Aortic Aneurism

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Aortic Aneurism
2010-03-01 19:41:55
nursing med surg IV

nursing care for arotic aneurism
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  1. goals with postop pt
    • maintaining adequate respiratory function
    • fluid and electrolyte balance
    • pain control
  2. post op AA graft
    • Monitor graft patency and renal perfusion
    • monitor and intervenes to limit or treat dysrhythmias, infections, and neurologic complications
  3. AA graft patency cont. maintain adequate BP
    prolonged hypotension
  4. prolonged hypotension => fraft thrombsis
    • administer IV fluids and blood components (as indicated)
    • CVP readings or PA pressuresand urinary output monitored hourly
    • -to assess hydration and perfusion
  5. AA graft patency cont.
    maintain adequate BP
    • stress onthe arterial anastomoses, resulting in leakage or rupture
    • Drug therapy w/
    • Diuretics
    • antihypertensive - Nipride, corlopam, cardene
  6. AA post op
    cardiovascular status
    • continuous /ecg monitoring
    • electrolyte and artrial blood gas
    • O2 adm.
    • antidysrhythmic meds
    • replacement of electrolytes as indicated
    • pain control
    • resumption of preop cardiac meds
  7. AA post op
    • broad spectrum antibiotic
    • temp
    • labs for elevated WBC (1st indication for infection)
    • adequate nutrition
    • incision site assessment; clean and dry
    • IV,arterial and CVP or PA caths cared for w/ strict asepsis
    • peri care for the pt w/ indwelling urinary cath
  8. AA post op
    GI status
    • paralytic ileus may devolp due to anthesia and bowel manipulation
    • NG tube on low intermittent suction (decompresses stomach, prvents aspiration, decreases pressure on suture lines)
    • -irrigated w/ NS - amnt and character of drainage noted
    • assess for absent bowel sounds, fever, abd. distention, diarrhea, and bloody stools
    • mouth care for the NPO pt.
  9. AA post op
    neurologic status
    • ASSENDING AORTA INVOLVED - assess LOC, pupil size, response to light, facial symmetyr, tonue deviation, speech, ability to move upper extremities, and hand grasps quality.
    • DECENDING AORTA - assess move lower extremities is added
  10. AA post op
    peripheral perfusion status
    • depending location of aneurysm
    • all peripheral pulses checked q/hr
    • ASCENDING AORTA AND AORTIC ARCH - carotid, radial and temporal
    • DESCENDING - femoral, popliteal, posterior tibial, dorsalis pedis
    • (mark with pen)
    • skin temp and color, cap refill, sensation and movement
    • decreased or absent pulse w/ cool, pale, mottled, painful extrmity = embolism of aneurysmal thrombus or plaque, or graft occlusion
  11. AA post op
    renal perfusion
    • urinary cath in place
    • hourly urine outputs
    • I & O
    • daily wts
    • CVP and PA for hydration status
    • daily blood BUN and creatinine (renal function)
    • hypotension, dehydration, prolonged aortic clamping or blood loss can lead to decreased renal perfusion => acute renal failure
  12. AA post op
    Home Care
    • fatigue, poor appetite, irregular bowel habits - expected
    • avoid heavy lifting 4-6 wks
    • redness, swellin, increased pain, drainage from incisions or fever>100 - call dr.
    • teach - color or warmth changes in extremities, palpate peripheral pulses for change in quality
    • prophylactic antibiotics before invasive procedures including dental
    • sexual dysfunction - common
  13. AA post op
    expected outcomes
    • patent arterial graft w/ adequate distal perfusion
    • adequate urine output
    • normal body temp
    • no signs of infection