Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm DescriptionAn aortic aneurysm is an abnormal dilation of the arterial wall caused by localized weakness and stretching in the medial layer or wall of an artery.The aneurysm can be located anywhere along the abdominal aorta.The goal of treatment is to limit the progression of the disease by modifying risk factors, controlling the BP to prevent strain on the aneurysm, recognizing symptoms early, and preventing rupture.

AssessmentProminent, pulsating () mass in abdomen, at or above the umbilicusSystolic bruit over the aortaTenderness on deep palpationAbdominal or lower back painDiagnostic EvaluationChest radiograph, angiogram, transesophageal echocardiography, and magnetic resonance imaging(MRI).Duplex ultrasonography or computed tomography (CT)

Primary Nursing DiagnosisRisk for fluid volume deficit related to hemorrhageOther Diagnoses that may occur in Nursing Care Plans For Abdominal Aortic AneurysmAcute pain related to surgical tissue traumaAnxiety related to threat to health statusDecreased cardiac output related to: changes in intravascular volume increased systemic vascular resistance third-space fluid shiftDeficient knowledge (preoperative and postoperative care) related to newly identified need for aortic surgery Ineffective breathing pattern related to: effects of general anesthesia endotracheal intubation presence of an abdominal incision

Medical Management

Medical or surgical treatment depends on the type of aneurysm. For a rupture aneurysm, prognosis is poor and surgery is performed immediately. When surgery can be delayed, medical measures include:Strict control of blood pressure and reduction in pulsatile (flow.Systolic pressure maintained at 100 to 120 mm Hg with antihypertensive drugs, such as nitroprusside.Pulsatile flow reduced by medications that reduce cardiac contractility, such as propanolol.Surgical ManagementRemoval of the aneurysm and restoration of vascular continuity with a graft (resection and bypass graft or endovascular grafting) is the goal of surgery and the treatment of choice for abdominal aortic aneurysms larger than 5.5 cm (2 inches) in diameter or those that are enlarging. Intensive monitoring in the critical care unit is required.Nonsurgical InterventionModify risk factors.Instruct the client regarding the procedure for monitoring BP.Instruct the client on the importance of regular physician visits to follow the size of the aneurysm.Instruct the client that if severe back or abdominal pain or fullness, soreness over the umbilicus, sudden development of discoloration in the extremities, or a persistent elevation of BP occurs to notify the physician immediately.Instruct the client with a thoracic aneurysm to report immediately the occurrence of chest or back pain, shortness of breath, difficulty swallowing, or hoarseness.Pharmacologic Highlights1-10 mg IV of opioid analgesic (morphine) to relieve surgical pain.50100 mcg IV of opioid analgesic (Fentanyl) to relieve surgical pain.Antihypertensives and/or diuretics for rising BP may stress graft suture lines.80-400 mg/day in divide doses of Beta blocker (propanolol) to use in people with small aneurysms without risk for rupture; decreases rate of AAA expansion

Nursing InterventionMonitor vital signs.Assess risk factors for the arterial disease process.Obtain information regarding back or abdominal pain.Question the client regarding the sensation of palpation in the abdomen.Inspect the skin for the presence of vascular disease or breakdown.Check peripheral circulation, including pulses,temperature, and color.Observe for signs of rupture.Note any tenderness over the abdomen.Monitor for abdominal distention.

Documentation GuidelinesLocation,intensity,and frequency of pain,and the factors that relieve painAppearance of abdominal wound (color,temperature,intactness,drainage)Evidence of stability of vital signs,hydration status,bowel sounds,electrolytesPresence of complications: Hypotension, hypertension, cardiac dysrhythmias, low urine out- put,thrombophlebitis,infection,graft occlusion,changes in consciousness,aneurysm rupture, excessive anxiety,poor wound healingDischarge and Home Healthcare GuidelinesWound care.Explain the need to keep the surgical wound clean and dry. Teach the patient to observe the wound and report to the physician any increased swelling,redness,drainage,odor,or separation of the wound edges. Also instruct the patient to notify the physician if a fever develops.Activity restriction.Instruct the patient to lift nothing heavier than 5 pounds for about 6 to 12 weeks and to avoid driving until her or his physician permits. Braking while driving may increase intra-abdominal pressure and disrupt the suture line. Most surgeons temporarily discourage activities that require pulling, pushing, or stretchingactivities such as vacuuming,changing sheets,playing tennis and golf,mowing grass,and chopping wood.Smoking cessation. Encourage the patient to stop smoking and to attend smoking cessation classes.Complications following surgery. Discuss with the patient the possibility of clot formation or graft blockage.Complications for patients not requiring surgery. Compliance with the regime of monitoring the size of the aneurysm by computed tomography over time is essential. The patient needs to understand the prescribed medication to control hypertension. Advise the patient to report abdominal fullness or back pain,which may indicate a pending rupture.Q.1) Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?A. Abdominal pain.B. Absent pedal pulses.C. Chest pain.D. Lower back pain.ExplanationLower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdomen, and the pain is referred to the lower back. Abdominal pain is the most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Chest pain usually is associated with coronary artery or pulmonary disease.

