aneurisms.pptx

7/30/2019 aneurisms.pptx

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ANEURISMSBINAL J

M. SC. N


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ANEURYSM


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DEFINITION

Aneurysm is a localized, blood-filled balloon-like bulgeof a blood vessel. Aneurysms can commonly occur in

the base of the brain (the circle of Willis) and an aortic

occurs in the main artery carrying blood from the left

the heart.

When the size of an aneurysm increases, there is a sig

of rupture, resulting in severe hemorrhage, other comp

death.


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DEFINITION: AORTIC ANEURISM

Abnormal dilation of a blood vessel at a site of we

or a tear in the vessel wall.

Usually secondary to atherosclerosis.

Most commonly affect the aorta


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CLASSIFICATION

TRUE

ANEURISM

FALS

ANEUR


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TRUE ANEURYSM

A true aneurysm is one that involves all threof the wall of an artery (intima, media and

adventitia).

True aneurysms include atherosclerotic, syp

and congenital aneurysms, as well as ventraneurysms that follow transmural myocardia

infarction


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FALSE ANEURYSM :

A false aneurysm or pseudo-aneurys

not primarily involve such distortion

vessel.

It is a collection of blood leaking comout of an artery or vein, but confined

the vessel by the surrounding tissue.


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FALSE ANEURYSMS

May result from

Trauma

Infection

After peripheral artery bypass graft surgery at siteanastomosis

Arterial leakage after cannulae removal


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MACROSCOPIC SHAPE AND SIZE :

FUSIFORM

ANEURISM

SACCU

ANEUR


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FUSIFORM ANEURISM:

Fusiform Fusiform ("spindle-shaped") an

are variable in both their diameter and leng

diameters can extend up to 20 cm (8 in). Th

involve large portions of the ascendtransverse aortic arch, the abdominal aorta

frequently the iliac arteries


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Fusiform

Most AAA are fusiform and 98% are below the

renal artery


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SACCULAR ANEURYSM

Saccular aneurysms are spherical in

and involve only a portion of the vess

they vary in size from 5 to 20 cm (8

diameter, and are often filled, either par

fully, by thrombus.


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ACCORDING TO LOCATION :

Aortic ThoracicArterial and

venousCerebral

aneurysmPeripheral

Aneurysms


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CLINICAL MANIFESTATIONS

Frequently asymptomatic

May have sub sternal, neck or back pain

Coughing, due to pressure placed on the windpipe (trachea)

Hoarseness

Difficulty swallowing Swelling (edema) in the neck or arms

Myocardial infarction, or stroke due to dissection or rupture inbranches of the aorta


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DIAGNOSIS

X-rays- Most are diagnosed without

symptoms on routine X-ray

Chest - Demonstrate abnormal widening of

thoracic aorta

Abdomen -May show calcification within wall of

AAA

ECG -to rule out MI


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DIAGNOSIS

Echocardiography

Assists in diagnosis of aortic valve insufficiency

Related to ascending aortic dilation

Ultrasonography Useful in screening for aneurysms

Monitor aneurysm size


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DIAGNOSIS

CT scan

Most accurate test to determine

Anterior to posterior length

Cross-sectional diameter

Presence of thrombus in aneurysm

MRI

Diagnose and assess the location and severity


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DIAGNOSIS

Angiography

Anatomic mapping of aortic system using contr

Not reliable method of determining diameter or

Can provide accurate info about involvement of

intestinal, renal or distal vessels


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AORTIC ANEURYSM

CLINICAL MANIFESTATIONS

May mimic pain associated with abdominal or back dis

Pain correlates to the size- can be excruciating

May spontaneously embolize plaque

Causing blue toe syndrome patchy mottling of feet/toes withof palpable pedal pulses

It can rupture, causing shock and death in 50% of ruptu


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COMPLICATION

AORTIC DISSECTION

Blood invades or dissects the layers of the vessel wall- m

thoracic

Dissecting aneurysms are unique and life

threatening. A break or tear in the tunica intima

and media allows blood to invade or dissect thelayers of the vessel wall. The blood is usually

contained by the adventitia, forming a saccular

or longitudinal aneurysm.


