Page 169 - Critical Care Nursing Demystified

154 CRITICAL CARE NURSING DeMYSTIFIED

Hallmark Signs and Symptoms
Most AAAs cannot be detected on physical examination, especially in obese
patients. Usually they are found during a routine physical or x-ray. During the
physical assessment the examiner may find a pulsating mass slightly left of midline
in the upper abdominal quadrant. An associated bruit is often present as well.
However, only 50% of patients with an AAA have a bruit present, so further diag-
nostic testing is necessary to confirm its presence. An AAA is not usually surgically
corrected unless it is larger than 5 cm.

NURSING ALERT

A pulsating abdominal mass should not be palpated aggressively as it could further dam-
age or cause the rupture of an AAA. Auscultate any pulsating masses first! If the patient is

experiencing pain, rupture may occur at any time! Notify the health care provider stat!

The most deadly complication of an AAA is rupture. Rupture can be indi-
cated by
• Sudden onset of severe, unrelieved back pain that radiates to the flank or
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• Pulsating mass with bruit around the umbilicus

• Extreme abdominal tenderness
• Loss of pulses to the lower extremities

NURSING ALERT

Severe, unrelieved pain in a patient with a history of AAA is a cause for activation of
the quick response team as it can preclude imminent rupture.

Prognosis
Over 1.5 million Americans have an AAA and the numbers are increasing. It is like
a ticking time bomb as most patients are asymptomatic, but it is the 13th leading
cause of death in America. It is a major cause of death in males over the age of 50.
If monitored closely and intervention is early to keep the BP down, prognosis
is good. However, if one ruptures or dissects, even if the patient is in a health care
setting when it happens, prognosis is very grave as death occurs due to an arterial
bleed.
Lifestyle modification in terms of lowering blood pressure, smoking cessa-
tion, and cholesterol lowering are usually done. Diagnostic tests monitor the
progress of the AAA.