A 65-year-old male patient with a 5.8 cm abdominal aortic aneurysm (AAA) and elevated C-reactive protein (CRP) is being monitored for potential complications. Which nursing intervention is most important to implement to prevent rupture while awaiting surgical consultation?

B) Administer antihypertensive medications as prescribed to maintain optimal blood pressure.

A) Encourage high-protein diet to improve hemoglobin levels.

B) Administer antihypertensive medications as prescribed to maintain optimal blood pressure.

C) Advise the patient to increase physical activity to improve circulation.

D) Apply warm compresses to the abdomen to reduce inflammation.

A 65-year-old patient with a history of hypertension and smoking has been diagnosed with an abdominal aortic aneurysm measuring 5.8 cm, with a thrombus and elevated inflammatory markers. Which nursing intervention is most critical to prevent complications prior to potential surgical intervention?

B) Administer antihypertensive medication as prescribed to maintain blood pressure within target limits.

A) Encourage the patient to perform regular abdominal exercises to strengthen the aortic wall.

B) Administer antihypertensive medication as prescribed to maintain blood pressure within target limits.

C) Advise the patient to increase dietary intake of vitamin K to promote blood clotting.

D) Suggest using hot compresses on the abdomen to improve circulation and reduce thrombus size.

A patient with an abdominal aortic aneurysm presents with increased abdominal pain, diaphoresis, and tachycardia. Repeat imaging shows an increase in aneurysm size and organized thrombus formation. Which nursing intervention is most critical to prioritize in this scenario?

D) Prepare the patient for an urgent endovascular aneurysm repair (EVAR).

A) Continue administering antihypertensive medications as prescribed.

B) Initiate IV fluid therapy to manage potential hypovolemia.

C) Monitor neurological status for signs of embolic events.

D) Prepare the patient for an urgent endovascular aneurysm repair (EVAR).

A patient with an abdominal aortic aneurysm (AAA) presents with increased abdominal pain and hemodynamic instability. The healthcare team has decided to proceed with endovascular aneurysm repair (EVAR). As the nurse preparing the patient for this procedure, which of the following interventions is most crucial to prioritize?

B) Ensuring the patient is NPO (nothing by mouth) to prevent aspiration during the procedure.

A) Administering the prescribed antihypertensive medications immediately to manage elevated blood pressure.

B) Ensuring the patient is NPO (nothing by mouth) to prevent aspiration during the procedure.

C) Initiating a blood transfusion to address the decreased hemoglobin level.

D) Monitoring for signs of embolic events, such as sudden limb pain or changes in neurovascular status.

A patient scheduled for endovascular aneurysm repair (EVAR) develops severe back pain, tachycardia, hypotension, and lethargy. What is the nurse's priority action in this situation?

B) Notify the surgical team immediately.

A) Administer pain medication as prescribed.

B) Notify the surgical team immediately.

C) Increase the intravenous fluid rate.

D) Reassess vital signs in 15 minutes.

A nurse is caring for a patient scheduled for endovascular aneurysm repair (EVAR) who begins to exhibit signs of possible retroperitoneal hemorrhage, including severe back pain, tachycardia, hypotension, and lethargy. Which nursing intervention should be prioritized to address the patient's current condition?

B) Notify the physician immediately and prepare for potential surgical intervention.

A) Administer prescribed analgesics to manage the patient's pain.

B) Notify the physician immediately and prepare for potential surgical intervention.

C) Elevate the patient's lower extremities to improve venous return.

D) Increase the IV fluid rate to stabilize blood pressure.

A patient has undergone an endovascular aneurysm repair and is now in the ICU. The nurse notes that the patient's urine output is low and is concerned about the potential for acute kidney injury. What is the most appropriate nursing intervention to address this concern?

B) Increase the rate of intravenous fluids to improve renal perfusion.

A) Administer diuretics to increase urine output.

B) Increase the rate of intravenous fluids to improve renal perfusion.

C) Monitor serum creatinine and blood urea nitrogen levels closely.

D) Educate the patient about dietary modifications to support kidney function.

A patient has undergone an endovascular aneurysm repair and is now being monitored in the ICU. The nurse notes the patient's urine output is low and suspects acute kidney injury. Which of the following actions is most appropriate to address this concern?

C) Assess the patient's hemodynamic status and review fluid balance.

A) Increase the rate of intravenous fluid administration.

B) Administer a diuretic to stimulate urine production.

C) Assess the patient's hemodynamic status and review fluid balance.

D) Prepare the patient for renal dialysis as a precautionary measure.

A postoperative patient in the ICU has developed acute kidney injury, evidenced by an increase in creatinine from 1.0 mg/dL to 2.1 mg/dL, and has a slightly elevated lactate level of 2.4 mmol/L. The patient is currently receiving 2 liters of oxygen via nasal cannula with an oxygen saturation of 94%. Which nursing intervention is the most appropriate to address the current clinical findings?

