Disorders of the Aorta

1
Disorders of the Aorta

• Susie Forehand RN, MSN
• Leslie S. Lorette, RN, MSN

2
Aortic Aneurysms

• Thoracic
• Account for 10
• Weakening of wall due to HTN arteriosclerosis
• Trauma
• Coarctation
• Tertiary syphilis
• Fungal infections
• Marfans syndrome

• Asymptomatic
• Symptoms with location
• Ascending arch
• Dysphagia
• Dyspnea
• Hoarseness
• Confusion
• Dizziness
• Rupture ? Death

3

• Abdominal
• HTN arteriosclerosis
• Increased age smoking (gt 70 yoa)
• 90 develop ? renal arteries
• Asymptomatic
• Pulsating mass in mid and upper abdomen
• Bruit over mass found on exam
• Pain is constant or intermittent
• Emboli in lower extremities
• Rupture

4
Diagnostics

• Chest X-ray
• Abdominal ultrasonography
• Transesophageal echocardiography (TEE)
• Contrast-enhanced CT or MRI
• Angiography

5
Treatment

• Asymptomatic and low risk for rupture
• Beta-blockers
• Clients with dissection
• Control heart rate and blood pressure
• beta-blockers and sodium nitroprusside (Nipride)
• Constant hemodynamic monitoring
• prevent rupture
• stabilize client before aneurysm is repaired
  surgically
• Post surgical
• anticoagulant therapy
• Heparin
• Oral anticoagulants or low-dose aspirin

6
Surgical Intervention

• Indications
• Symptomatic or rapidly expanding aneurysms
• Thoracic gt6 cm diameter
• Abdominal gt5 cm diameter
• Types of procedures
• Excised and replaced with synthetic fabric graft
• Endovascular stent grafts

7
Post-op Management

• Monitor for Graft leakage
• ? ecchymosis
• ? abdominal girth
• Weak or absent distal pulses
• ? HH
• ? abdominal, pelvic, back or groin pain
• ? urine output
• ? CVP or PWCP

8
Post-op Management

• Fluid replacement
• Maintain arterial perfusion
• Monitor for extremity embolism
• 6 Ps
• Monitor for bowel ischemia
• Maintain renal function
• Monitor for spinal cord ischemia

9
Home Care

• Not had repair of aneurysm
• Manifestations of increasing size, dissection, or
  rupture
• Control of hypertension
• Smoking cessation

• Who have had surgical repair
• Wound care
• Medications
• anticoagulation
• antihypertensive
• Nutritional needs
• ? PO fluids fiber
• Adequate rest
• Exercise
• Reportable symptoms