ANEURYSM

Aneurysm

• abnormal DILATION of the ARTERIAL WALL caused by localized WEAKNESS & STRETCHING in the medial layer or wall of the artery.

Classification According to Form

Fusiform: outpouching on BOTH SIDES of the artery

Saccular: ONE SIDEDissecting: separation /tear in the tunica intima

and media

Classification According to Location

1. Thoracic Aortic AneurysmS/Sx:

Back painsyncopeDyspnea, dysphagiaincreased pulsecyanosisweakness

Classification According to Location

2. Abdominal Aortic AneurysmS/Sx:

pulsating mass in abdomensystolic bruit over the aortatenderness on deep palpationabdominal or lower back pain

Classification According to Location

3. Cerebral AneurysmS/Sx:

headachevomiting^ ICP

Most common cause – HYPERTENSIONMost dangerous complication- RUPTURE

Medical management

• Antihypertensive drugs• Analgesics• Surgery if aneurysm is greater than 4cm

Surgery

• Open-abdominal surgery• Endovascular surgery• Videos-..\..\..\Desktop\AAA

Post- operative Nursing Care:

• Assess the surgical sites for swelling and pain and bleeding

• Monitor peripheral perfusion closely, ambulation is allowed the day after the day of surgery.

• Clients may ask if they can feel the hooks in the aorta

• They should be told that they will not jbe able to feel the hooks because the aorta cannot sense the hook.

• Before dismissal, the location of the graft may be confirmed with CT scan, ultrasound, or x-ray study.

Monitor for and report manifestations of graft leakage:

• Ecchymoses of the scrotum,perineum, or penis, a new expanding hematoma

• Increased abdominal girth• Weak or absent peripheral pulses, tachycardia,

hypotension• Decreased motor function or sensation in the

extremities• Increasing abdominal,pelvic, back or groin pain• Decreasing CVP, pulmonary artery pressure, or

pulmonary artery wedge pressure

Cont:

• Report manifestations of lower extremity embolism

• Report manifestations of bowel schemia or gangrene

Nursing intervention

• Maintain adequate BP to promote graft patency.

• Maintain IV fluid to maintain adequate blood flow to the graft.

• CVP readings or pulmonary artery pressures and urinary output should be monitored hourly in the immediate post-op period to help assess the patient state of hydration.

Reynaud’s disease

Reynaud’s disease

• Primary – idiopathic• Secondary – causes are known.• Is a rare disorder that affects the arteries• Vasospasm, which a narrowing of blood

vessels.• Vasospasm of the arteries reduces the blood

flow to the finger and toes.• It can also occur to the tip of the ear and nose.

Etiology of secondary Reynaud’s

• Scleroderma• Lupus• RA• Sjogren’s syndrome• Diseases of the arteries• Carpal tunnel syndrome• Repetitive actions• Hand and foot injuries• Exposure to certain chemicals• medicines • Smoking

RISK FACTORSPRIMARY SECONDARY

• GENDER• AGE• FAMILY HX• LIVING AREA CLIMATE

• AGE• CERTAIN DISEASE & CONDITION• WORK PLACE• REPETITIVE ACTION• SMOKING• MEDICINES

Clinical Manifestation

• During the reynaud”s attack arteries become narrow and no blood supply to the area, this will cause:

1. Turn pale or white and then blue2. Feel numb, cold or painful

Diagnostic test

• Cold stimulation test• Nailfold cappilaroscopy• Antinuclear antibody (ANA)

- Erythrocyte Sedimentation rate (ESR)- C-Reactive protein Test (CRPT)

Nail fold cappilaroscopy

Medical Treatment

• Calcium channel blocker – Norvas c• Alpha Blockers – prazosin• Vasodilators – Losartan (cozaar)

Surgical treatment

• Nerve Surgery – symphatectomy• Chemical injection• Amputation

Complication

• Complete loss of blood to the digits will cause:1. Deformities of finger and toes2. Gangrene3. ulcer

Health education

• Stop smoking• exercise• Control stress• Avoid caffeine• Take care of feet and hand• Dress warmly outdoors

Nursing diagnosis

• Ineffective tissue perfusion related to lack of blood supply to extremities.

GOAL :Increased arterial blood supply to extremities.

Nursing ResponsibilitiesNURSING INTERVENTION RATIONALE

• Assess the patient for the blood circulation, color and sensation of the extremities.

• Apply warm compress on the affected area.

• Encourage patient to perform extremities exercises while siting or during work.

• Monitor the blood circulation to the extremities every two hours.

• Administer the medication as prescribed; vasodilator, ca channel blocker, alpha blocker.

• For further investigation and treatment.

• To promote good circulation.

• Muscular exercises promotes blood flow and the development of collateral circulation.

• To assess the blood circulation in the extremities.

• To vasodilate blood vessel and increase blood supply to the extremities.

Evaluation

• Patient`s extremities are warm to touch, improve in colour and no complain of numbness.

Nursing Diagnosis

• Deficient knowledge regarding self care activities.

• GOAL: The patient will be able to carry out daily activity by understanding the health education by a nurse based on the disease.

Nursing responsibilitiesNURSING INTERVENTION RATIONALE

• Assess client knowledge level.

• Encourage client to perform extremities exercise.

• Advice patient to place the finger or toe under the warm water during the attack.

• Advice patient to stop smoking.

• Advise patient not to wear tight wrist band or watch clothing

• For the nurses to give adequate health education to client.

• To promote the blood flow to affected area.

• The warm water will vasodilate and encouarge the blood flow.

• Reducing the risk factor may reduce symptoms or slow the disease progression.

• Constrict clothing and accessories impede circulation.

Evaluation

• Client is able to carry out the daily activities by implementing the health education given.

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