List five problems that are high priorities in A.H.'s postoperative care.
Can anyone name a few?
Question 2The resection of A.H.'s aneurysm is successful, but for the first 3 postoperative days he is delirious and requires one-to-one nursing care before he becomes coherent and oriented again. He is transferred back to your floor.
What assessments should be made that are specific to his postoperative care?
Question 3During your assessment you notice a pulsation in A.H.'s upper abdomen, slightly left of the midline, between the umbilicus and the xiphoid process.
True or False: You will need to palpate this mass as part of your physical assessment. Explain your answer.
Question 4What is the most serious, life-threatening complication of AAA and why?
What single problem mentioned at the beginning of this case study presents a risk for AAA
rupture? Why?
Question 5While A.H. awaits his surgery, it is important that you monitor him carefully for decreased tissue perfusion.
Identify five things you would assess for, and state your rationale for each.
Question 6Angiography reveals an aneurysm with a shape as in the accompanying illustration. What type of aneurysm is this?
a. Saccular aortic aneurysm
b. Fusiform aortic aneurysm
c. Aortic dissection
d. False aortic aneurysm
Question 7A.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, Potassium chloride (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 (VS) 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 that are evident from his health history. Identify and explain three factors.
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