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Vascular DisordersMedical Surgical Nursing

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How do you know if an abdominal aortic aneurysm has ruptured in the posterior peritoneal cavity or anteriorly in the abdominal cavity?
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Posteriorly: back pain with or without bruising (Gray Turner's sign) Anteriorly: they die from hemorrhage
________ is the process of anatomically mapping the aortic system by contrast imaging. It can be useful for determining the amount of vessel involvement in an aneurysm and can detect thoracoabdominal or suprarenal aneurysms.
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Angiography
What is the most accurate tool for determining the extent of an aneurysm, including length, diameter and presence of a thrombus?
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CT Scan
What is considered the threshold of repair for an aneurysm?
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5.5 centimeters
When would repair of an aneurysm be considered even if it is too small according to standard guidelines?
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If a woman has an abdominal aortic aneurysm, if the patient is young and low risk, if the aneurysm is growing rapidly or if the patient is symptomatic
What types of grafts are typically utilized to repair aneurysms?
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Dacron or Polytetrafluoroethylene (PTFE)
Which patients are most likely to have an endovascular graft procedure?
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Elderly, higher risk patients (it is less invasive than the standard surgery)
Who are not an ideal candidate for an endovascular graft procedure? (3)
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-Anyone with a aortoiliac occlusive disease -anyone with an aneurysm with renal artery involvement -Women with a small femoral artery
What is the most common post-endovascular graft surgical complication?
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Perigraft leak: seeping of blood from the graft site into the aneurysm
What are the possible indications of an aortic aneurysm rupture?
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Diaphoresis, paleness, weakness, tachycardia, hypotension, abdominal-back-groin or periumbilical pain, changes in LOC, or development of a pulsatile mass
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What are some preoperative nursing considerations/responsibilities prior to surgery for aneurysm repair?
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-the patient usually has bowel prep (laxatives, enemas, etc) -NPO after midnight prior to surgery -preoperative shower with antimicrobial soap -IV antibiotics prior -ICU orientation for the family
Postoperatively, patients who have undergone a surgery to repair an aortic aneurysm go to the ICU. What should the nurse tell the family with respect to what they can expect to see?
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The patient will be on mechanical ventilation with an endotracheal tube, will have an arterial line, central venous pressure or pulmonary artery catheter, NG tube, ECG hook-up, a urinary catheter, peripheral line IV and will possibly a chest tube.
What are the general things a nurse monitors a post-aneurysm correction surgical patient for?
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Graft patency, cardiovascular status, infection, GI status, Neuro status, peripheral perfusion status, and renal perfusion status
How is graft patency monitored and maintained (after aneurysm surgery)?
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Monitored via CVP (central venous pressure) or PA (pulmonary artery) measurements, BP measurements and urinary output hourly. Maintained: IV fluids and blood component administration to prevent thrombosis by keeping BP within normal range. If patient is hypertension, diuretics and antihypertensives via IV.
What conditions are the greatest dangers to graft patency after an aneurysm repair?
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Hypotension and hypertension
How is cardiovascular status after an aneurysm repair surgery monitored and maintained?
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Monitored: Continuous ECG, frequent electrolyte levels, frequent ABGs Maintained: admin of antidysrhythmics, oxygen, replacement of electrolytes, pain control, resumption of presurgical cardiac meds
How is GI status after an aneurysm repair surgery monitored and maintained?
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Monitored: auscultation bowel sounds, noting color/amount of material suctioned from NG tube, s/s of bowel ischemia: no bowel sounds, fever, distention, diarrhea, bloody stools Maintained: NG tube with low level suction, client is NPO until bowel sounds return and/or patient has flatus, early ambulation, ice chips and/or lozenges to ease throat irritation if ordered
How is neuro status after an aneurysm repair surgery monitored?
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Monitored: FOR ASCENDING AORTA AND AORTIC ARCH-assess LOC, pupil size and response to light, facial symmetry, tongue deviation, speech ability to move upper extremities, quality of hand grasp For descending aorta: ability to move lower extremities in addition to all above
How is peripheral perfusion status after an aneurysm repair surgery monitored and maintained?
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Monitored: check all peripheral pulses every hour, mark them with a pen once they are located, note skin temp., color, cap refill time, sensation and movement of extremities Maintained: development of absent lower extremity pulses with cool, pale, mottled or pain can indicate embolization or graft occlusion. Report it to the doctor
You are assessing your patient for peripheral pulses after they underwent repair of an aneurysm. You can't find the pulses in their lower extremities. What should you do and why?
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First look at the preoperative status of the patient to determine their baseline. They may have had PAD in the lower extremities prior and therefore no cause for concern. Sometimes pulses are absent immediately after surgery from hypothermia or vasospasm...reassess. If the extremities hurt, are cool, pale or mottled notify the physician. These are signs of embolization or graft occlusion.
How is renal perfusion status after an aneurysm repair surgery monitored?
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Monitor: hourly urine outputs, fluid intake, daily weights, CVP or PA readings (hydration status), Daily BUN and creatinine studies
  
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