Page 168 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 153

Administer antirejection medications for life to decrease the incidence of
graft-host rejection.
Attach and prepare for temporary epicardial pacing if the HR remains lower
than normal to maintain CO.
Observe for right ventricular failure as this is the most common complica-
tion after transplantation (for unknown reasons).
Teach the patient about orthostatic hypotension and to rise slowly in the
morning and during activity as the denervated heart does not respond as
quickly as the normal heart.
Encourage the patient to attend cardiac rehabilitation programs to help
strengthen the heart to respond to demands. The heart cannot respond to
direct sympathetic nervous system stimulation; it must wait for circulating
catecholamines, which may take more than 3 to 5 minutes. Exercise toler-
ance must be helped using warm-up and cool-down exercises.
Encourage the patient to keep annual stress test, angiography, or ultrasonog-
raphy appointments as the denervated heart does not experience angina, so
pain is not experienced and other quantitative means of heart function are
needed to monitor progress. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Abdominal Aortic Aneurysm (AAA)

What Went Wrong?
An aneurysm is a weakening in the medial layer of the arterial wall that causes it
to dilate. High pressure within the arterial system further weakens this area, caus-
ing it to balloon outward. Just like with an overfilled balloon, any more pressure
can make it rupture or pop. When an AAA ruptures, the patient hemorrhages into
the retroperitoneal space and quickly bleeds to death. Arteriosclerosis changes due
to aging, hypertension, and smoking are risk factors associated with AAA. Genet-
ics and race play an important part as AAAs tend to run in families.
There are two types of aneurysms: true and dissecting. A true aneurysm
involves all three linings of the artery. It can be saclike, involving either side of
the artery (fusiform), or one sided (saccular). Saccular aneurysms tend to rup-
ture more frequently as the areas of weakness are concentrated into small areas.
The problem with true AAAs is that they can rupture, causing death due to
hemorrhage into the peritoneal cavity. A false or dissecting aneurysm is a tear
that opens in the inner wall of the artery and is frequently associated with
Marfan’s syndrome.