Transcript Valvular Heart Disease/Myopathy/Aneurysm

by Laurie Dickson
Valvular Heart Disease
 Heart contains
 Two atrioventricular valves


Mitral
Tricuspid
 Two semilunar valves

Aortic
Pulmonic

Valvular Disease

Valvular Heart Disease
 Types of valvular heart disease
depend on
 Valve or valves affected
 Two types of functional alterations




Stenosis
Regurgitation
HeartPoint: HeartPoint Gallery
Flashcards about Ch 19 NETI KQ- on your own
Valvular Heart Disease
 Valvular disorders occur
 in children and adolescents primarily from congenital
conditions
 in adults from degenerative heart disease
 Risk Factors
 Rheumatic Heart Disease MI
 Congenital Heart Defects
 Aging
 CHF
Pathophysiology
 Stenosis- narrowed valve, increases afterload
 Regurgitation or insufficiency- increases preload.
The heart has to pump same blood
 **Blood volume and pressures are reduced in front
of the affected valve and increased behind the
affected valve.
 This results in heart failure
 All valvular diseases have a characteristic murmur
murmurs
Mitral Valve Stenosis
Fig. 37-9
Fish mouth
Mitral Stenosis
 Dec. flow into LV
 LA hypertrophy
 Pulmonary pressures increase
 Pulmonary hypertension
 Dec. CO
 Early symptom is DOE
 Later get symptoms of R heart failure
 A fib is common- anticoagulants
 Usually secondary to rheumatic fever
Mitral Regurgitation
 Regurg of blood into LA during systole
 LA dilation and hypertrophy
 Pulmonary congestion
 RV failure
 LV dilation and hypertrophy-to accommodate inc.
preload and dec CO
Mitral Regurgitation
MitraClip 3D
Animation
Mitral Valve Prolapse
 A type of mitral insufficiency
 Usually asymptomatic- click murmur
 May get atypical chest pain related to fatigue
 Tachydysrhythmias may develop
 Risk for endocarditis may be increased
Mitral Valve Prolapse
Live Search Videos: mitral valve prolapse
Midsytolic click & late systolic murmur
A&P 1 Heart part 1
Fig. 37-10
Mitral Valve Prolapse
 Usually benign, but serious complications can occur
 Mitral valve regurgitation
 Infective endocarditis
 Sudden death
 Cerebral ischemia
 heart association guidelines
Mitral Valve Prolapse
 Clinical manifestations
 Most patients asymptomatic for life
 Murmur from insufficiency that gets more intense through systole
Late or holosystolic murmur
Clicks mid to late systole that may be constant or vary beat to beat
Dysrhythmias
Paroxysmal supraventricular tachycardia
Ventricular tachycardia
 Palpitations
 Lightheadedness
 Dizziness





