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test_3_outline[1]

test_3_outline[1]

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NUR2744
TEST 3 OUTLINE
\u2022
Aortic Aneurysm- outpuuching or dilations of the arterial wall and are
common problems involving the aorta
\u2022
Pathophysiology of Aortic Aneurysms-
o
most common cause atherosclerosis
o
trauma to intimal layer of the vessel causing thinning of the vessel wall
o
2 classifications:
\ue000
True- @least 1 layer still intact
\u2022
Fusiform- circumferential & relatively uniform in
shape
\u2022
Saccular- pouch-like c narrow neck connecting the
bulge to one side of the arterial wall
\ue000
False- disruption of al layers resulting in bleeding contained by
surrounding structures
o
Risk factors
\ue000
Anything causing increased BP
\ue000
Trauma
\ue000
MI
\ue000
Cholesterol
\ue000
HTN
\u2022
Clinical manifestation of AA- sharp stabbing pain radiating to the back
o
Bp different on one arm= MI or AAA
\u2022
Thoracic=
o
usually asymptomatic
o
Deep, diffuse chest pain
o
Hoarseness
o
Dysphagia
o
Decrease venous drainage resulting in JVD
o
Edema of head & arms
\u2022
Abdominal =
o
Mostly asymptomatic
o
Pulsatile mass
o
Bruits
o
Mimic pain associated with any abdominal or back disorder
o
Back pain
o
Deep, diffuse chest pain
o
Epigastric discomfort c 0r s alteration in bowels
o
Blue toe syndrome
o
Throbbing h/a at the beginning that disappears
\u2022
Complications : RUPTURE (grey turners sign= retroperitoneal flank ecchymosis)
\u2022
Dx studies:
o
Physical exam: pulsating mass
o
CXR
o
ECG
o
Echocardiography
o
CT
o
MRI
o
Aortography
o
Arteriography
o
Doppler ultrasound/DSA
o
Ultrasonic scanning
\u2022
Medical Mgmt:
o
Ultrasound test to document the size
o
Pharmacology
o
Physical checkups
\u2022
Surgical MGMT of AA
o
Graft (worry about perfusion everywhere)
o
Incision of diseased segment of aorta, removing thrombus or plaque,
inserting graft, suturing aortic wall
\u2022
Preop nsg. Care or pt having aortic aneurysm repair-
o
Hydrated and any abnormalities with electrolyte, coagulation, and
hematocrit are corrected
o
Antibiotics
o
Antiseptic showers
o
Pt and family teaching
o
Providing support for pt and family
o
Careful assessment of all systems
o
Usually bowel prep
o
NPO p midnight
\u2022
Nsg Dx:
o
Alteration in peripheral tissue perfusion
o
Acute pain
o
Fear
o
Anxiety
o
Risk for infection
\u2022
Nsg interventions
o
H &P
o
Monitor for sx\u2019s of vascular problems
o

Monitor for rupture: diaphoresis, paleness, weakness, tachycardia,
hypotension, abd, back, groin, or periumbilical pain, changes in
sensorium, pulsating abd mass

