Abdominal Aneurysm

Abdominal Aneurysm An aneurysm—that is, an abnormal dilation or outpouching of a weakened site of a blood vessel—often involves an artery. The abdominal aorta is a common site of aneurysms, possibly due to the high volume of blood flow in that area. A variety of factors may be implicated in the development of an abdominal aortic aneurysm (AAA), including smoking, male gender, hypertension, trauma, infection, genetic predisposition, and degeneration. Degenerative changes due to plaque formation of fatty deposits over the years are likely to result in arteriosclerosis (arterial thickening and hardening) or atherosclerosis (a form of local arteriosclerosis). These conditions are thought to be linked to the loss of elasticity and weakening of the arterial walls, potentially leading to aortic dilation. The larger the size of the aneurysm, the higher the risk of rupture. Main Symptoms Most patients with an AAA experience no symptoms. In some patients, a pulsating mass in the area around the umbilicus may be evident with bruits (vascular sounds), which can often be auscultated if the patient is not obese. If a patient with an AAA experiences a sudden onset of abdominal pain radiating to the lower back and groin, with a numbing or tingling sensation in the feet, and shows signs of hypotension or shock, the impending rupture of the aneurysm may be suspected. Such a rupture is a life-threatening emergency. Selected Nursing Tips 1. Early detection and prompt treatment are essential to prevent aneurysm rupture and subsequent massive hemorrhage. 2. Be vigilant for signs of rupture, which can be instantly fatal. Signs of acute blood loss include hypotension, tachycardia (rapid heartbeat), tachypnea (rapid respiration), restlessness, and cool and clammy skin. In some aneurysm-rupture cases, the signs of hemorrhage may be subtle, emerging over a period of hours. 3. Once an aneurysm is located, the size should be monitored and any coexisting conditions treated. Reduce the modifiable risks, such as by normalizing blood pressure (BP). 4. Avoid deep palpation, which could rupture the aneurysm. 5. Surgical repair is commonly indicated for a symptomatic patient and a ruptured aneurysm; preparing the patient for surgery may be a nursing priority. 6. After surgery, nursing care aims at maintaining the patient's hemodynamic status to prevent complications. Monitorpulmonary and renal functions as well as vital signs and lab test results. Points to Consider 1. A healthy lifestyle, including regular exercise and weight reduction with consumption of a low-fat and low-cholesterol diet, may lower the risk for aortic aneurysm. 2. Male individuals and smokers are more susceptible to abdominal aortic aneurysm of atherosclerotic origin. 3. Ultrasound may be utilized to screen for abdominal aortic aneurysms and to monitor the size of aneurysms. 4. Kidney damage may result when the blood supply is compromised due to shock or repair surgery. Monitor blood urea nitrogen (BUN), creatinine levels, and urine output; urine output of less than 30 mL/h warrants nursing intervention. 5. Individuals with hereditary Marfan's syndrome (a premature degeneration of aortic tissue) may have a relatively higher risk for developing aneurysms and may need to avoid certain vigorous (contact) sports. Precaution Auscultate the pulsating abdominal mass for bruits (vascular sounds), but avoid deep palpation to lower the risk of bursting the aneurysm.