Mitral Valve Prolapse
 May or may not be present with chest pain
 If pain occurs, episodes tend to occur in clusters,
especially during stress
 Pain may be accompanied by dyspnea, palpitations, and
syncope
 Does not respond to antianginal treatment
Aortic Stenosis
Aortic Valve Problems
Aortic Stenosis
 Increase in afterload
 Reduced CO
 LV hypertrophy
 Incomplete emptying of LA
 Pulmonary congestion
 RV strain
Symptoms
Syncope
Angina
Dyspnea
This triad reflects left ventricular
failure
Aortic Stenosis
 May be asymptomatic for many years due to
compensation
 DOE, angina, and exertional syncope are classic
symptoms
 Later get signs of R heart failure
 Untreated-poor prognosis- 10-20%sudden cardiac
death
 Poor prognosis when experiencing symptoms and
valve obstruction is not relieved
 Nitroglycerin is contraindicated because it reduces
preload
Aortic Regurgitation
Aortic Regurgitation
 Get increased preoad- 60% of SV can be regurgitated
 Characteristic water hammer pulse
 A jerky pulse that is full and then collapses because of aortic insufficiency
(when blood ejected into the aorta regurgitates back through the aortic
valve into the left ventricle ).
 Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or
trip-hammer pulse. YouTube - Corrigan's sign
 Regurgitation of blood into the LV
 LV dilation and hypertrophy
 Dec. CO
Echocardiography
Aortic Valve Regurgitation
 Clinical manifestations
 Sudden manifestations of cardiovascular collapse
 Left ventricle exposed to aortic pressure during diastole
 Weakness
 Severe dyspnea
 Chest pain
 Hypotension
 Constitutes a medical emergency
Tricuspid and Pulmonic Valve
Disorders
 Uncommon
 Both conditions cause an increase in blood volume in
R atrium and R ventricle
 Result in Right sided heart failure
Diagnostic Tests
 Echo- assess valve motion and chamber size
 CXR
 EKG
 Cardiac cath- get pressures
Medications
 Like Heart Failure
 ACE inhibitors
 Digoxin
 Diuretics
 Vasodilators
 Beta blockers
 Anticoagulants
 *Prophylactic antibiotics
Medical/ Surgical Treatment
 Percutaneous balloon valvuloplasty
 Surgical therapy for valve repair or replacement:
 Valve repair is typically the surgical procedure of
choice
 Open commissurotomy- open stenotic valves
 Annuloplasty- can be used for both
 Valve replacement may be required for certain
patients Heart valve surgery
 Mechanical-need anticoagulant
 Biologic-only last about 15 years
 Ross Procedure
 MedlinePlus: Interactive Health Tutorials
 YouTube - Robotic Mitral Valve Repair Surgery Animation
Ross Procedure
This is an excised porcine bioprosthesis. The main
advantage of a bioprosthesis is the lack of need for
continued anticoagulation. The drawback of this type of
prosthetic heart valve is the limited lifespan, on average from
5 to 10 years (but sometimes shorter) because of wear and
calcification.
This is a mechanical valve prosthesis of the more modern tilting
disk variety (for the mitral valve). Such mechanical prostheses
will last indefinitely from a structural standpoint, but the patient
requires continuing anticoagulation because of the exposed nonbiologic surfaces.
Medical Animation. Aortic valve replacement
Nursing Diagnoses
 Activity intolerance
 Excess fluid volume
 Decreased cardiac output
 Ineffective therapeutic regimen management
What is new?
 Percutaneous Transcatheter Heart Valve Implantation Metallic clip -for the treatment of mitral regurgitation
 Longer-lasting replacement valves
 Stem cell research and the use of endothelial cells
Cardiomyopathy
 Condition is which a
ventricle has become
enlarged, thickened or
stiffened.
 As a result heart’s ability
as a pump is reduced
Cardiomyopathy
 Primary-idiopathic
 Secondary
 Ischemia- from CAD
 infectious disease
 exposure to toxins
-alcohol, cocaine
 Metabolic disorders
 Nutritional deficiencies
 Pregnancy
3 Types
 Dilated
 Hypertrophic
 Restrictive
Pathophysiology
Dilated
 Most common- heart failure in 25-40%
 Cocaine and alcohol abuse
 Chemotherapy, pregnancy
 Hypertension
 Genetic
 * Heart chamber dilate and contraction is impaired
and get dec. EF%
 *Dysrhythmias are common- SVT Afib and VT
 Prognosis poor-need transplant
This very large heart has a circular shape
