GROUP MEMBERSAARON KUM’BWEZA BANDA

PRECIOUS KATAIKA

MISHERI NKHANITEMWANANI KALUA

VITUMBIKO GONDWERUTH KAUNDA

AORTIC ARNEURYSM

By the end of the presentation listeners must be able to:

(a) know the definition of aortic aneurysm (b) describe Etiology Classification Pathophysiology Clinical manifestations Nursing management Medical Management Complications

OBJECTIVES

An aneurysm is an abnormal dilation of a blood vessel commonly at a site of a weakness or tear in the vessel .

Aneurysm mostly affects the aorta and peripheral arteries because of increased pressure in these vessels

Aneurysm occur more often in men than women and their incidence increases with age.

DEFINITION

Aneurysm is divided into two types and these are(a)True : this is where aneurysm forms with at least one layer of vessel still intact. True aneurysm can be farther divided into

Fusiform- circumferential and relatively uniform in shape

Saccular- pouch-like with a narrow neck

(b)False (pseudoaneurysm) : is not aneurysm but a disruption of all layers of the arterial wall resulting in rupture.

CLASSIFICATION

Congenital Traumatic Inflammatory Mechanical Infectious Pregnancy-related degenerative anastomotic and graft aneurysm

ETIOLOGY

In normal cases the aorta is made up of structural proteins called collagen and elastin. Collagen provides tensile strength while elastin recoils after systole. Aneurysm form due to the weakness of the arterial wall. Destruction of elastin and collagen in the wall of the aorta leads to abnormal dilation and rapture of the aorta respectively, and this result into aneurysm (Wung & Aouizerat, 2004.)

Aneurysm also occur due to hypertension and long-term eroding atherosclerosis.

PATHOPHYSIOLOGY

Dyspnea Hoarseness and dysphagia Edema of the face and the neck Distended neck veins Back, neck or substernal pains Mild to severe mid-abdominal and

lumbar back pains.

CLINICAL MANIFESTATIONS

Diagnostic studies Chest X-ray to visualize thoracic

aortic aneurysm Abdominal Ultrasonography to

diagnose abdominal aortic aneurysm

Contrast –enhanced CT that allows precise measurement of the aneurysm

ECG may be performed to rule out evidence of myocardial infarction.

MEDICAL MANAGEMENT

medications Medications that are administered

to patients with aneurysm include: Beta –blockers e.g. propranolol,

that control the myocardial contractility

Anti-hypertensives e.g. nifedipine,

Surgery

Nursing assessment Thorough history and physical assessment

should be performed. The nurse should watch for signs of cardiac,

pulmonary, cerebral, and lower extremity vascular problems

The nurse should monitor the patient for indications of aneurysm rupture such as diaphoresis, paleness, weakness, tachycardia, hypotension and abdominal pain

NURSING MANAGEMENT

Altered comfort; pain related to inflammatory processes

Risk for ineffective tissue perfusion related to aneurysm rupture as evidenced by hemorrhage and lack of blood flow to tissues.

Risk for injury related to pressure on the aneurysm

Anxiety related to the nature of the disorder

NURSING DIAGNOSES

Acute interventions It is seen in two ways (a) preoperative (b) post operative

NURSING INTERVENTIONS

Nurse the patient in the supine position to relieve pain

Brief explanation of the disease process Teaching the patient and family about the

procedure that is to take place on the patient Provide support for the patient and the family with

careful assessment of all body systems Assess the patient ready for the planned surgery. Pre-surgical assessment include giving IV fluids,

Sample collection, vital signs and dressing the patient with theatre clothes

PRE-OPERATIVE.

In most cases such patients are nursed in ICU for close monitoring

The nurse inserts the following: Urinary indwelling catheter Endotracheal tube Nasogastric tube

POST-OPERATIVE

The nurse should monitor BP, administer IV fluids and blood components which are important for adequate blood flow to the graft.

The nurse should monitor urinary input and output which help in assessing the patient’s hydration and perfusion status

ECG monitoring, ABG determination, administration of oxygen and IV anti-dysrhythmc medications as needed.

CONT’D

Health promotion Teaching patient measures of

health promotion with special attention to patients with family history of aneurysm.

The patient should encouraged to reduce cardiovascular risk factors such as BP control, smoking cessation, increasing physical activity and maintaining normal body weight

CONT’D

Ambulatory and home care Encourage the patient to express any concerns

and assure the patient that you are available. Assure the patient that normal activities of daily

living will be resume soon. The patient should be instructed of increase

gradually in activities such as fatigue, poor appetite and regular habits should be expected

Heavy lifting should be avoided. Any increased pain, drainage from incision,

increased fever of greater than 38⁰c should be reported to the hospital.

Cardiac temponade Rupture Hemorrhage death.

COMPLICATIONS

Expected outcomes Adequate tissue perfusion Normal body temperature No sign of infection

EVALAUTION

Lewis, Heitkemper, Dirksen (2007) Medical Surgical, Nursing; 7th edition, Mosby Elsevier, USA.

Priscilla Lemone and Karen Burk(2008) Medical Surgical Nursing, Fourth Edition, Pearson Education Inc. New Jersey, USA

REFERENCES

PHLEBITIS

DEFINITION It the inflammation of the vein

(Brunner & Suddarth’s, 2007 ) The term is used clinically to

indicate a superficial and localized condition that can be treated with application of heat (Lippincott Manual of Nursing)

ETIOLOGY Phlebitis is caused by the following:(a) bacterial: stimulates inflammation(b) Chemical: irritating solutions(c) Mechanical: physical trauma; skin puncture;

movement of the cannula of the vein during insertion

(d) Medications; e.g. Celecoxib(e) Genetic; pass from one generation to

another(f) Alcohol abuse

CLINICAL MANIFESTATION Redness and warmth with a

temperature elevation of a degree above the baseline

Pain or burning along the length of the vein

Swelling Vein being hard and cord-like Fever

OCCURENCE The incidence of phlebitis

increases with the length of time the I.V. is in place, the composition of fluid or medication infused, the size of the cannula inserted, inadequate anchoring of the line and introduction of microorganism at the site of insertion

NURSING DIAGNOSIS Altered thermoregulation;

hyperthermia related to inflammatory processes secondary to infections.

Altered comfort; pain related to inflammatory process

Risk for skin integrity due skin puncture

Nursing Interventions Apply warm compresses immediately to

relieve pain and inflammation. Follow with moist, warm compresses to

stimulate circulation and promote absorption.

Administer analgesic to relieve pain and fever

Document interventions and assessments.

Preventive Measures

Anchor the needle or catheter securely at the insertion site.

Change the insertion site at least every 72 hours. If the facility phlebitis rate goes above 5%, insertion sites should be changed every 48 hours

Use large veins for irritating fluid because of higher blood flow, which rapidly dilutes the irritant.

Sufficiently dilute irritating agents before infusion.