C) Monitor urine output hourly to assess renal perfusion

A) Increase oxygen delivery to 4 liters per minute via nasal cannula

B) Initiate diuretic therapy to prevent fluid overload

C) Monitor urine output hourly to assess renal perfusion

D) Administer IV fluids rapidly to improve hemodynamic stability

A postoperative patient in the ICU presents with a heart rate of 115 bpm, respiratory rate of 22 breaths per minute, and oxygen saturation of 94% on 2 liters of oxygen via nasal cannula. The patient also has cool extremities and delayed capillary refill. Laboratory findings include a creatinine level of 2.1 mg/dL and a lactate level of 2.4 mmol/L. What is the most appropriate initial nursing intervention to address the patient's current condition?

B) Administer a fluid bolus to improve perfusion.

A) Increase the oxygen flow rate to improve oxygen saturation.

B) Administer a fluid bolus to improve perfusion.

C) Notify the healthcare provider for potential initiation of diuretic therapy.

D) Position the patient in a Trendelenburg position to enhance venous return.

Abdominal Aortic Anyeurism - Nursing Case Study

Pathophysiology

• Primary mechanism: Abdominal aortic aneurysm (AAA) primarily results from the degradation of the aortic wall's structural proteins, collagen, and elastin, due to chronic inflammation and oxidative stress. This weakens the aortic wall, causing it to dilate and form an aneurysm.

• Secondary mechanism: Hemodynamic stress plays a significant role, where increased blood pressure and turbulent flow in the abdominal aorta contribute to further expansion and weakening of the aneurysm, potentially leading to rupture.

• Key complication: If the aneurysm ruptures, it can lead to massive internal bleeding, hypovolemic shock, and is life-threatening, requiring immediate medical intervention.

Patient Profile

Demographics:

67-year-old male, retired construction worker

History:

• Key past medical history: Hypertension, hyperlipidemia, history of smoking (30 pack-years)

• Current medications: Lisinopril, Atorvastatin, Aspirin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Abdominal pain and back discomfort

• Key symptoms: Intermittent abdominal pain, pulsatile abdominal mass, fatigue, nausea

• Vital signs: Blood pressure 150/95 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 37.5°C, oxygen saturation 95% on room air

Section 1

New Diagnostic Results:

Following the initial assessment, the healthcare team proceeded with diagnostic imaging to evaluate the extent of the abdominal aortic aneurysm and to monitor for any signs of impending rupture. A CT angiography was performed, revealing that the aneurysm measured 5.8 cm in diameter, consistent with a significantly increased risk of rupture. The imaging also showed signs of a thrombus within the aneurysm sac, which, while potentially stabilizing the aneurysm temporarily, poses a risk for distal embolization. Blood tests indicated elevated inflammatory markers, such as C-reactive protein (CRP) at 15 mg/L, suggesting ongoing inflammatory processes. Additionally, the patient's hemoglobin level was slightly decreased to 11.5 g/dL, which, although not critically low, raised concerns about chronic blood loss or possible micro-bleeding from the aneurysm.

These findings underscore the need for meticulous monitoring and intervention. The thrombus within the aneurysm and the inflammatory markers highlight potential complications that could escalate into acute events. Given the patient's history of hypertension and smoking, the hemodynamic stress continues to play a critical role in the aneurysm's progression. The healthcare team deliberates the best course of action, considering both surgical intervention and conservative management. The decision hinges on balancing the risks of immediate surgery against the potential for rupture, requiring careful clinical reasoning and collaboration among the multidisciplinary team. As they prepare for possible surgical intervention, they also emphasize optimizing medical management to stabilize the patient's blood pressure and reduce further stress on the aortic wall.

Section 2

Change in Patient Status

Two days following the initial diagnostic results, the patient began experiencing increased abdominal pain, now rated at 7 out of 10, which was previously reported as a dull ache at 4 out of 10. This escalation in pain prompted further evaluation, as it could indicate an expansion of the aneurysm or impending rupture. On examination, the patient appeared more diaphoretic and anxious, with a heart rate elevated to 110 beats per minute and blood pressure measuring 150/95 mmHg, despite being on two antihypertensive medications. These vital sign changes suggested increased hemodynamic instability, warranting immediate attention.

In response to these changes, the healthcare team ordered another set of lab tests and a repeat CT angiography to reassess the aneurysm's status. The blood tests revealed a further decrease in hemoglobin to 10.8 g/dL, raising concerns about ongoing blood loss. The repeat CT angiography showed a slight increase in the aneurysm size to 6.0 cm, with the thrombus appearing more organized, which paradoxically increased the risk of embolic events. The patient's elevated white blood cell count of 13,000 cells/mm³ and CRP level now at 19 mg/L indicated an exacerbated inflammatory response, possibly due to micro-tearing within the aneurysm wall.

These findings necessitated a shift in the clinical approach. The team decided to expedite surgical intervention, considering the increased risk of rupture and the patient's deteriorating clinical picture. The patient was prepped for an endovascular aneurysm repair (EVAR), chosen over open surgery due to its reduced recovery time and lower immediate risk. Meanwhile, the focus remained on optimizing blood pressure control and addressing potential embolic complications, underscoring the importance of timely and precise clinical decision-making in this high-stakes scenario.