because all of the chambers are dilated. It
felt very flabby, and the myocardium was
poorly contractile. This is an example of a
cardiomyopathy.
Normal weight 350 gms now 700 gms
Pathophysiology
Hypertrophic-HOCM
 Genetic
 Also known as IHSS or HCM
 Get hypertrophy of the ventricular mass and
impairs ventricular filling and CO
 Symptoms develop during or after physical activity
 Sudden cardiac death may be first symptom
 Symptoms are dyspnea, angina and syncope
HOCM Patho
 1. Massive ventricular
hypertrophy
 2. Rapid, forceful contraction
of the LV
 3. Impaired relaxation or
diastole
 4. Obstruction to aortic
outflow
 Primary defect is diastolic
filling
 **HCM most common cause
of SCD in young adulthood
There is marked left ventricular hypertrophy, with asymmetric
bulging of a very large interventricular septum into the left
ventricular chamber. This is hypertrophic cardiomyopathy. About
half of these cases are genetic. Both children and adults can be
affected, and sudden death can occur.
HOCM
Fig. 37-14
 Symptoms
 Dyspnea
 Fatigue-dec CO
 Angina, syncope
 S4 and systolic
murmur
 Diagnostics
 Echo- TEE
 Heart cath
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Interventions
Goal- improve vent filling and relieve LV outflow
obstruction
 Beta blockers- metoprolol
 Calcium channel blockers
 Digoxin- only for A-fib if present
 Anti-arrhythmics- amiodorone or sotalol
 ICD- to dec. risk of sudden death
 AV pacing
HOCM treatment
Ventriculomyotomy and myomectomy- incising
the septum muscle and removing some of the
hypertrophied muscle
PTSMA- alcohol induced percutaneous trans
luminal septal myocardial ablation
- inject alcohol into small branch of LAD which
causes ischemia and MI of septal wall. (Grey’s
Anatomy episode relief of heart failure
 Live Search Videos: cardiomyopathy
Nursing
 Relieve symptoms
 Prevent complications
 Provide pysch and emotional support
 Teaching Avoid strenuous exercise and dehydration
 Avoid anything increasing the SVR (afterload) makes
obstruction worse
 If chest pain- rest and elevation of feet for venous
return
 Avoid vasodilators like nitroglycerine- decrease
venous return to the heart
Pathophysiology
Restrictive
 Least common
 Rigid ventricular walls that impair filling
 Contraction and EF normal
 Signs of CHF
 Prognosis-poor
Diagnostics
 Echo-wall motion and
EF
 EKG
 CXR
 Hemodynamics
 Perfusion scan
 Cardiac cath
 Myocardial biopsy
Treatment
Medications
Same as for heart failure except for hypertrophic
Surgery
 Vad-bridge to transplant
 Heart Transplant
 Myoplasty
 ICD- antiarrhythmics are negative inotropes
 Dual chamber pacemaker
 Hypertrophic- excision of ventricular septummyotomy, inject denatured alcohol in coronary
artery that feeds the top portion of septum.
Nursing Diagnoses
 Decreased Cardiac Output
 Fatigue
 Ineffective Breathing Pattern
 Fear
 Ineffective Role Performance
 Anticipatory grieving
Case study 15
Ms. C. 81y/o admitted to CCU with SOB. She has a hx of
mitral valve regurgitation with left ventricular enlargement.
She received 100mg lasix IV in ER and her dyspnea improved.
She has O2 at 3L/min. She has crackles bibasilar and monitor
is SR rate 94-96 with occ. PVC’s. The only med ordered is
MSO4 2-4mg IV as needed for chest pain or dyspnea.
As you go to assess her you find her in bed at 60 degree angle.
She is pale, has circumoral cyanosis and respirations are rapid
and labored.
Question 1
What action should you take first?
1. Listen to breath sounds
2. Ask when the dyspnea started
3. Increase her O2 to 6L minute
4. Raise the HOB to 75-85 degrees
Case Study 15- #2
 Which one of these complications are you most
concerned about, based on your assessment?
 1. Pulmonary edema
 2. Cor pulmonale
 3. Myocardial infarction
 4. Pulmonary embolus
#3
 Which action will you take next?
 1. Call the physician about client’s condition.
 2. Place client on a non-rebreather mask with FiO2
at 95%.
 3. Assist client to cough and deep breathe.
 4. Administer ordered morphine sulfate 2mg IV.
#4
 What additional assessment data are most important
to obtain at this time?
 1. Skin color and capillary refill
 2. Orientation and pupil reaction to light
 3. Heart sounds and PMI
 4. Blood pressure and apical pulse
