Mixed Topics
Innermost lining of aorta, lined by endothelium
Tunica intima
Middle part of aorta, thick and provides elasticity to the aorta
Tunica media
Outer part of the aorta, provides tensile strength
Tunica adventitious
The aorta is divided into 2 parts, what are they?
Thoracic aorta and abdominal aorta
How do you care for AAA's that are > 4 cm and < 5 cm?
Exams q.6 months
What is a priority nursing diagnosis for TAA, and whate are possible interventions to prepare for?
1. Altered fluid and electrolytes
2. Prepare for IV fluids, possible blood transfusion
3. Prepare patient for OR/procedure
What divides the thoracic and abdominal aorta
The diaphragm
What is the main concern for patients who have had repair of descending and thoracoabdominal aorta?
Signs of paraplegia
How do you care for AAA's that are < 4 cm?
Annual exams
How do you care for AAA's that are > 5 cm, symptomatic and growing by more than 1 cm per year?
Surgical or endovascular treatment
What are the three descriptions of aneurysms
1. Saccular = partial involvement
2. Fusiform = full involvement
3. Ruptured = massive internal bleeding
How are thoracic aneurysms diagnosed?
1. Abdominal ultrasound
2. TTE (transthoracic echo)
3. MRI (magnetic resonance imaging)
4. CT (computerized tomography)
Nursing care for patients with TAA (thoracic aortic aneurysm)
1. Manage BP
2. Assess for changes, be aware of new pain between shoulder blades, N/V, HOTN
What is the most common cause of AAA's?
Atherosclerosis
What are the early signs of AAA?
1. Nausea
2. Vomiting
3. Syncope
4. Sudden onset of "ripping" across the abdomen
What is the percentage breakdown for the risk of having each type of aneurysm
1. Aortic root/ascending aorta aneurysm = 60%
2. Descending aortic aneurysm = 35%
3. Aortic arch aneurysm = 10%
Medical management for thoracic aneurysms
1. Reduce shear stress on diseased segment of aorta by reducing BP and cardiac contractility (vasodilators - ACE, ARBs, BBs)
2. Keep BP less than 140/90
3. Smoking cessation
4. Surgery
5. TEVAR (trans endovascular aortic repair)
Postop nursing care for patient after aneurysm repair
1. Monitor cardiac output (watch for dysrhythmias R/T coronary ischemia
2. Ventilator support
3. Watch for bleeding
4. Control BP
5. Monitor urine output q.h.
6. Monitor distal pulses (altered tissue perfusion)
AAA Triad; up to 50% of patients with AAA's report these symptoms
1. Sudden onset of abdominal pain
2. Pulsatile mass
3. HOTN
What would you do as the nurse for a patient with late signs of TAA/AAA?
1. Notify MD NOW!
2. Anticipate surgery
3. Think IV fluids, blood?
4. Stay with the patient
5. Assess for shock
What are some R/F for aortic disease
1. Male
2. Smoking
3. HTN
4. Family hx
5. Age
6. Atherosclerosis
7. COPD
8. Infection/inflammation
9. Marfan syndrome
What are the symptoms of thoracic aneurysm?
1. Acute deep, aching or throbbing chest
2. Systolic bruit
3. Constant or intermittent abd. pain that can spread to back, buttocks, groin or legs
4. Pulsating sensation or feeling of fullness in the abd, suggestive of dissection, described as "feeling of rupture)
5. Cough/SOB
6. Hoarse voice (due to pressure on the left laryngeal nerve)
7. Difficult or painful swallowing, seen esp. w/large TAs
What are the early signs of TAA?
2. Nausea
3. Vomiting
4. HOTN
What are the later signs for TAA/AAA (both the same)?
1. HOTN
2. Decreased pulses
3. Diaphoresis
4. Pallor
5. Shock
6. Cullen (around the umbilicus) or Turner (flank, retroperitoneal) signs, INDICATE BLEEDING!!
What are possible causes of hypoactive bowel sounds?
1. Paralytic ileus
2. Peritonitis
3. Decreased bowel motility
4. Late intestinal obstruction