Abdominal Aneurysm nursing care will be explained for this time. Abdominal aneurysm is the condition that commonly occurs in aorta and iliac arthery (kidney arthery). Before we are going to talk about it, let’s have a look to abdominal aneurysm as follow:

Definition

Patient with abdominal aneurysm has abnormal dilatation of arterial wall, commonly it occurs in aorta between renal and iliac artery. Aneurysm is much more common in male than female with hypertension, and much more prevalent in 50 to 80 years old white people. Most of abdominal aneurysm case that has no treatment will develop to death for 2 years after diagnosis, it is because of hemorrhagic and shock that is caused by aneurysm rupture.

Etiology

  • Arteriosclerosis or atherosclerosis
  • Cystic medial necrosis
  • Syphilis and other infections
  • Trauma

Sign and symptoms

  • Peripheral pulse is weaken
  • Hypotension
  • Lumbar pain that spread to other body part and thigh. This lumbar pain indicates widen rupture
  • Throbing pain in periumbilical area
  • Severe and persistent Abdominal pain or back pain caused by rupture into peritoneal cavity
  • Shock
  • Sweaty
  • Abnormal systolic in aorta
  • Tachycardia
  • Deep palpation assessment can palpate the aneurysm
  • Weakness

Diagnosis Examination

  • Aneurysm is looked in x-ray examination
  • Abdomenal ultrasoundography or echocardiogram can determine size, form, and location of aneurysm
  • Anteroposterior and lateral x-ray in abdomen show the mass of aneurysm
  • Aortagraphy shows the condition of proximal and distal aneurysm, but it can not determine the diameter of aneurysm

Treatment

Operation Treatment

  1. Resection can be done for aneurysm and the damage parts will be replaced with Dacron graft to prevent rupture.
  2. Endovasculer graft is a minimal invasive procedure for patient with abdominal aneurysm, especially in aorta aneurysm. Endovascular graft can strightened aorta wall to prevent rupture and aneurysm expansion.
  3. This procedure is done with fluoroscopy and catheter that conducting with  graft, then insert the graft through small incision in femoral artery or iliac artery with a wire. This conducted catheter target is aorta, and put in front of aneurysm.  A balloon in the catheter widen graft and stick it on blood vassel. This procedure generally needs 2-3 hours. The patient that is already done this procedure must be asked to walk in first day after procedure, and he / she can go home after 3 days hospitalization.
  4. Asymptomatic patient of aneurysm is suggested to do an operation if the aneurysm is larger than 6 cm

Farmacology

  1. Beta-adrenergic inhibitor can be prescribed to prevent aneurysm development.

Nursing Care

  1. Monitor the vital sign and crossmatch blood
  2. Get kidney function test result like blood urea nitrogen, creatinine, and electrolytes, blood samples
  3. Evaluate electrocardiogram and cardiac, pulmonary function test, and arterial blood gas
  4. Pay attention to rupture signs. Monitor accurately blood loss signs like hypotension, tachycardia, dyspnea,  patient feels cold, sweaty skin, agitation, and sensory deficits.
  5. If rupture or aneurysm break is occurred, immediately do emergency surgery. Medical antishock troushers can be used during patient’s  moving to operating theater. The surgery probably can compress the aorta directly to control the bleeding. Resuscitative period will need much blood to replace the blood loss. For this condition, kidney failure can be a complication of abdominal aneurysm operation, and the patient will need hemodialysis.
  6. After elective surgery, measure the patient’s body weight, insert the two line blood catheter and help the patient to insert arterial set with artery pulmonary catheter to control the fluid balance. Prescribe antibiotic prophylaxis.
  7. If patient operated with complex abdominal surgery (a surgery with infusion set, endotracheal intubation, nasogastric, and mechanic ventilation), explain the patient about the procedure of operation and post operation.
    After surgery, monitor the vital signs, intake and output of patient every hour, neurology status like consciousness level, pupil size, and extremities sensations, and analysis blood gas.
  8. Assess the patient’s breathing like respiration sound every hour
  9. Aware of bleeding like tachycardia, dyspnea, and hypotension that can happened retroperitoneal from the graft installation. Check abdominal bandage to monitor the bleeding or excessive drainage.
  10. Aware of infection and other infection sign and symptoms
  11. After nasogastric intubation to intestinal decompression, routinely pour the NG with water  to make sure the patency of NG. Note drainage in it.
  12. Do endotracheal intubation care like suck the secret around the patient’s respiratory system. If the patient can breathe without endotracheal intubation, clear breathing sound, normal ABG result, normal volume tidal, the patient will do extrubation and he / she will needs oxygen through masker. Measure the patient body weight every day to evaluate fluid balance.
  13. Help patient to walk 1 – 2 days after surgery
  14. Give emotional support for patient and family