o
Establish baseline data
o
Peripheral pulses
o
Prevent rupture \u201cwait and see\u201d
o
Prepare for preop eval
o
Emotional support/ psychosocial support
o
Post op care
o
Assure pt safety
o
Prevent complications
o
Maintain nutritional status
o
Pt. teaching and discharge planning
o
Acute interventions:
\ue000
Large bore IV= NS (maintain graft patency)
\ue000
Monitor BP, CVP/PA or UOP hourly
\ue000
ECG monitoring
\ue000
Electrolyte monitoring
\ue000
ABG\u2019s
\ue000
O2 and IV antiarrythmics
\ue000
Pain control
\ue000
Infection
\ue000
VS
\ue000
CBC w dif
\ue000
Nutrition
\ue000
NG tube care (flatus)
\ue000
Neuro status
\ue000
Peripheral perfusion QH x several hours
\ue000
Renal status
\ue000
I/O daily weight
\ue000
BUN Creatinine
\u2022
Home care
o
Gradual increase in activities
o
Fatigue, poor appetite, irregular bowels expected
o
No heavy lifting 4-6 wks
o
s/sx\u2019x of infection
o
perfusion of extremities
o
sexual dysfunction common in men
o
Blood thinners
o
BP meds
o
Routine checkups
o
Diet- low fat, low cholesterol
\u2022
Pathophysiology or aortic dissection
o
Tear in the intimal lining of the arterial wall that allows blood to enter
between the intima and media, thus creating a false lumen
o
As the heart contracts, each systolic pulsation causes increased pressure
on the damaged area
o
Further increasing the dissection
o
As it extends distally or proximally t may occlude major branches of the
aorta cutting off blood supply to other areas
\u2022
Clinical manifestations of aortic dissection
o
Depends on location and extent of dissection
o
Sudden, severe pain anterior chest or intrascuplar pain radiating down
the spine into the abdomen or legs
o
Described as \u201ctearing\u201d or \u201cripping\u201d
o
Pain may mimic MI
o
As dissection progresses, pain may be located both above and below the
diaphragm
o
CV, Resp., Neuro signs may also be present
o
If the arch is involved= neurological
\u2022
Collaborative care of aortic dissection-
o
Bed rest
o
Initial goal s complication= decreased Bp & myocardial contractility to
diminish force
\ue000
IV trimethaphan (Arfonad) Nitroprusside (Nipride) rapidly
reduce systolic blood pressure.
\ue000
Beta blockers (lol) decrease force of contractility (propranolol
(Inderal)
o
Conservative therapy- without complications
\ue000
Pain relief, blood transfusion (if required), and mgmt of heart
failure(if indicated)
o
Surgical Therapy-
\ue000
Indicated when drug therapy is ineffective or complications are
present
\u2022
Shock Syndrome - syndrome characterized by decreased tissue perfusion and
impaired cellular metabolism. Results in imbalance between supply and demand
of O2
\u2022
Three major classifications-
o
Cardiogenic Shock
o
Hypovolemic Shock
o
Vasogenic
\ue000
Septic Shock
\ue000
Anaphylactic Shock
\ue000
Neurogenic Shock
\u2022
Precipitating Factors-
o
Vascular tone/ vasodilation
o
Hypovolemia
o
Pump failure
o
Etiology of the shock
\u2022
Clinical manifestations:
o
Decreased CO
o
Hypotension
o
Decreased perfusion (cardiac, renal, cerebral, and peripheral)
o
Decreased UOP
o
Progressive multisystem, organ dysfunction
\u2022
Dx Studies-
o
CBC
o
BUN
o
Serum Creatinine
o
Electrolytes
o
ABG\u2019s
o
Urine specific gravity
o
Hemodynamic monitor
o
Blood cultures
\u2022
Medical Mgmt-
o
Airway mgmt
o
Iv therapy including blood products
o
Pharm
o
Correction of acid/ base imbalance
o
Pacemaker
o
IABP
\u2022
Nsg. DX-
o
Decreased CO
o
Decreased tissue perfusion
o
Potential for impaired gas exchange
\u2022
Nsg Interventions-
o
Maintain patent airway
o
Assess level of consciousness
o
Maintain resp. status
o
Correct acid/base disturbances
o
Monitor hemodynamic parameters
o
ECG
o
Check for potential bleeding
o
Prevent complications
o
Maintain nutritional status
o
Maintain fluids & electrolyte balance
o
Provide emotional/psychological
o
Pt teaching
\u2022
Assess patients with shock syndrome.-
o
DX:
\ue000
CBC- different in diff forms
\ue000
BUN- increased
\ue000
Serum Creatinine- increased
\ue000
Electrolytes- increased
\ue000
ABG\u2019s- Resp. alkalosis, Metabolic Acidosis
\ue000
Urine specific gravity- increased, fixed @ 1.010
\ue000
Hemodynamic monitor
\ue000
Blood cultures- organism growth
\u2022
Select appropriate nursing diagnosis for a patient with shock syndrome.-
o
Decreased CO RT shock
o
Fear and Anxiety RT severity of condition
o
Organ ischemia/ dysfunction
o
Decreased tissue perfusion
o
Potential for impaired gas exchange

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