Page 170 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 155

Interpreting Test Results

Ultrasounds are a noninvasive way to assess for an aneurysm and monitor its
growth.

CT scans can also look at whether clots are present in a dissecting or leaking
aneurysm.

Arteriography and angiography must be done prior to surgery. Surgical inter-
vention is rarely done on aneurysms smaller than 4 to 5 cm (see Table 3–18).

Nursing Diagnoses for AAA Expected Outcomes
Pain, acute RT expansion of vascular The patient will have pain controlled
mass from 0 to +1/10
Tissue perfusion, alteration in The patient will have 0 expansion of
(peripheral) due to expanding vascular lesion
vascular lesions

TABLE 3–18 Types of Surgeries for AAA
Surgery Description Postoperative Care 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.
Open repair Incision below xiphoid process Airway care—intubated
with an to symphysis pubis Breathing—cough and
endoaneurys- Cross clamp above and below deep breathing Incentive
morrhaphy aneurysm spirometry
Plaque and clots removed Circulation—monitor VS
Graph is placed around AAA and especially BP as graft can
sutured in place to aneurysm clot or leak if BP is too
low or high
Discharge planning—a
longer hospital stay
Endovascular Less invasive than open repair; Airway care—intubated
stent graft or decreased hospitalization and Breathing—cough and
endovascular recovery time deep breathing Incentive
aneurysm repair Bilateral groin incisions made. Con- spirometry
trast medium is injected so allergy Circulation—bilateral
to dye is assessment is critical calf-high compression
Metal mesh stent inserted through stockings applied. Observe
femoral artery via fluoroscopy for bleeding at the site
Graft is positioned by balloon infla- Discharge planning—
tion that bypasses the aneurysm usually sent home very
Graft hooks on to intima of the quickly
artery; allows blood to flow
through it to lower extremities