Cardiovascular Module:

1
Adult Medical-Surgical Nursing

• Cardiovascular Module
• Aortic Aneurysm

2
Aneurysm Description

• An aneurysm is a weakening and dilatation of part
  of an arterial wall which may rupture if large
  enough
• Aneurysm mainly affects the aorta
• Abdominal aorta 75
• Thoracic aorta 25

3
Aneurysm Classification

• Types of aneurysm
• Fusiform
• Ballooning of the whole arterial circumference
• Saccular
• Ballooning as a sac from one side

4
Aneurysm Pre-disposing risk factors

• Hypertension
• Smoking
• Atherosclerosis

5
Aortic Aneurysm Pathophysiology

• The arterial lining consists of the inner intima,
  the media and the outer adventitia
• Atherosclerotic plaques (lipid/ fibrous tissue)
  develop below the intima of the aorta
• This leads to
• Loss of elasticity, weakening of the media and
  dilatation (ballooning)
• May lead to rupture
• Thrombi are deposited around the aneurysm
• Emboli may break off causing occlusion distally

6
Aortic Aneurysm Complications

• Rupture
• If a posterior rupture, the surrounding
  structures tamponade (there may be signs of
  shock, severe backache and bruising)
• If an anterior rupture, massive haemorrhage
  occurs and death is probable

7
Clinical Manifestations (Thoracic)

• Chest pain
• Hoarseness (pressure on recurrent laryngeal
  nerve)
• Dyspnoea
• Dysphagia
• All symptoms are related to increased pressure

8
Clinical Manifestations (Abdominal)

• Asymptomatic
• Detected on routine examination
• Pulsatile mass in periumbilical region
• May be associated with hypotension
• May have patchy mottling of feet from mini-emboli
  in capillaries blue toe syndrome

9
Aortic Aneurysm Diagnosis

• Patient history if symptoms
• Thoracic and abdominal Xray shows calcification
  and aortic arch outline
• Ultrasound
• CT scan
• MRI
• These tests reveal the size and position of the
  aneurysm

10
Aortic Aneurysm Management

• If small (lt5cm in diameter)
• Monitor growth frequently by Ultrasound, CT or
  MRI scans
• Anticoagulant/ antiplatelet therapy to prevent
  emboli
• If gt5cm in diameter
• Surgery is required

11
Aortic Aneurysm Surgery

• Surgery if gt 5cm diameter as there is risk of
  rupture
• Surgery involves
• Resection of diseased area
• Arterial graft / stent (Dacron)
• Anticoagulant cover to prevent thrombi and emboli

12
Nursing Responsibilities

• Patient education about the condition
• Awareness about risks related to anticoagulant
  therapy

13
Surgical Nursing Responsibilities

• If surgery nursing care in ICU
• Vital signs and nursing records
• Maintain normal BP to prevent stasis and clotting
  and to reduce the risk of haemorrhage
• Monitor temperature (risk of infection)
• Monitor for dysrhythmias
• Note peripheral pulses, neuro status, renal
  perfusion
• Observe for paralytic ileus (NG tube)
• Observe dressings, drains
• ABG, electrolytes