Medical-Surgical

1. Aortic Aneurysm
FIGURE 31-11 Characteristics of arterial aneurysm. (A) Normal artery. (B) False aneurysm—actually a
pulsating hematoma. The clot and connective tissue are outside the arterial wall. (C) True aneurysm.
One, two, or all three layers of the artery may be involved. (D) Fusiform aneurysm—symmetric, spindle-
shaped expansion of entire circumference of involved vessel. (E) Saccular aneurysm—a bulbous
protrusion of one side of the arterial wall. (F) Dissecting aneurysm—this usually is a hematoma that
splits the layers of the arterial wall.
The most common cause of abdominal aortic aneurysm is atherosclerosis.
It affects men four times more often than women and is most prevalent in elderly patients.
Most of these aneurysms occur below the renal arteries (infrarenal aneurysms).
All aneurysms involve a damaged media layer of the vessel. This may be caused by congenital weakness,
trauma, or disease. After an aneurysm develops, it tends to enlarge.
Risk factors:
genetic predisposition
smoking (or other tobacco use)
hypertension; more than one half of patients with aneurysms have hypertension.
Symptoms:
abdominal pain and back pain
feel an abdominal mass or abdominal throbbing

2. groin pain and flank pain
 may be experienced because on increasing pressure on other structures
Asymptomatic
If the abdominal aortic aneurysm is associated with thrombus, a major vessel may be occluded or
smaller distal occlusions may result from emboli. A small cholesterol, platelet, or fibrin emboli may lodge
in the interosseous or digital arteries,causing blue toes.
The most important diagnostic indication of an abdominal aortic aneurysm is a pulsatile mass in
the middle and upper abdomen. About 80% of these aneurysms can be palpated. A systolic bruit
may be heard over the mass.
Duplex Ultrasonography or CT - is used to determine the size, length, and location of the
aneurysm .
Ultrasonography - When the aneurysm is small
- conducted at 6-month intervals until the aneurysm reaches a size at which
surgery to prevent rupture is of more benefit than the possible complications
of a surgical procedure.
Gerontologic Considerations
ages of 60 and 90 years.

3. If the elderly patient is considered at moderate risk for complications related to surgery or
anesthesia, the aneurysm is not repaired until it is at least 5 cm (2 inches) wide.
An expanding or enlarging abdominal aneurysm is likely to rupture. Surgery is the treatment of choice
for abdominal aneurysms wider than 5 cm (2 inches) wide or those that are enlarging.
open surgical repair
- Is the standard treatment for abdominal aortic aneurysm repair.
Endovascular grafting
- An alternative for treating an infrarenal abdominal aortic aneurysm.
- involves the transluminal placement and attachment of a sutureless aortic graft prosthesis across an
aneurysm.
- This procedure can be performed under local or regional anesthesia.
- if the patient’s abdominal aorta and iliac arteries are not extremely tortuous and if the aneurysm does
not begin at the level of the renal arteries.
Preoperative:
 The nurse must……
Assess and document all peripheral pulses for baseline comparison
postoperatively.
 If dissection or rupture has occurred, the client may receive intravenous fluids (often
large volumes) for maintenance of tissue perfusion
 The client and significant others require psychological support & preoperative teaching
Postoperative care:
 24 to 48 hours (client is admitted to a critical care area)
 Monitor VS
 Monitor hemodynamic parameters
 Manage fluid and electrolytes
 Obtain daily weights

4.  Monitor pulmonary status
 Maintaining on a ventilator (at least overnight)
- To facilitate respiratory exchange.
 Assess circulation at least hourly
 Any signs of occlusion below the graft, including changes in pulses, severe pain, cool to cold
extremities, and pale or cyanotic extremities, are reported to the physician immediately.
Signs of impending rupture:
Severe back pain or abdominal pain
- which it may be persistent or intermittent and is often localized in the middle or lower
abdomen to the left of the midline
Low back pain
- It may also be present because of pressure of the aneurysm on the lumbar nerves. This
is a serious symptom, usually indicating that the aneurysm is expanding rapidly and is
about to rupture.
Indications of a rupturing abdominal aortic aneurysm:
constant, intense back pain
Falling blood pressure
Decreasing hematocrit
Rupture into the peritoneal cavity is rapidly fatal.
A retroperitoneal rupture of an aneurysm (may result in hematomas in the scrotum, perineum,
flank, or penis)
Signs of heart failure or a loud bruit (may suggest a rupture into the vena cava)
 Possible complications of surgery include:
Arterial occlusion
Hemorrhage
infection
ischemic bowel
renal failure
Impotence