Question

A.H. is a 70-year-old retired construction worker who has experienced lumbosacral pain, nausea, and upset stomach for the past 6 months. He has a history of heart failure, high cholesterol, hypertension (HTN), sleep apnea, and depression. His chronic medical problems have been managed over the years with oral medications: benazepril (Lotensin) 5 mg/day, fluoxetine (Prozac) 40 mg/day, furosemide (Lasix) 20 mg/day, KCl 20 mEq bid, and lovastatin (Mevacor) 40 mg with the evening meal. A.H. has just been admitted to the hospital for surgical repair of a 6.2-cm abdominal aortic aneurysm (AAA) that is now causing him constant pain. On arrival on your floor, his vital signs are 109/81, 61, 16, and 98.3° F (36.8° C). When you perform your assessment, you find that his apical heart rhythm is regular and his peripheral pulses are strong. His lungs are clear, and he is awake, alert, and oriented. There are no abnormal physical findings; however, he hasn't had a bowel movement for 3 days. His electrolytes, blood chemistries, and clotting studies are within normal range, except his hematocrit is 30.1%, and hemoglobin is 9 g/dL. A.H. has several common risk factors for AAA, which are evident from his health history. Identify and explain three factors. While A.H. awaits his surgery, it is important that you monitor him carefully for decreased tissue perfusion. 2. What are the priority assessments for this patient? State your rationale for at least 3 priorities. 3. What is the most serious, life-threatening complication of AAA, and why? What one problem mentioned in the first paragraph of this case study presents a risk for AAA rupture? Why? The patient has a successful resection of the aneurysm, was transferred to ICU post op due to confusion, and is returned to your floor post op day 2. 4. What assessments should be made specific to his postoperative care? 5. What are the high nursing priorities in A.H.'s postoperative care?

Answer 1

1. Age of the patient is 70 years ( aneurysms commonly seen in people age 65 and older)

High cholesterol

Hypertension

( Both High cholesterol and Hypertension weaken the vessel wall)

2.

Assessment	Rationale
Assess for decreased tissue perfusion in the lower extremities such as edema. altered skin color (Pallor and cynosis), temperature (coolness), sensation or integrity of skin, and pulselessness	Decreased tissue perfusion in lower limbs can be observed due to arterial insufficiency in patients with AAA
Assessment of Fast pulse, low blood pressure and sudden onset of persistent sever abdominal or back pain	These are the signs and symptoms of aneurysm rupture
Assess the GI function, loss of appetite, decreased or absent bowel sounds, nausea or vomiting, abdominal distension, and constipation.	Are the trigger factors of neurysm and sudden rupture

3.  The most serious, life-threatening complication of AAA is Aneurysum rupture. It can cause internal bleeding that can leads hypovolemic shock and death.

Risk for AAA rupture for this patient could be loss of bowel movement for 3 days as Constipation exert mechanical stress on the aortic vessel wall, may leads to rupture of aneurysum

4. Close monitoring of haemodynamic status and mental status because low blood pressure or urine output, increased heart rate and altered mental status like confusion may be the signs of graft rupture, haemorrhage, and shock during post operative period

5. Monitor blood pressure and other vitals: low blood pressure indicates postoperative haemorrhage and high blood pressure can cause graft failure because high pressure can damage the graft

Monitor urine output: Graft occlusion may decreases renal blood flow and leads to renal failure

Frequent assessment of abdomen: For pain and distention, are the signs of graft occlusion

Assessment of wound and wound drain: Check the wound for signs of infection or healing process, observe the wound drain for amount and type exudate

Assessment of pain and its management

Reduce the risk of other postoperative risk like DVT, Pulmonary embolism and pressure sore development by early mobilization of the patient