ACHARYA COLLEGE OF NURSING

CHOLANAGAR, BANGALORE.

SEMINAR ON

AORTIC ANEURYSM

SUBMITTED TO: Mrs.Ponnarasi, HOD, Medical Surgical nursing, Acharya College of nursing.

SUBMITTED BY:

Mrs.A.Kalaichelvi, II year M.Sc. Nursing, Acharya College of nursing.

MASTER PLAN

UNIT SUBJECT

: MEDICAL SURGICAL NURSING. : AORTIC ANEURYSM

DATE OF PRESENTATION: TIME OF PRESENTATION: SL. NO 1 2. 3. 4. 5. 6. 7. 8. 9. 10. 12. 13. 14. INTRODUCTION OBJECTIVES TEDRMINOLOGIES DEFINITION ETIOLOGY PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS DIAGNOSTIC EVALUATION MANGEMENT/COMPLICATIONS CONCLUSION JOURNAL ABSTRACTS BIBLIOGRAPHY AV AIDS.

CONTENT

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INTRODUCTION: An aneurysm is a localized sac or dilation formed at a weak point in the wall of the aorta (Fig. 31-11). It may be classied by its shape or form. The most common forms of aneurysms are saccular or fusiform. A saccular aneurysm projects from one side of the vessel only. If an entire arterial segment becomes dilated, a fusiform aneurysm develops. Very small aneurysms due to localized infection are called mycotic aneurysms. Approximately 85% of all cases of thoracic aortic aneurysm are caused by atherosclerosis. They occur most frequently in men between the ages 40 and 70 years. The thoracic area is the most common site for a dissecting aneurysm. About one third of patients with thoracic aneurysms die of rupture of the aneurysm OBJECTIVES: Over all objective:Make the student to gain knowledge regarding Aortic Aneurysm and nurses role in it. Learning objectives:The student will be able to, State the definition of Aortic Aneurysm. Enlist the etiological factors of Aortic Aneurysm Understand the pathophysiology of Aortic Aneurysm. List out the clinical manifestations of Aortic Aneurysm. Enumerate the diagnostic evaluation of Aortic Aneurysm Describe the management of Aortic Aneurysm. TERMINOLOGIES: Inammatory (noninfectious): Associated with arteritis (Takayasus disease, giant cell arteritis, systemic lupus erythematosus, Behets syndrome, Kawasakis disease) and periarterial inammation (ie, pancreatitis) Infectious (mycotic): Bacterial, fungal, spirochetal infections Anastomotic (postarteriotomy) and graft aneurysms: Infection, arterial wall failure, suture failure, graft failure 3

AORTIC ANEURYSM
Definition: An aneurysm is a localized sac or dilation formed at weak point in the wall of aorta. Incidence: This disease is three times more common in men than in women in the age of 5070 yrs. Etiology: The physical change in the aortic diameter occur secondary to Types False aneurysm Actually a pulsating haematoma , the clot and connective tissue are out side the arterial wall. True aneurysm One or two or all the layers of the artery may be involved. Fusiform aneurysm Symmetric spindle shaped expansion of entire circumference of involved vessel. Sacular aneurysm A bulbus protrusion of one side of the arterial wall. Trauma, Infection, An intrinsic defect in the protein construction of the aortic wall, or Due to progressive destruction of aortic proteins by enzymes.

Dissecting aneurysm This is usually a haemetoma that splits the layers of the arterial wall. Throcic aortic aneurysm Thoracic aortic aneurysm is caused by arthrosclerosis. This is the most common type of aneurysm (85%). Abdomoinal aortic aneurysm This is caused by congenital weakness, trauma, or disease, smoking, and athrosclerosis.

. (A) Normal artery. (B) False aneurysm(C) True aneurysm (D) Fusiform aneurysm. (E) Saccular aneurysm (F) Dissecting aneurysm

Patho physiology : Due to causes there will be change in aortic wall Due to hypertension aortic wall become weakens Progressive destruction of aortic proteins by enzymes. Dilation and formation of sac Aortic aneurysm

Clinical manifestations: 1. May be asymptomatic in early stages 2. Pain in supine position 3. Dyspnoea due to pressure of sac against trachea 4. Cough 5. Hoarseness stridor 6. Aphonia (complete loss of voice due to compression of recurrent laryngeal nerve) 7. Dysphagia Diagnostic evaluation: 1. Chest x ray 2. CT scan 3. MRI scan 4. Trans esophageal echocardiography Medical management: Medical therapy of aortic aneurysms involves strict blood pressure control. This does not treat the aortic aneurysm per se, but control of hypertension within tight blood pressure parameters may decrease the rate of expansion of the aneurysm. Anti hypertensive medication Eg betablockers, Proponolal Surgical management 1. The definitive treatment for an aortic aneurysm is surgical repair. This usually involves the insertion of an endovascular stent inside the aortic walls for the length of the aneurysm. This works as a substitute vessel along the affected part, thus re-enforcing the weakened aortic wall and preventing further deterioration. 2. Open surgery typically involves opening up of the dilated portion of the aorta and insertion of a synthetic (Dacron or Gore-Tex) patch tube. Once the tube is sewn

into the proximal and distal portions of the aorta, the aneurysmal sac is closed around the artificial tube. Instead of sewing, the tube ends, made rigid and expandable by nitinol wire frame, can be much more simply and quickly inserted into the vascular stumps and there permanently fixed by external ligature Nursing management Evaluating radial, brachial, ulna, femoral and post tibial pulses. Assess color and temperature of the extremity Check capillary refill time Check Doppler study for every hour for first 8 hrs. Monitoring urinary output Assess bowel sounds If need do nasogastric suctioning Monitor signs for thrombosis

Major nursing diagnosis Impaired skin integrity related to vascular insufficiency Impaired physical mobility related to activity restrictions of the therapeutic regimen and pain Imbalanced nutrition: less than body requirements, related to increased need for nutrients that promote wound healing Potential complication Death is the only thing at last CONCLUSION Most abdominal aneurysms occur in patients between the ages of 60 and 90 years. Rupture is likely with coexisting hypertension and with aneurysms wider than 6 cm. In most cases at this point, the chances of rupture are greater than the chance of death during surgical repair. If the elderly patient is considered at moderate risk for complications related to surgery or anesthesia, the aneurysm is not repaired 7

until it is at least 5 cm (2 inches) wide. JOURNAL ABSTRACT Abdominal aortic aneurysms (AAAs) represent a degenerative process of the abdominal aorta that is often attributed to atherosclerosis; however, the exact cause is not known. A familiar clustering of AAAs has been noted in 15-25% of patients undergoing repair of the problem. Degenerative aneurysms account for more than 90% of all infrarenal AAAs. Other causes include infection, cystic medial necrosis, arteritis, trauma, inherited connective-tissue disorders, and anastomotic disruption. The disease generally affects elderly white men. Smoking appears to be the risk factor most strongly associated with AAA. BIBLIOGRAPHY Suzanne and Burnard Brunner, Textbook of medical surgical nursing Vol2.10th edition.Pg no..834-840 Sandra M Nettina, The Lippincott Manual of Nursing Practice, seventh edition,

lippincott publishers Philadelphia page no:1678 The text book of medical surgical nursing by Joyce M.Black, 8 th edition, published by Saunders Elsevier, page no:808-816 http://emedicine.medscape.com/article/463354-overview AV aids OHP Black board