Q.2) With which of the following disorders is jugular vein distention most prominent?A. Abdominal aortic aneurysmB. Heart failureC. Myocardial infarctionD. PneumothoraxExplanationElevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein distention isnt a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesnt cause jugular vein distention.

Thejugular veinsareveinsthat bring deoxygenated blood from theheadback to the heart via thesuperior vena cava.

Q.3) What is the most common cause of abdominal aortic aneurysm?A. AtherosclerosisB. DMC. HPND. SyphilisExplanationAtherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are related to the development of an aneurysm, none is a direct cause.

Q.4) In which of the following areas is an abdominal aortic aneurysm most commonly located?A. Distal to the iliac arteriesB. Distal to the renal arteriesC. Adjacent to the aortic branchD. Proximal to the renal arteriesExplanationThe portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isnt surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.

Q.5) A pulsating abdominal mass usually indicates which of the following conditions?A. Abdominal aortic aneurysmB. Enlarged spleenC. Gastic distentionD. GastritisExplanationThe presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic distention cause pulsation.

Q.6) What is the most common symptom in a client with abdominal aortic aneurysm?A. Abdominal painB. DiaphoresisC. HeadacheD. Upper back painExplanationAbdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. Headache and diaphoresis arent associated with abdominal aortic aneurysm.

Q.7) Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

A. Abdominal painB. Absent pedal pulsesC. AnginaD. Lower back painExplanationLower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries.

Q.8) What is the definitive test used to diagnose an abdominal aortic aneurysm?

A. Abdominal X-rayB. ArteriogramC. CT scanD. Ultrasound

Q.9) Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?

A. HPNB. Aneurysm ruptureC. Cardiac arrythmiasD. Diminished pedal pulses

Q.10) Which of the following blood vessel layers may be damaged in a client with an aneurysm?

A. ExternaB. InternaC. MediaD. Interna and MediaThe factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so its more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.

Q.11) When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?

A. Right upper quadrantB. Directly over the umbilicusC. Middle lower abdomen to the left of the midlineD. Midline lower abdomen to the right of the midlineThe aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.

Q.16) A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:

A. Loss of sensation in the lower extremitiesB. Back pain that lessens when standingC. Decreased urinary outputD. Pulsations in the periumbilical area

Q.17) Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurses priority should be :

A. placing her in a trendeleburg positionB. putting several warm blankets on herC. monitoring her hourly urine outputD. assessing her VS especially her RR

Q.19) A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?

A. The patient will be admitted to the medicine unit for observation and medication.B. The patient will be admitted to the day surgery unit for sclerotherapy.C. The patient will be admitted to the surgical unit and resection will be scheduled.D. The patient will be discharged home to follow-up with his cardiologist in 24 hours.

Q.20) A 76 year old man enters the ER with complaints of back pain and feeling fatigued. Upon examination, his blood pressure is 190/100, pulse is 118, and hematocrit and hemoglobin are both low. The nurse palpates the abdomen which is soft, non-tender and auscultates an abdominal pulse. The most likely diagnosis is:

A. Buergers diseaseB. CHFC. Secondary hypertensionD. Aneurysm

Q.21) An adult client has continued slow bleeding from the graft after repair of an abdominal aortic aneurysm. Because of the clients unstable condition, he is in the intensive care unit where visitors are limited to the family. The client insists on having a visit from a medicine man whom the family visits regularly. How should the nurse interpret this request?

A. The principle of justice prohibits giving one client a privilege that other clients are not permitted.B. Faith healers do not meet the standards for clergy exemption from visitation rules.C. Medicine men are not approved by the hospital as legitimate health care providers.D. Provision of holistic care requires that the clients belief system is honored.

A client is admitted to the health care facility for treatment of anabdominal aortic aneurysm. When planning this client's care, the nurse formulates interventions with which goal in mind?

Stabilizing the heart rate and blood pressure and easing anxiety

RATIONALES: For a client with an aneurysm, nursing interventions focus on stabilizing the heart rate and blood pressure, to avoid aneurysm rupture. Easing anxiety also is important because anxiety and increased stimulation may speed the heart rate and boost blood pressure, precipitating aneurysm rupture. Typically, the client with an abdominal aortic aneurysm is hypertensive, so the nurse should take measures to lower the blood pressure, such as administering antihypertensive agents, as prescribed, to prevent aneurysm rupture. To sustain major organ perfusion, a mean arterial pressure of at least 60 mm Hg should be maintained. Although mobility must be assessed individually, most clients need bed rest initially when attempting to gain stability.

A client is recovering from surgical repair of a dissecting aortic aneurysm. The nurse should evaluate the client forsignsof bleeding or recurring dissection. These signs include:

hypotension and tachycardia.