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http://images.google.com/imgres?imgurl=http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/CV74.JPG&imgrefurl=http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/iliac.html&h=504&w=600&sz=133&hl=en&start=7&um=1&tbnid=bTl0DNh435wf0M:&tbnh=113&tbnw=135&prev=/images?q=aortic+dissection&ndsp=20&svnum=10&um=1&hl=en&rlz=1T4ADBS_enUS220US220&sa=N


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Affects men more often thanwomen

Occurs most frequently between

fourth and seventh decades of

lifeAcute and life threatening

Mortality rate 90% if not

medically or surgically treated

M if t ti f A ti D i


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Manifestations of Aortic D isse

Aneurysm Abrupt, severe, ripping or

tearing pain in area of

aneurysm Mild or marked

hypertension early

Weak or absent pulses andblood pressure in upperextremities

S yncope

C omplications: hemorrhage,ischemic kidneys (renalfailure), MI, heart failure,cardiac tamponade, sepsis ,weakness or paralysis oflower extremities .


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AORTIC DISSECTION

COLLABORATIVE CARE

Initial goal BP and myocardial contractility to diminish pulsatile forces within a

Drug therapy

IV -adrenergic blocker

Esmolol (Brevibloc)

Other hypertensive agents Calcium channel blockers

Sodium Nitroprusside

Angiotensin-converting enzyme


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AORTIC DISSECTION

Surgical therapy

When drug therapy is ineffective

or

When complications of aortic dissection are present

Heart failure, leaking dissection, occlusion of an artery

Surgery may be delayed to allow edema to decrease

and permit clotting of blood.

Even with prompt surgical intervention

30-day mortality of acute aortic dissections remains high(10%-28%)


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Stent Graft Repair


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NURSING MANAGEMENT: ASSESSME

Cardiovascular status

Continuous ECG monitoring

Electrolyte monitoring

Arterial blood gas monitoring

Oxygen administration

Antidysrhythmic/pain

medications

Renal perfusionstatus

Urinary output

Fluid intake

Daily weight

CVP/PA pressu

Blood urea

nitrogen/Creatin


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ASSESSMENT

Infection

Antibiotic admin

Assessment of btemperature

Monitoring of WAdequate nutriti

Observe surgicafor signs of infec

Gastrointestinal status

Nasogastric tube

Abdominal assessment

Passing of flatus is key

sign of returning bowel

function

Watch for manifestations

of bowel ischemia


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Neurologic status

Level of consciousness

Pupil size and response to light

Facial symmetry

Speech

Ability to move upper

extremities

Quality of hand grasps

Peripheral perfu

Pulse assessme

Mark pulse lofelt-tip pen

Extremity asses

(5Ps) Tempecapillary refillsensation anof extremities

ASSESSMENT


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NURSING DIAGNOSIS

Risk for IneffectiveTissue Perfusion

Risk for Injury

Anxiety

Pain

Knowledge Deficit


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NURSING MANAGEMENT

Ambulatory and Home Care

Encourage patient to express concerns

Patient instructed to gradually increase activities

No heavy lifting

Educate on signs and symptoms of complications Infection

Neurovascular changes


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1.Ultrasound is extremely effective at detecting AAAs.The UPreventive Services Task Force (USPSTF) recommends that 65 to 75 who has ever smoked undergo a one-time ultrasouscreening for AAA

2.Prevent atherosclerosis

3.Treat and control hypertension

4.Diet- low cholesterol, low sodium and no stimulants

5.Careful follow-up if less than 5cm. It can grow .5cm /year

PREVENTION


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OTHER COMPLICATIONS

Rupture- signs of ecchymosis (triad) Back pain

Hypotension

Pulsating mass

Thrombi

Renal Failure


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RUPTURE TRIAD

Back

pain

HypotensionPulsatinghematoma


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