Aortic aneurysm (Abdominal Aneurysm; Dissecting Aneurysm; Thoracic Aneurysm;) is a localized, circumscribed, blood-filled abnormal dilation of an artery caused by disease or weakening of the vessel wall.
True aneurysms involve dilation of all layers of the vessel wall. The two types of true aneurysms are: (1) saccular, which is characterized by a bulbous out-pouching of one side of the artery resulting in localized stretching in localized stretching of the artery wall, and (2) fusiform, which is characterized by a uniformly shaped dilation of the entire circumference of the artery. True aneurysms are asymptomatic and are typically diagnosed by physical examination or a diagnostic ultrasound or computed tomography (CT) scan. The natural history of an aneurysm is enlargement; as a rule, the larger it is, the greater the chance of rupture. Aneurysms are most commonly seen in the abdominal aorta. Abdominal aortic aneurysm (AAAs) account for about 75% and thoracic aneurysms for about 25% of all cases. They occur more often in men than in women. Risk factors include smoking and familial history of aneurysms. When an aneurysm becomes large enough for risk for rupture, it can be repaired by open surgical repair or a less-invasive endograft-covered stent repair.
Dissecting aneurysms occur when the inner layer of the blood vessel wall tears and splits, creating a false channel and cavity of blood between the intimal and adventitial layers. They are typically classified according to the location. According to the Stanford classification, type A involves the ascending aorta and its transverse arch and type B involves the descending aorta. A dissecting AAA is the most catastrophe involving the aorta, and it has a high mortality rate if not detected early and treated with surgery. More than 90% of clients present with sudden onset of severe pain which is usually described, as sharp, tearing, or stabbing in nature. Symptoms depend on the size and location of the dissection or rupture. Risk factors for dissection include congenital, inflammatory, hypertension, pregnancy, trauma, and Marfan syndrome.
Nursing care plan for clients with an aortic aneurysm is to modify risk factors, controlling the BP to prevent strain on the aneurysm, recognizing symptoms early, and preventing the occurrence of a rupture.
Here are four (4) nursing care plans (NCP) and nursing diagnosis for patients with aortic aneurysm:
Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
May be related to
- Close monitoring by medical or nursing staff
- Fear of death
- Impending surgery
- Multiple tests and procedures
- Sudden onset of illness
Possibly evidenced by
- Constant demands
- Increased alertness
- Increased questioning
- Request to have family at bedside all the time
- Tense, anxious appearance
- Client will verbalize strategies to reduce his anxiety level.
- Client will demonstrate positive coping method.
|Assess the client’s anxiety level (mild, severe). Note signs and symptoms, especially nonverbal communication.||Aortic dissection and/or rupture can result in an acute life-threatening situation that will produce high levels of anxiety in the client as well as in significant others.|
|Acknowledge awareness of the client’s anxiety.||Acknowledgement of the client’s feelings validates the feelings and communicates acceptance of those feelings.|
|Provide a quiet, private place for significant others to wait.||A quiet environment can reduce anxiety.|
|Reduce unnecessary external stimuli.||Anxiety may escalate with excessive conversation, noise, and equipment around the client.|
|Explain all procedures as appropriate, using simple, concrete words.||Information helps allay anxiety. Clients who are anxious may not be able to comprehend anything more than simple, clear, brief instructions.|
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