Thoracic aortic aneurysm can cause a heart tamponade, fluid accumulation in the heart cavity, that is very dangerous and threatened life. So here is some of guidance for nurses to plan some guidance in thoracic aortic aneurysm nursing care.
Thoracic aortic aneurysm is signed by abnormal enlargement of aorta (the largest artery in the body). The aortic upward is the most common and fatal aneurysm. Aneurysm can be like disection, it seperates hemorrhage (bleeding) from aortic wall (the medial layer of aorta). Its forms are like a balloon or fusiform (enlargement like spindle that cover all of aortic circles).
Some of aneurysm develops serious complication and lethal, for instance a rupture in dissection thoracic aneurysm that is not handled will spread to pericardium, tamponade occurs soon.
- Congenital defect
- Fungus infection (mitotic aneurysm) in aortic curve and downward segment
- Traumatic history in chest
- Hypertension in dissection aneurysm
- Intimal tear in upward aorta that indicate dissection aneurysm
- Syphilis in downward aorta caused by accident that cut aorta horizontally (acceleration and deceleration injury)
- Trauma in downward aorta caused by cut aorta horizontally (acceleration and deceleration injury)
Sign and Symptoms
- Sudden neurology deficits if the dissection involves carotid artery
- Aortic insufficiency
- Different blood pressure between right and left hand
- Severe pain like stubbing pain that spreads to neck, shoulder, lower spine, and abdomen area, but it may spread to jaw and hand, especially right side.
- Friction of pericardia caused by hemopericardium
- In downward aortic aneurysm, the patient will feel sharp pain that occurs suddenly between scapula and chest area
- In horizontal aortic aneurysm, the patient will feel sharp and biting pain suddenly that spread to shoulder, and it will make the patient’s voice hoarse, dysphagia, and cough
- In same intensity between carotid artery and radial artery
- Aortography is the most accurate diagnosis examination, it shows aneurysm lumen, size, and location, include pseudo lumen in dissection aneurysm
- Electrocardiography helps distinguish thoracic aortic aneurysm and myocardia infarct
- Normal hemoglobin or low hemoglobin level depend on the blood loss
- Computed tomography (CT) scan and magnetic resonance imaging ensure and find location of aneurysm, it also can be used to monitor the development of thoracic aortic aneurysm
- Echocardiography transesophageal is used to measure aneurysm in upward and downward aneurysm.
As a collaboration in thoracic aortic aneurysm nursing care, we must collaborate with doctors and other health care workers in nursing care. Some of the treatmeants that may be performed are as follows;
- Anti-hypertension like nitroprusside
- Negative Inotropic reduces contraction
- Oxygen for respiratory distress
- Fluid and blood transfussion intravenously
- Operating aneurysm ressection, this operation bring back normal blood flow through Darcon and Teflon graft and if the patient has aortic valve insuficience, so the patient will have aortic valve replacement operation.
Thoracic Aortic Aneurysm Nursing Care
So here are some of the best nursing care plan in thoracic aortic aneurysm nursing care;
- Monitor the blood pressure, pulomnary artery wedge pressure, and central venous pressure. Beside that, evaluate pain, brething, carotid pulse, radial pulse, and femoral pulse
- Check the laboratory result such as like blood counts, electrolyte, analysis blood gas, and urinalysis
- Help control of urine output with catheter. Give dextrose 5% or Ringer Lactat and an antibiotic. Accurately monitor nitroprusside infusion, use different infusion for it. Match the doses slowly from low doses to high doses while checking blood pressure every 5 minutes until the patient’s condition stabile
- If there is a aneurysm burst, give the patient right infusion immediately
- Explain diagnosis examination and inform the patient if the patient needs to be operated. Step by step tell the patient about post operative nursing cares like I.V infusion, endotracheal and drainage pipe, cardiac monitoring, and ventilation
- After thoracic aneurysm recovery
- Evaluate the patient’s consciousness level. Monitor the presence of vital sign, pulmonary artery pressure, pulmonary artery wedge pressure, and central venous pressure like pulse, urine output, and pain
- Monitor respiratory function. Observe and note types and chest drainage pipe and monitor the breathing sounds
- Monitor intravenous fluid therapy
- Give right medications
- Aware of infection signs, especially fever and excessive wound bleeding
- Help patient to do lower extremity exercise to prevent thromboembolism caused by venostasis during long hospitalization
- After vital signs and repiration are in stabile, help patient to change the position, effective cough, and deep breathing. Give intermittent positive pressure to help lung expansion
- Help patient to walk after the patient get the recovery
- Before patient go home, make sure she/he has anti-hypertension therapy and know about the medications, inform patient about how to handle hypertension
- During hospitalization, give patient emotional support to be healthy