#5
 Client’s B/P is 98/52 and AP is 116 and irregular in
ST rate 110-120 with frequent multifocal PVC’s. You
call the physician and receive these orders. Which
one should be done first?
 1. Obtain serum dig level
 2. Give furosemide 100mg. IV
 3. Check blood potassium level
 4. Insert #16 french foley catheter
#6
 Which order could be assigned to an LVN?
 1. Obtain serum digoxin level
 2. Give furosemide 100mg. IV
 3. Check blood potassium level
 4. Insert #16 french foley catheter
#7
 While you are waiting for the the potassium
level, you give morphine sulfate 2mg IV to the
the client. A new graduate asks why you are
giving her the morphine. What is the best
response?
 1. It will help prevent any chest pain from
occurring.
 2. It will decrease her respiratory rate.
 3. It will make her more comfortable if she has
to be intubated.
 4. It will decrease venous return to her heart.
#8
 Her K is 3.1. the physician orders KCL 20meq. IV.
How will you administer it.
 1. Utilize a syringe pump to infuse the KCL over 10
minutes.
 2. Dilute the KCL in 100 ml of D5W and infuse over
1 hour.
 3. Use a 5ml syringe and push the KCL over at least
1 minute.
 4. Add the KCL to 1 liter of D5W and administer
over 8 hours.
#9
 After you have infused the KCL, you give the lasix.
Which of these nursing actions will be most useful
in evaluating whether the lasix is having the
desired effect?
 1. Obtain the client’s daily weight
 2. Measure the hourly urine output
 3. Monitor blood pressure
 4. Assess the lung sounds
#10
 The physician orders a natrecor 100mcg IV bolus
and an infusion of 0.5 mcg/ min. Which
assessment data is most important to monitor
during the infusion?
 1. Lung sounds
 2. Heart rate
 3. Blood pressure
 4. Peripheral edema
#11
 Which nurse should be assigned care for this
client?
 1. A float RN who has worked on CCU step
down for 9 years and has floated before to CCU
 2. An RN from a staffing agency who has 5 years
CCU experience and is orienting to your CCU
today
 3. A CCU RN who is already assigned to care for
a newly admitted client with chest trauma
 4. The new graduate RN who needs more
experience in caring for client with left
ventricular failure.
#12
 Which information would be important to report to
the physician?
 1. Crackles and oxygen saturation
 2. Atrial fibrillation and fuzzy vision
 3. Apical murmur and pulse rate
 4. Peripheral edema and weight
#13
 All meds are scheduled for 9 AM. Which would you
hold until you discuss it with the physician?
 Furosemide 40mg po bid
 Ecotrin 81mg po daily
 KCL 10meq three times a day
 Captopril 6.25mg po three times a day
 Lanoxin .125mg po every other day
Aortic Aneurysms
Aortic Aneurysm - Page 5
Aorta
Largest artery
Responsible for
supplying
oxygenated blood to
essentially all vital
organs
Aortic Aneurysms –
Etiology and Pathophysiology
 May involve the aortic arch, thoracic aorta, and/or
abdominal aorta
 Most are found in abdominal aorta below renal arteries
 ¾ of true aortic aneurysms occur in abdominal aorta
 ¼ found in thoracic
 Dilated aortic wall becomes lined with thrombi than can
embolize
 Leads to acute ischemic symptoms in distal branches
 Important to assess peripheral pulses
Aortic Aneurysms
 Atherosclerotic plaques deposit beneath the intima
 Plaque formation is thought to cause degenerative changes
in the media
 Leading to loss of elasticity, weakening, and aortic dilation
Aortic Aneurysms
 Studies suggest strong genetic predisposition
 *Male gender and smoking stronger risk factors than
hypertension and diabetes
 Abdominal aortic aneurysms (AAA)
 Occur in 4.1% to 14.2% of men
 0.35% to 6.2% of women over 60
 Cause of 16,000 deaths per year
 In Canada, account for 0.7% of all mortalities
Thoracic Aortic Aneurysm
Clinical Manifestations
 Frequently asymptomatic
 May have substernal, neck or back pain
 Coughing, due to pressure placed on the
windpipe (trachea)
 Hoarseness
 Difficulty swallowing
 Swelling (edema) in the neck or arms
 Myocardial infarction, or stroke due to
dissection or rupture involving the branches of
the aorta
Ascending Aortic Aneurysm
Aortic Arch
Clinical Manifestations
ASH
 Angina
 Hoarseness
 If presses on superior vena cava

