Abdominal Aortic Aneurysm

An abdominal 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. An aneurysm can be located anywhere along the abdominal aorta.

An Abdominal Aortic Aneurysm (AAA) is a permanent localized dilatation of the abdominal aorta. The disorder is conventionally diagnosed if the aortic diameter is 30 mm or more, or increase in the size of Vessel 1 and half times normal diameter.

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Pathophysiology

It is characterized by pathological changes in the aortic wall, which is an inflammatory process. Causing breakdown of elastic elements in media, decreasing tensile strength, therefore, leading to expansion.

Risk factors

  • Main risk factors are
  • Male
  • Smoking history
  • Hypertension
  • Family history
  • Increasing age
  • Atherosclerosis
  • COPD
  • Infection/inflammation

Morphological Classification

  • A true aneurysm
  • Fusiform aneurysms
  • Saccular aneurysms
  • Pseudo-aneurysms

The operative mortality of treating a ruptured aneurysm is 80%. For elective AAA cases, the operative mortality rate is drastically reduced, approximately only 2-7% of cases result in death. AAA ruptures can be avoided by identifying the population at risk and conducting simple and inexpensive ultrasound examinations. Abdominal Aortic Aneurysm If untreated, the AAA may rupture. When the aneurysm diameter reaches 5cm, the risk of rupture is generally considered to be higher than the operative risk.

Why do you have a decisive role in preventing AAA ruptures?

You are the first to see the patient. No national or international AAA screening program is in place today, except in the U.S.A. A simple ultrasound examination easily detects aneurysms.

Clinical Features

The majority of AAA are asymptomatic. Symptomatic AAA can present with the spectrum.

Physical Examination:

With palpation, pulsating mass in the middle of a patient’s abdomen. However, you may miss up to 80% of AAA if the diagnosis is limited to physical examination. An ultrasound scan has proven to be a reliable and cost-effective way to diagnose an AAA. This test an extremely sensitive test for all AAA sizes. It is painless, non-invasive and cost-effective. An additional benefit of ultrasound examination is that you may help diagnose other vascular diseases: Carotid artery disease (CAD), renal artery disease, peripheral artery disease (PAD).

Who is primarily at risk?

AAA primarily affects people over 60 years old and are more common in men than in women.
Other main risk factors include:

  • Smoking history
  • Hypertension
  • The family history of AAA

What if an AAA is diagnosed?

Clinical practice suggests table based on protocols used in various AAA patient screening programs. Follow-up recommendations may vary. Please contact your vascular specialist for more information. 33-38 Aneurysm diameter. Follow-up action less than 4cm Recall annually. More than 4cm and less than 5cm Recall every 6 months. More than 5cm or symptomatic or growing by more than 1cm per year Endovascular or surgical management.

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.

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Care Plan

Assessment

  • Prominent, pulsating mass in the abdomen, at or above the umbilicus
  • Systolic bruit over the aorta
  • Tenderness on deep palpation
  • Abdominal or lower back pain Diagnostic

Evaluation

  • Chest radiograph, angiogram, transesophageal echocardiography, and magnetic resonance imaging(MRI). because
  • Duplex ultrasonography or computed tomography (CT) Primary Diagnosis Risk for fluid volume deficit related to hemorrhage. because

Other Diagnoses that may occur in 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 in intravascular volume, increased systemic vascular resistance, third-space fluid shift, deficient knowledge (preoperative and postoperative care) related to newly identified need for aortic surgery. Ineffective breathing pattern related to effects of general anesthesia, endotracheal intubation, and presence of an abdominal incision. Abdominal Aortic Aneurysms because

Medical Management

Medical or surgical treatment depends on the type of an aneurysm. For a ruptured aneurysm, the prognosis is poor and surgery is performed immediately. When surgery can be delayed, medical measures can be taken. And thus they 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 propranolol. because

Surgical Management Removal of an aneurysm and restoration of vascular continuity with a graft (resection and a 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. Abdominal Aortic Aneurysm because

Nonsurgical Intervention

  • Modify risk factors. because
  • Instruct the client regarding the procedure for monitoring BP. because
  • Explain the client on the importance of regular physician visits to follow the size of an aneurysm. because
  • 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. because
  • Explain the client with a thoracic aneurysm to report immediately the occurrence of chest or back pain, shortness of breath, difficulty swallowing, or hoarseness. Abdominal Aortic Aneurysm because

Pharmacologic Highlights

  • 1-10 mg IV of an opioid analgesic (morphine) to relieve surgical pain.
  • 50–100 mcg IV of an opioid analgesic (Fentanyl) to relieve surgical pain.
  • Antihypertensives and/or diuretics for rising BP may stress graft suture lines.
  • 80-400 mg/day in divided doses of Beta blocker (propranolol) to use in people with small aneurysms without risk for rupture; decreases the rate of AAA expansion. Abdominal Aortic Aneurysm because
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Intervention

  • Monitor vital signs. because
  • Assess risk factors for the arterial disease process.
  • Obtain information regarding back or abdominal pain.
  • Question the client regarding the sensation of palpation in the abdomen.
  • Inspect the skin for the presence of vascular disease or breakdown.
  • Check peripheral circulation, including pulses, temperature, and color.
  • Observe for signs of rupture.
  • Note any tenderness over the abdomen.
  • Monitor for abdominal distention.  because of Abdominal Aortic Aneurysm because

Documentation Guidelines

Location, intensity, and frequency of pain, and the factors that relieve pain. The appearance of the abdominal wound (color, temperature, intactness, drainage). Evidence of stability of vital signs, hydration status, bowel sounds, electrolytes. because

Presence of complications: Hypotension, hypertension, cardiac dysrhythmias, low urine output, thrombophlebitis, infection, graft occlusion, changes in consciousness, aneurysm rupture, excessive anxiety, poor wound healing. Abdominal Aortic Aneurysm  because

Discharge and Home Healthcare Guidelines

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. 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. because

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. Complications following surgery. Discuss with the patient the possibility of clot formation or graft blockage.  because

Complications for patients not requiring surgery

Compliance with the regime of monitoring the size of an 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.

because of Abdominal Aortic Aneurysm

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