3.  By the end of the presentation listeners must be able to:
(a) know the definition of aortic aneurysm
(b) describe
Etiology
Classification
Pathophysiology
Clinical manifestations
Nursing management
Medical Management
Complications

4.  An aneurysm is an abnormal dilation of
a blood vessel commonly at a site of a
weakness or tear in the vessel .
 Aneurysm mostly affects the aorta and
peripheral arteries because of increased
pressure in these vessels
 Aneurysm occur more often in men
than women and their incidence
increases with age.

5. Aneurysm is divided into two types and these are
(a)True : this is where aneurysm forms with at
least one layer of vessel still intact. True
aneurysm can be farther divided into
 Fusiform- circumferential and relatively uniform in
shape
 Saccular- pouch-like with a narrow neck
(b)False (pseudoaneurysm) : is not aneurysm but
a disruption of all layers of the arterial wall
resulting in rupture.

6.  Congenital
 Traumatic
 Inflammatory
 Mechanical
 Infectious
 Pregnancy-related degenerative
 anastomotic and graft aneurysm

7.  In normal cases the aorta is made up of
structural proteins called collagen and elastin.
Collagen provides tensile strength while elastin
recoils after systole. Aneurysm form due to the
weakness of the arterial wall. Destruction of
elastin and collagen in the wall of the aorta
leads to abnormal dilation and rapture of the
aorta respectively, and this result into
aneurysm (Wung & Aouizerat, 2004.)
 Aneurysm also occur due to hypertension and
long-term eroding atherosclerosis.

8.  Dyspnea
 Hoarseness and dysphagia
 Edema of the face and the neck
 Distended neck veins
 Back, neck or substernal pains
 Mild to severe mid-abdominal and
lumbar back pains.

9.  Diagnostic studies
 Chest X-ray to visualize thoracic aortic
aneurysm
 Abdominal Ultrasonography to diagnose
abdominal aortic aneurysm
 Contrast –enhanced CT that allows
precise measurement of the aneurysm
 ECG may be performed to rule out
evidence of myocardial infarction.

10. medications
 Medications that are administered to
patients with aneurysm include:
 Beta –blockers e.g. propranolol, that
control the myocardial contractility
 Anti-hypertensives e.g. nifedipine,
 Surgery

11. Nursing assessment
 Thorough history and physical assessment
should be performed.
 The nurse should watch for signs of cardiac,
pulmonary, cerebral, and lower extremity
vascular problems
 The nurse should monitor the patient for
indications of aneurysm rupture such as
diaphoresis, paleness, weakness, tachycardia,
hypotension and abdominal pain

12.  Altered comfort; pain related to inflammatory
processes
 Risk for ineffective tissue perfusion related to
aneurysm rupture as evidenced by
hemorrhage and lack of blood flow to tissues.
 Risk for injury related to pressure on the
aneurysm
 Anxiety related to the nature of the disorder

13. Acute interventions
 It is seen in two ways
(a) preoperative
(b) post operative

14.  Nurse the patient in the supine position to relieve
pain
 Brief explanation of the disease process
 Teaching the patient and family about the
procedure that is to take place on the patient
 Provide support for the patient and the family with
careful assessment of all body systems
 Assess the patient ready for the planned surgery.
 Pre-surgical assessment include giving IV fluids,
Sample collection, vital signs and dressing the
patient with theatre clothes

15.  In most cases such patients are nursed
in ICU for close monitoring
 The nurse inserts the following:
 Urinary indwelling catheter
 Endotracheal tube
 Nasogastric tube

16.  The nurse should monitor BP, administer
IV fluids and blood components which are
important for adequate blood flow to the
graft.
 The nurse should monitor urinary input
and output which help in assessing the
patient’s hydration and perfusion status
 ECG monitoring, ABG determination,
administration of oxygen and IV anti-
dysrhythmc medications as needed.

17. Health promotion
 Teaching patient measures of health
promotion with special attention to
patients with family history of
aneurysm.
 The patient should encouraged to
reduce cardiovascular risk factors such
as BP control, smoking cessation,
increasing physical activity and

18. Ambulatory and home care
 Encourage the patient to express any concerns
and assure the patient that you are available.
 Assure the patient that normal activities of daily
living will be resume soon.
 The patient should be instructed of increase
gradually in activities such as fatigue, poor
appetite and regular habits should be expected
 Heavy lifting should be avoided.
 Any increased pain, drainage from
incision, increased fever of greater than 38⁰c
should be reported to the hospital.

19.  Cardiac temponade
 Rupture
 Hemorrhage
 death.

20.  Expected outcomes
 Adequate tissue perfusion
 Normal body temperature
 No sign of infection

21.  Lewis, Heitkemper, Dirksen (2007)
Medical Surgical, Nursing; 7th edition,
Mosby Elsevier, USA.
 Priscilla Lemone and Karen Burk(2008)
Medical Surgical Nursing, Fourth
Edition, Pearson Education Inc. New
Jersey, USA

23. DEFINITION
 It the inflammation of the vein (Brunner
& Suddarth’s, 2007 )
 The term is used clinically to indicate a
superficial and localized condition that
can be treated with application of heat
(Lippincott Manual of Nursing)

24. ETIOLOGY
 Phlebitis is caused by the following:
(a) bacterial: stimulates inflammation
(b) Chemical: irritating solutions
(c) Mechanical: physical trauma; skin puncture;
movement of the cannula of the vein during
insertion
(d) Medications; e.g. Celecoxib
(e) Genetic; pass from one generation to another
(f) Alcohol abuse

25. CLINICAL MANIFESTATION
 Redness and warmth with a
temperature elevation of a degree
above the baseline
 Pain or burning along the length of the
vein
 Swelling
 Vein being hard and cord-like
 Fever

26. OCCURENCE
 The incidence of phlebitis increases with
the length of time the I.V. is in place,
the composition of fluid or medication
infused, the size of the cannula
inserted, inadequate anchoring of the
line and introduction of microorganism
at the site of insertion

27. NURSING DIAGNOSIS
 Altered thermoregulation; hyperthermia
related to inflammatory processes
secondary to infections.
 Altered comfort; pain related to
inflammatory process
 Risk for skin integrity due skin puncture

28. Nursing Interventions
 Apply warm compresses immediately to
relieve pain and inflammation.
 Follow with moist, warm compresses to
stimulate circulation and promote
absorption.
 Administer analgesic to relieve pain and
fever
 Document interventions and assessments.

29. Preventive Measures
 Anchor the needle or catheter securely at the
insertion site.
 Change the insertion site at least every 72 hours.
If the facility phlebitis rate goes above 5%,
insertion sites should be changed every 48 hours
 Use large veins for irritating fluid because of
higher blood flow, which rapidly dilutes the
irritant.
 Sufficiently dilute irritating agents before
infusion.