Decreased venous return can cause
 Distended neck veins
 Edema of head and arms
Abdominal Aortic Aneurysm
Clinical Manifestations
 Abdominal aortic aneurysms (AAA)
 Often asymptomatic
 Frequently detected


On physical exam
 Pulsatile mass in periumbilical area
 Bruit may be auscultated
When patient examined for unrelated problem (i.e., CT scan,
abdominal x-ray)
Aortic Aneurysm
Clinical Manifestations
 AAA
 May mimic pain associated with abdominal or back
disorders
 Pain correlates to the size
 May spontaneously embolize plaque

Causing “blue toe syndrome” patchy mottling of feet/toes with
presence of palpable pedal pulses
 It can rupture causing shock and death in 50% of
rupture cases

Etiology and
Pathophysiology
 May have aneurysm in
more than one location
 Growth rate
unpredictable
 Larger the aneurysm
greater risk of rupture
Aortic Aneurysms
Classification
 2 basic classifications- True and False
 True aneurysm
 Wall of artery forms the aneurysm
 At least one vessel layer still intact


Fusiform
 Circumferential, relatively uniform in shape
Saccular
 Pouchlike with narrow neck connecting bulge to one side of
arterial wall
Saccular
Fusiform
Most are fusiform and 98% are below the renal artery
Aortic Aneurysms
Classification
 False aneurysm
 Also called pseudoaneurysm
 Not an aneurysm
 Disruption of all layers of arterial wall

Results in bleeding contained by surrounding
structures
Aortic Aneurysms
Classification
 May result from
 Trauma
 Infection
 After peripheral artery bypass graft surgery at site of
anastomosis
 Arterial leakage after cannulae removal
Types of Aneurysms
Fig. 38-3
Dissecting
 Blood invades or dissects the layers of the vessel wall
Dissecting aneurysms are unique and life threatening. A break or tear
in the tunica intima and media allows blood to invade or dissect the
layers of the vessel wall. The blood is usually contained by the
adventitia, forming a saccular or longitudinal aneurysm.
Aortic dissection occurs when blood enters the wall of
aorta, separating its layers, and creating a blood filled
cavity.
Aortic Dissection
 Often misnamed “dissecting aneurysm”
 Not a type of aneurysm
 Occurs most commonly in thoracic aorta
 Result of a tear in the intimal lining of arterial wall
 Affects men more often than women
 Occurs most frequently between fourth and seventh
decades of life
 Acute and life threatening
 Mortality rate 90% if not surgically treated
Aortic Dissection
Etiology and Pathophysiology
 As heart contracts, each systolic pulsation ↑ pressure on
damaged area
 Further ↑ dissection
 May occlude major branches of aorta
 Cutting off blood supply to brain, abdominal organs,
kidneys, spinal cord, and extremities
 People with Marfan’s at risk
Marfan’s
Dissection of Thoracic Aorta
Manifes tations of Aortic D is s ection
Aneurys m
 Abrupt, s evere, ripping or
tearing pain in area of
aneurys m
 Mild or marked
hypertens ion early
 Weak or abs ent puls es and
blood pres s ure in upper
extremities
 S yncope
C omplications : hemorrhage,
is chemic kidneys (renal
failure), MI, heart failure,
cardiac tamponade, s eps is ,
weaknes s or paralys is of
lower extremities .
Aortic Dissection
Collaborative Care
 Initial goal
 ↓ BP and myocardial contractility to diminish pulsatile forces
within aorta
 Conservative therapy
 If no symptoms
Can be treated conservatively for a period of time
 Success of the treatment judged by relief of pain
 Emergency surgery is needed if involves ascending aorta