RATIONALES: When caring for a client recovering from surgical repair of a dissecting aortic aneurysm, the nurse must monitor for hypotension with reflextachycardia, decreased urine output, and unequal or absent peripheral pulses all potential signs of bleeding or recurring dissection.Hematuria, increased urine output, andbradycardiaaren't signs of bleeding from aneurysm repair or recurring dissection.

Which of the following complications ismostcommon after an abdominal aortic aneurysm resection?

Hemorrhage and shock

RATIONALES: Hemorrhage andshockare the most common complications after abdominal aortic aneurysm resection. Renal failure can occur as a result of shock or from injury to the renal arteries during surgery. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

Themostcommon site of aneurysm formation is in the:

abdominal aorta, just below the renal arteries.

RATIONALES: About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the ascending aorta and aortic arch. Debakey type III aneurysms are found in the descending aorta.

What is the most common cause of abdominal aortic aneurysm?

Atherosclerosis

Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are related to the development of an aneurysm, none is a direct cause.

In which of the following areas is an abdominal aortic aneurysm most commonly located?

Distal to the renal arteries

The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isnt surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.

A pulsating abdominal mass usually indicates which of the following conditions?

Abdominal aortic aneurysm

The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic distention cause pulsation.

What is the most common symptom in a client with abdominal aortic aneurysm?

Abdominal pain

Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. Headache and diaphoresis arent associated with abdominal aortic aneurysm.

Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

Lower back pain

Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries.

What is the definitive test used to diagnose an abdominal aortic aneurysm?

Arteriogram

An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound dont give a direct view of the vessels and dont yield as accurate a diagnosis as the arteriogram.

Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?

Aneurysm rupture

Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but isnt life threatening. Cardiac arrhythmias arent directly linked to an aneurysm.

Which of the following blood vessel layers may be damaged in a client with an aneurysm?

Media

The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so its more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.

When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?

Middle lower abdomen to the left of the midline

The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.

Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?

HPN

Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isnt as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesnt have direct link to aneurysm.

Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?

Bruit

A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface.

Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?

Severe lower back pain, decreased BP, decreased RBC, increased WBC

Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it cant be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldnt increase. For the same reason, the RBC count is decreased not increase. The WBC count increases as cells migrate to the site of injury.

Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?

Retroperitoneal rupture at the repair site

Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesnt cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma wont form.

Which hereditary disease is most closely linked to aneurysm?

Marfan's syndrome

Marfans syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasnt been linked to aneurysms. Lupus erythematosus isnt hereditary. Myocardial infarction is neither hereditary nor a disease.

Which of the following treatments is the definitive one for a ruptured aneurysm?

Surgical intervention

When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.

A nurse is assessing a client with an abdominal aortic aneurysm. Which of the following assessment findings by the nurse is probably unrelated to the aneurysm?

Hyperactive bowel sounds in that area

Not all clients with abdominal aortic aneurysms exhibit symptoms. Those who do describe a feeling of the heart beating in the abdomen when supine or be able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass. Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm.

Which of the following treatments is the definitive one for a ruptured aneurysm?

Surgical intervention

Which hereditary disease is most closely linked to aneurysm?

Marfan's syndrome

Marfans syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasnt been linked to aneurysms. Lupus erythematosus isnt hereditary. Myocardial infarction is neither hereditary nor a disease.Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?

Retroperitoneal rupture at the repair site

Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesnt cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma wont form.

Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?

Severe lower back pain, decreased BP, decreased RBC, increased WBC

Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it cant be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldnt increase. For the same reason, the RBC count is decreased not increase. The WBC count increases as cells migrate to the site of injury.Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?

Bruit

A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface.

Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?

HPN

Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isnt as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesnt have direct link to aneurysm.

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?a) Slow heart rate and high blood pressureb) Constant, intense back pain and falling blood pressurec) Constant, intense headache and falling blood pressured) Higher than normal blood pressure and falling hematocritIndications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor?a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissectionb) BP, pulse, respirations, and signs of hemorrhage or dissectionc) Cultural needs, characteristics of pain, and signs of hemorrhage or dissectiond) Intake and output, nutrition level, respirations, and characteristics of painThe nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions?a) Increasing blood pressure and monitoring fluid intake and outputb) Decreasing blood pressure and increasing mobilityc) Stabilizing heart rate and blood pressure and easing anxietyd) Increasing blood pressure and reducing mobilityFor a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

Which of the following is the most common site for a dissecting aneurysm?a) Cervical areab) Sacral areac) Thoracic aread) Lumbar areaThe thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?a) Elevated blood pressure and rapid respirationsb) Decreased pulse rate and blood pressurec) Increased abdominal and back paind) Retrosternal back pain radiating to the left arm

Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor?a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissectionb) Intake and output, nutrition level, respirations, and characteristics of painc) Cultural needs, characteristics of pain, and signs of hemorrhage or dissectiond) BP, pulse, respirations, and signs of hemorrhage or dissectionThe nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common?a) Renal failureb) Graft occlusionc) Hemorrhage and shockd) Enteric fistulaRenal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

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