Section 3

Following the decision for an endovascular aneurysm repair (EVAR), the patient was closely monitored for any changes in status during the preoperative period. However, within a few hours, there was a notable change in the patient’s condition. The patient began to complain of sudden, severe back pain, rated at 9 out of 10, which was different in character from the previous abdominal pain. This new symptom raised immediate flags for potential retroperitoneal hemorrhage, a complication that could indicate an acute expansion or impending rupture of the aneurysm.

The patient's vital signs showed further deterioration, with a heart rate now at 120 beats per minute and a drop in blood pressure to 100/60 mmHg, suggesting possible hypovolemic shock. The skin was cool and clammy, and the patient appeared increasingly lethargic, indicating a significant drop in perfusion. An urgent repeat hemoglobin test showed a decrease to 9.5 g/dL, supporting the suspicion of internal bleeding. These alarming changes prompted the medical team to expedite the surgical intervention to prevent catastrophic outcomes.

In response to these developments, the patient was prioritized for immediate transfer to the operating room. The rapid evolution of symptoms and vital sign changes underscored the critical need for timely surgical intervention. The interdisciplinary team, including anesthesia and surgical staff, prepared for potential complications such as hemodynamic instability and the need for blood transfusions. This scenario highlighted the importance of continuous assessment and the ability to swiftly adapt clinical plans based on dynamic patient presentations. The focus was on stabilizing the patient both preoperatively and intraoperatively to maximize the likelihood of a successful outcome in this rapidly evolving case.

Section 4

As the patient was rushed to the operating room, the interdisciplinary team swiftly initiated preparations for the surgical repair. The anesthesiology team, aware of the patient's hemodynamic instability, implemented strategies to manage potential intraoperative complications. They began with a rapid sequence induction, carefully titrating medications to maintain adequate blood pressure and cardiac output. Meanwhile, the surgical team was briefed on the likelihood of encountering a significant retroperitoneal hematoma given the clinical presentation and the patient's precipitous decline.

Intraoperatively, the surgical team discovered a sizeable retroperitoneal hematoma, confirming the suspicion of a contained rupture, which had been causing the severe back pain and hemodynamic compromise. As the procedure progressed, the patient's vital signs remained precarious, with blood pressure fluctuating between 90/50 mmHg and 110/70 mmHg despite aggressive fluid resuscitation and vasopressor support. Hemoglobin levels continued to decline, reaching 8.7 g/dL, necessitating the administration of packed red blood cells to support oxygen delivery and tissue perfusion.

The surgical team proceeded with the endovascular aneurysm repair, deploying a stent graft to exclude the aneurysm from circulation. Postoperatively, the patient was transferred to the intensive care unit for close monitoring, with particular attention to renal function given the prolonged low perfusion state. Urine output was initially low, raising concerns for acute kidney injury, but began to improve with continued hemodynamic support and careful fluid management. The patient's condition remained critical, but the successful intervention provided a measure of stability, setting the stage for further recovery efforts and vigilance for potential complications such as graft-related issues or further bleeding.

Section 5

As the patient settled into the intensive care unit, the nursing team conducted a comprehensive initial assessment to establish a baseline for ongoing monitoring. The patient's vital signs showed a blood pressure of 105/65 mmHg, heart rate of 115 beats per minute, respiratory rate of 22 breaths per minute, and an oxygen saturation of 94% on 2 liters of oxygen via nasal cannula. Although these values indicated relative stability, the elevated heart rate and respiratory rate suggested a compensatory response to ongoing stress. Physical examination revealed cool extremities and delayed capillary refill, consistent with the patient's recent hemodynamic challenges and potential ongoing perfusion deficits.

The nursing team closely observed the patient for signs of further complications, particularly related to renal and cardiovascular function. Laboratory results returned, showing a creatinine level of 2.1 mg/dL, up from a baseline of 1.0 mg/dL prior to surgery, confirming the suspicion of acute kidney injury likely due to the earlier low perfusion state. Additionally, the patient's lactate level was slightly elevated at 2.4 mmol/L, indicating some degree of tissue hypoxia, but not at a critically high level. These findings necessitated a delicate balance of fluid management to support renal perfusion while avoiding fluid overload, particularly given the patient's tenuous cardiac status.

In the ensuing hours, the patient's condition remained under vigilant observation. The interdisciplinary team planned for continuous renal monitoring, potential diuretic therapy if fluid overload signs emerged, and serial assessments of cardiac function. As the patient continued to recover from the immediate postoperative period, the team prepared for the possibility of additional interventions, should complications such as graft-related problems or further hemodynamic instability arise. This careful coordination aimed to guide the patient towards stabilization and eventual recovery, with the understanding that vigilance and prompt response to any new developments would be crucial in navigating this complex post-surgical course.