Aortic Dissection
Collaborative Care
 Drug therapy
 IV Beta- adrenergic blocker
Esmolol (Brevibloc)
 Other antihypertensive agents
 Calcium channel blockers
 Sodium Nitroprusside
 Angiotensin converting enzyme

Aortic Dissection
Collaborative Care
 Surgical therapy
 When drug therapy is ineffective
or
 When complications of aortic dissection are present
 Heart failure, leaking dissection, occlusion of an
artery
 Surgery is delayed to allow edema to decrease and
permit clotting of blood Surgical therapy
 Even with prompt surgical intervention 30-day
mortality of acute aortic dissections remains high
(10%-28%)
Aortic Aneurysm
Diagnostic Studies
 X-rays
 Chest - Demonstrate mediastinal silhouette and any
abnormal widening of thoracic aorta
 Abdomen -May show calcification within wall of AAA
 ECG -to rule out MI
Aortic Aneurysm
Diagnostic Studies
 Echocardiography
 Assists in diagnosis of aortic valve insufficiency
 Related to ascending aortic dilation
 Ultrasonography
 Useful in screening for aneurysms
 Monitor aneurysm size
Aortic Aneurysm
Diagnostic Studies
 CT scan Most accurate test to determine



Anterior to posterior length
Cross-sectional diameter
Presence of thrombus in aneurysm
 MRI
 Diagnose and assess the location and severity
 Angiography
 Anatomic mapping of aortic system using contrast
 Not reliable method of determining diameter or length
 Can provide accurate info about involvement of intestinal, renal or
distal vessels
Angiography of Aneurysm
Fig. 38-2
Medical Treatment
 Anti-hypertensives
 Beta blockers,
 Vasodilators
 Calcium channel blockers
 Nipride
 Sedatives
 Niacin, mevocor, statins
Post-op anti-coagulants
Surgery
 Usually repaired if >5cm
 Open procedure- abd incision, cross clamp aorta,aneuysm
opened and plaque removed, then graft sutured in place
 Pre-op assess all peripheral pulses
 Post-op-check urine output and peripheral pulses
hourly for 24 hours- (when to call Dr.)
 Endovascular stents- placed through femoral artery
YouTube - Abdominal
Aortic Aneurysm
Graft Repair
Endo
vasc
ular
Repai
r of
an
Abdo
minal
Aorti
c
Aneu
rysm
(Courtesy
of Guidant
Corporatio
n)
YouTube - Cook's
modular AAA graft
an "engineering
achievement"
Aortic Aneurysm
Collaborative Care
 Endovascular graft procedure, con’t
 New approach is percutaneous femoral access

Advantages
 Shorter operative time
 Shorter anesthesia time
 Reduction in use of general anesthesia
 Reduced groin complications within first 6 months
Nursing Management
Acute Intervention- Post-op ICU monitoring
 Arterial line
 Central venous pressure (CVP) or pulmonary artery (PA)







catheter
Continuous ECG monitoring
Oxygen administration/Mechanical ventilation
Pulse oximetry/ Arterial blood gas monitoring
Urinary catheter
Nasogastric tube
Electrolyte monitoring
Antidysrhythmic/pain medications
Nursing Management
 Acute Intervention

Infection
 Antibiotic administration
 Assessment of body temperature
 Monitoring of WBC
 Adequate nutrition
 Observe surgical incision for signs of infection
Nursing Management
 Acute Intervention

Gastrointestinal status
 Nasogastric tube
 Abdominal assessment
 Passing of flatus is key sign of returning bowel
function
 Watch for manifestations of bowel ischemia
Nursing Management
 Acute Intervention


