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Chapter 2
•
Cardiovascular Care
43
Loeys–Dietz syndrome
is an
autosomal dominant aortic
aneurysm syndrome characterized
by the triad of arterial tortuosity and
aneurysms, hypertelorism, and bifid
uvula or cleft palate. Loeys–Dietz
syndrome is caused by heterozygous
mutations in the genes and have
a high risk of aortic dissection or
rupture at an early age. Mean age
at death is 26 years, with thoracic
aortic dissection as the leading cause
of death.
Nursing Considerations
•
Allow the patient to express his
fears and concerns. Help him
identify effective coping strategies
as he attempts to deal with his
diagnosis.
•
Before elective surgery, weigh
the patient, insert an indwelling
urinary catheter and an IV line,
and assist with insertion of the
arterial line and pulmonary artery
catheter to monitor hemodynamic
balance.
In an Acute Situation
•
Obtain multiple large-bore
intravenous access to facilitate
blood replacement.
•
Prepare the patient for impending
surgery.
•
As ordered, obtain blood samples
for kidney function tests (such as
blood urea nitrogen, creatinine,
and electrolyte levels), a complete
blood count with differential,
blood typing and cross-matching,
and ABG levels.
•
Monitor the patient’s cardiac
rhythm and vital signs.
•
Assist with insertion of a
pulmonary artery line and arterial
line to monitor for hemodynamic
status.
•
Administer ordered medications,
such as an antihypertensive and a
beta-adrenergic blocker to control
aneurysm progression and an
analgesic to relieve pain.
•
Be alert for signs of rupture, which
may be fatal. Watch closely for any
signs of acute blood loss (such
as decreasing blood pressure,
increasing pulse and respiratory
rates, restlessness, decreased
sensorium, and cool, clammy
skin).
•
If rupture occurs, transport
the patient to surgery as soon
as possible. Medical anti-shock
trousers may be used while
transporting to surgery.
TIP:
Aneurysm size remains the
most important predictor of an-
eurysm rupture.
Teaching About
Aortic Aneurysm
LESSON PLANS
•
Explain the surgical
procedure and
the expected
postoperative care
in the intensive care
unit for patients
undergoing open,
complex abdominal
surgery (intravenous
access, central line
access, endotracheal
intubation, and
mechanical
ventilation).
•
Instruct the patient to take all
medications as prescribed and
to carry a list of medications
at all times, in case of an
emergency.
•
Tell the patient not to push,
pull, or lift heavy objects until
the physician indicates that it is
okay to do so.