ANEURYSMS
An aneurysm is a localized sac or dilatation of an artery formed at a weak point in the vessel wall.
Causes
Atherosclerosis is the most common cause. Wall trauma, infection (pyogenic or syphilitic) and congenital defects of the artery wall.
Most common sites Aorta and cerebral arteries
Types
- Mycotic aneurysms are small aneurysms due to local infection.
- Saccular aneurysm is an aneurysm that is somewhat larger and projecting from one side of the vessel only.
- Fusiform aneurysm is an aneurysm in which the entire arterial segment becomes dilated.
- Dissecting aortic aneurysm is an aneurysm in which there is separation of the layers of the aorta, even through no dilatation may be present.
Aortic aneurysm may be classified according to the section of the artery in which the defect is located. i.e.Thoracic aortic Aneurysm & Abdominal aortic Aneurysm
Clinical Manifestations:
- Signs & Symptoms may be absent until the aneurysm is large enough to compress the adjacent structures.
- Patient with a thoracic aneurysm chest pain, dyspnea, hoarseness due to vocal cord paralysis and/or congestion of the veins in the neck because of pressure on the superior vena cava
- Abdominal aneurysm Patient will have mid-abdominal, lumbar or pelvic pain, often severe
- Dissecting aortic Aneurysm pain described as ripping or tearing in nature and may involve the chest, back and/or abdomen. Blood pressure drops and there may be discrepancy in pulses in various locations in the body.
Diagnostic Investigations
Careful physical examination, x-rays, echocardiograms and/or aortography. Confirm the diagnosis.
Management
Surgical Intervention - If a small blood vessel is affected, it may be tied off and the flow of blood diverted to another artery.
For an aortic aneurysm, the area is resected and replaced with a graft of inert synthetic material such as Teflon or Dacron,
Nursing Management
- Allow the patient to express his fears and concerns.
- Offer patient and family psychological support. Provide reassurance and answer all questions.
- In an acute situation, monitor BP and CVP, Assess pain, breathing and carotid, radial and femoral pulses. Administer analgesics as ordered.
- Make sure laboratory tests include a complete blood count with differential, electrolyte measurements, typing and cross matching for whole blood, arterial blood gas analyses and urinalysis.
- - Catheterize patient and monitor hourly output.
- - Administer antibiotics and IV fluids (RL, 5% GDW) as prescribed.
After repair of thoracic aneurysm:
- Assess level of consciousness, vital signs, CVP, urine output and pain.
- Observe and record type and amount of chest tube drainage.
- Monitor IV therapy and I/O to determine adequacy of renal function,
- Administer analgesics.
- Encourage and assist in turning, cough and deep breathing.
- Watch for signs of infection fever, excessive drainage.
- Assist with range of motion exercises of legs prevent thromboemboli from venostasis during prolonged bed rest.