Neurologic status
 Level of consciousness
 Pupil size and response to light
 Facial symmetry
 Speech
 Ability to move upper extremities
 Quality of hand grasps
Peripheral perfusion status
 Pulse assessment
 Mark pulse locations with felt-tip pen
Nursing Management



Peripheral perfusion status
Pulse assessment
 Mark pulse locations with a felt tip pen
Extremity assessment
 Temperature, color, capillary refill time, sensation
and movement of extremities
Nursing Management
 Acute Intervention

Renal perfusion status
 Urinary output
 Fluid intake
 Daily weight
 CVP/PA pressure
 Blood urea nitrogen/Creatinine
Nursing Management
 Ambulatory and Home Care




Encourage patient to express concerns
Patient instructed to gradually increase activities
No heavy lifting
Educate on signs and symptoms of complications
 Infection
 Neurovascular changes
Nursing Diagnoses
 Risk for Ineffective Tissue Perfusion
 Risk for Injury
 Anxiety
 Pain
 Knowledge Deficit
Prevention
 1.Ultrasound is extremely effective at detecting
AAAs.The U.S. Preventive Services Task Force
(USPSTF) recommends that anyone aged 65 to
75 who has ever smoked undergo a one-time
ultrasound screening for AAA
 2.Prevent atherosclerosis
 3.Treat and control hypertension
 4.Diet- low cholesterol, low sodium and no
stimulants
 5.Careful follow-up if less than 5cm. It can grow
.5cm /year
Complications
 Rupture- signs of ecchymosis
 Back pain
 Hypotension
 Pulsating mass
 Thrombi
 Renal Failure
Rupture Triad
Back
pain
Hypotension
Pulsating
hematoma
Aortic Aneurysm
Complications
 Rupture- serious complication related to untreated
aneurysm
 Posterior rupture
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

Bleeding may be tamponaded by surrounding structures,
thus preventing exsanguination and death
Severe pain
May/may not have back/flank ecchymosis
Turner’s sign and Cullen’s sign
Aortic Aneurysm
 Rupture
 Serious complication related to untreated aneurysm
 Anterior rupture
 Massive hemorrhage
 Most do not survive long enough to get to the hospital
 Live Search Videos: aortic aneurysm
 http://www.austincc.edu/adnlev4/rnsg2331online/mo
dule05/aneurysm_case_study.htm
Priority Question # 29
 During the initial post-operative assessment of a




patient who has just transferred to the post-anesthesia
care unit after repair of an abdominal aortic aneruysm
all of these data are obtained. Which has the most
immediate implications for the client’s care?
A. The arterial line indicates a blood pressure of 190/112.
B. The monitor shows sinus rhythm with frequent
PAC’s.
C. The client does not respond to verbal stimulation.
D. The client’s urine output is 100ml of amber urine.
Priority Question #30
 It is the manager of a cardiac surgery unit’s job to develop a




standardized care plan for the post-operative care of client having
cardiac surgery. Which of these nursing activities included in the
care plan will need to be done by an RN?
A. Remove chest and leg dressings on the second post-operative
day and clean the incisions with antibacterial swabs.
B. Reinforce patient and family teaching about the need to deep
breathe and cough at least every 2 hours while awake.
C. Develop individual plan for discharge teaching based on
discharge medications and needed lifestyle changes.
D. Administer oral analgesisc medications as needed prior to
assisting patient out of bed on first post-operative day.
Priority Question # 25
 These clients present to the ER complaining of acute abdominal




pain. Prioritize them in order of severity.
A. A 35 year old male complaining of severe, intermittent cramps
with three episodes of watery diarrhea, 2 hours after eating.
B. An 11 year old boy with a low-grade fever, left lower quadrant
tenderness, nausea, and anorexia for the past 2 days.
C. A 40 year old female with moderate left upper quadrant pain,
vomiting small amounts of yellow bile, and worsening symptoms
over the past week.
D. A 56 year old male with a pulsating abdominal mass and sudden
onset of pressure-like pain in the abdomen and flank within the
past hour.