Week 4 - Aortic Dissection

Question 1

what is aortic dissection

Answer 1

• tearing of the inner layer of the aorta

= blood surges thru the tear causing layers of the vessel to separate

Question 2

what can cause aortic dissection

Answer 2

• degeneration of the elastic fibres in the medial layer

- -> HTN

Question 3

what does aortic dissection cause

Answer 3

• cut off blood supply to critical areas such as the brain, kidneys, spinal cord, extremities

Question 4

what are predisposing factors to aortic dissection (6)

Answer 4

• HTN
• age
• male sex
• CHD
• CT disorders
• atherosclerosis

Question 5

what signs are seen in an ascending aortic dissection (3)

Answer 5

• sudden, severe onset of excruciating chest pain, back pain, or both
• pain radiates to back or soulder
• sharp, ripping, tearing, pain

Question 6

where is pain seen in a descending aortic dissrection (2)

Answer 6

• pain to back, abdomen, legs

Question 7

if the aortic arch is involved in the dissection, what signs will you see (5)

Answer 7

• neuro deficits
• altered LOC
• weakened or absent carotid & temporal pulses
• dizziness
• syncope

Question 8

an ascending aortic dissection produced disrupted blood flow to??

Answer 8

• the coronary arteries

Question 9

a descending aortic dissection produces disrupted blood flow to?? (2)

Answer 9

• abdominal organs

- lower extremities

Question 10

an aortic dissrection involving the aortic arch will cause disrupted blood flow to??

Answer 10

• the brain (= emergency)

Question 11

what are 3 complications of aortic dissection

Answer 11

• cardiac tamponade
• aortic rupture
• occlusion of blood supply to organs

Question 12

how does aortic dissections lead to cardiac tamponade

Answer 12

• when blood flow the dissection leaks into the pericardial sac

Question 13

what are clinical manifestations of cardiac tamponade (4)

Answer 13

heart not pumping well due to pressure on heart:

• hypotension
• narrowed pulse pressure
• jugular venous distension
• muffled heart sounds

Question 14

how can aortic dissection lead to aortic rupture

Answer 14

• if it is weakened by the dissection

Question 15

what does aortic rupture lead to

Answer 15

• hemorrhage into the mediastinal, pleural, or abdominal cavities
  = exsanguination and death

Question 16

an aortic dissection can lead to occlusion of blood supply to which organs (4)

Answer 16

• spinal cord,
• kidneys
• brain
• the mesentry

Question 17

what are symptoms of spinal cord iscemia (3)

Answer 17

• weakness
• decreased sensation to lower extremities
• paralysis of lower extremities

Question 18

what can renal ischemia lead to

Answer 18

• renal failure

Question 19

what are symptoms of abdominal (mesentry) ischemia (4)

Answer 19

• abdominal pain
• decreased BS
• altered bowel fnxn
• bowel necrosis

Question 20

what diagnostics can be used to diagnose aortic dissection (4)

Answer 20

• chest xray
• CT
• transesophageal echo (TEE)
• MRI

Question 21

what are the initial goals of therapy for aortic dissection (2)

Answer 21

• BP control

- pain control

Question 22

why is BP control imp for aortic dissection

Answer 22

• reduces stress on aortic wall

Question 23

what is the other goal of treatment of aortic dissection

Answer 23

• prevent rupture and progression of dissection

Question 24

what are different types of treatment for aortic dissection (3)

Answer 24

• conservative therapy (BP and pain control, if no complications)
• endovascular dissection reapir
• surgery

Question 25

what is endovascular dissection repair

Answer 25

- similar to EVAR - synthetic graft attached to end of catheter which goes thru femoral artery - graft is threaded thru the artery to the affected parts for repair

Question 26

what is a different between endovascular dissection repair and EVAR

Answer 26

- endovascular dissection repair may insert a temporary lumbar drain for cerebrospinal fluid to reduce spinal cord edema and prevent paralysis

Question 27

when is endovascular dissection repair a good option for treatment of aortic dissection

Answer 27

- if has symptoms or complications (hemodynamically unstable, peripheral ischemia, etc.)

Question 28

when is surgery indicated as the treatment for aortic dissection

Answer 28

- acute ascending aortic dissection - if drug therapy ineffective - if complications occur

Question 29

describe surgery for aortic dissection

Answer 29

- involves resection of the aortic segment containing the tear and replacement with a synthetic graft

Question 30

describe nursing care for a pt with aortic dissection preop (11)

Answer 30

- semi-fowler position - maintain quiet enviro - keep systolic BP at lowest possible lvl that maintains organ perfusion (110-120) - opioids (pain control) - sedatives - manage pain and anxiety (for comfort and to prevent increase in BP) - VS frequently (q2-3 min until target BP reached) - ECG - assess for changes in peripheral pulses - assess pain - assess LOC

Question 31

describe postop care for a pt with aortic dissection

Answer 31

- similar for aortic aneurysm repair

Question 32

describe discharge teaching for a pt with aortic dissection (4)

Answer 32

- will require long-term therapy to control BP - teach drug regimen, side effects, etc. - require follow up wit regularly scheduled MRI or CTs - if pain or sx return, call 911 (could indicate redissection or aneurysm)

Question 33

a nursing diagnosis r/t surgical repair of aorta is risk for peripheral neurovascular dysfunction d/t graft thrombosis, prolonged aortic cross clamping, hypotension, & blood loss. what interventions could help maintain effective peripheral tissue perfusion (5)

Answer 33

- perform comprehensive assessment of peripheral circulation (establish baseline and detect changes) - maintain adequate hydration (decrease blood viscosity) - avoid applying direct heat to extremitity - admin antiplt or anticoag

Question 34

what neuro monitoring should be done r/t the risk of peripheral neurovascular dysfunction in surgical repair of the aorta (3)

Answer 34

- monitor VS - monitor invasive hemodynamic parameters - monitor for parasthesia

Question 35

a nursing diagnosis r/t surgical repair of the aorta is risk for infection. what infection protecting nursing interventions can be done (5)

Answer 35

- monitor for S&S - monitor CBC - maintain asepsis - instruct pt to take ab as prescribed - promote sufficient nutritional intake to promote healing