Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  43

• 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.

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.

Teaching About Aortic Aneurysm

• 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

LESSON PLANS

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.

TIP: Aneurysm size remains the most important predictor of an- eurysm rupture.