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ABDOMINAL AORTIC ANEURYSM | NCLEX

Abdominal Aortic Aneurysm Medical Editor: Uta Hüning

OUTLINE III) SIGNS AND SYMPTOMS

I) GENERAL
II) CAUSES
III) SIGNS AND SYMPTOMS
IV) RUPTURE
V) SURGERY
VI) APPENDEX
VII) REVIEW QUESTIONS

I) GENERAL
Abdominal aortic aneurysm (AAA)

Aorta:
o Largest vessel from heart
o Supplies blood to the rest of body

Abdominal aorta:
o Part of aorta below diaphragm in our abdominal cavity
Aneurysm:
o Dilation/ballooning of an artery in a weak spot
Other important structure near abdominal aorta
o Inferior vena cava
o Kidneys
o…

II) CAUSES

(A) RISK FACTORS

Asymptomatic (usually)
It’s symptoms are:
o Back pain
o Abdominal pain
Often coincidental finding on ultrasound, CAT scan,
(1) When the patient has abdominal pain
Assess abdominal cavity by: Look + Listen + Feel

Look:
(1) Atherosclerosis
 Color
Buildup of plaque (fats, cholesterol)
 Size
o Why?
 Shape
o Hard plaque reduces elasticity of vessel wall  Pulsation
 Scars, markings on skin

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 Sound a little bit to the left of patient's aorta
• Bruit: created by turbulent blood flow from
(2) Smoking aneurysm
 4 quadrants: listen along path of colon to find
Can lead to hypertension (increased BP) blockages or similar
(3) Hypertension
Feel
Increased BP puts strain on vessel wallsObesity
 Palpate complete abdomen to find pain
(4) Age
(5) Being male

(B) MODIFIABLE RISK FACTORS

Stop smoking
Lifestyle changes to lose weight and reduce hypertension
Drugs to manage hypertension
Drugs to manage lipid disorders

Abdominal Aortic Aneurysm | NCLEX NURSING: Note #1. 1 of 4

 IV) RUPTURE
EMERGENCY!
Rupture = serious complication of an aneurysm
Since the aorta is the largest vessel, it holds a lot of blood
Rupture of the aortic aneurysm leads to massive blood
loss (hemorrhage) into the abdominal cavity
(1) Signs and symptoms
Tearing / ripping pain
Signs of hypovolemic shock (from hemorrhage)
o Increased HR = tachycardia
o Decreased BP = hypotension
o Change in mental status
o Low pulse
o Diaphoresis (sweating)

V) SURGERY
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(A) CRITERIA FOR SURGERY (C) POST-SURGERY

(B) PRE-SURGERY

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(1) Marking pulses with an X

Particularly posterior tibialis or dorsal pedis
Why?
o For consistency, checking pulses at the exact same
spots throughout the entire treatment
o Especially after AAA surgery with stent placement it is
important to check the pulses below/distal to that site
and one of those is the posterior tibialis or the dorsal
pedis artery

Check for:
(3) Monitor baseline data
o Occlusion (block)
Neuro: change in mental status o Leakage
Renal: urine output (adult should have: 30ml/h)
To avoid hypovolemic shock!
(4) Breathing exercises Signs of occlusion, leakage = signs of hypovolemic shock
o Changes in BP
After any surgery learn breathing exercises to encourage
o Changes in pulses
deep breathing and coughing
o Changes in mental status
o Changes in renal output
o Pain and pain medication, both can lead to a
o + Bruising (leakage) in area of: groin, penis,
decreased inspiration which favor the development of
perineum, scrotum/labia
pneumonia

Remember
Exercises:
o Incentive spirometer
We're nurses, we're smart.
o Coughing exercises We're ninja nerd nurses.
o Splinting: hug bear or pillow to slightly press on We're trying to stay ahead of the game!
incision site during coughing to reduce pain

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(1) Monitor: (2) Education
CBC Educate patient on what they can and can't do when back
Blood (hematocrit, hemoglobin) home
Urine output o Lifting: not over 15 lbs for min. 6-12 weeks
BP  Why? Pressure could rupture open wounds from
Beathing exercises surgery
o Splinting:
Head in bed must be lower than at a 45° angle (prevent o Take blood pressure medication
pinching off or occluding the stent)  Take drugs in morning before doing anything else
 Get up slowly when changing positions
o Watch out for:
 Bruising (ecchymosis) in area
 Changes in mental status
 Changes in pulses
• Capillary refill: blanch fingertip, it will turn from
white back to a red
• Squeeze toes and look for any discoloration
 Changes in urine output
 Bloating, any type of expansion of the abdomen

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Abdominal Aortic Aneurysm | NCLEX NURSING: Note #1. 3 of 4

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VI) APPENDEX

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VII) REVIEW QUESTIONS

1) Abdominal aortic aneurysm are: 4) The signs of occlusion and leakage after placement
of the stent are signs of:
b) Never symptomatic a) Cardiogenic shock
c) Usually asymptomatic b) Septic shock
d) Present by vomiting and nausea c) Neurogenic shock
2) A ruptured AAA presents with: d) Hypovolemic shock
a) Bradycardia and hypotension 5) How many weeks after the surgery is the patient not
b) Tachycardia and hypertension allowed to lift heavy objects?
c) No symptoms a) 2-3 weeks
d) Tachycardia and hypotension b) 4-8 weeks
3) During pre-surgery preparations we’re marking c) 6-12 weeks
pulses to: d) Half a year
a) Enable doctors and nurses to check pulses always
on the exact same spot
b) Make it easier finding the good points
c) Help the patient orientate
d) No reason

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