgey. Discuss with the patient the possibility of clot

formation or graft blockage.

5. Complicatios for patients not requiring surgery. Compliance with the regime of

monitoring the size of the aneurysm by computed tomography over time is

essential. The patient needs to understand the prescribed medication to control

hypertension. Advise the patient to report abdominal fullness or back pain,which

may indicate a pending rupture.