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Aneurysms

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An aneurysm is the enlargement of an artery caused by weakness of the arterial wall. It is often asymptomatic until a rupture occurs. Most commonly comes in tandem with atherosclerosis.

  • Clinical Manifestations: usually clinically silent until rupture. Non-ruptured aneurysms may cause obstruction or promote clotting (thromboembolism) which may lead to a stroke or other complications. Thoracic aneurysms may cause dyspnea or dysphagia.
  • Complications:
    • Severe chest or back pain may indicate aortic aneurysm.
    • Acute severe headache may indicate an SAH.
    • Angina (chest pain) may indicate obstruction of the coronary arteries by an embolus.
    • Any ruptures may cause pain, hypotension, tachycardia, and lightheadedness.
  • Risk Factors include hypertension, poor diet, sedentary living, and obesity. The most common is smoking (it increases risk of both an aneurysm and a rupture).
  • Nursing Assessment: anticipate a rupture. Assess for activity of all the organs.

Aortic Aneurysm

The largest artery. Most commonly affected site is the abdominal aorta: Abdominal Aortic Aneurysm (AAA; Triple A). It is normally 2 cm in diameter, and may dilate up to 5 cm. Past 5.5 cm, surgery is necessary. Uncommonly, a Thoracic Aortic Aneurysm (TAA) may occur. It has a higher survival rate but presents the same.

Cerebral Aneurysm

Also known as “berry” aneurysms, as they appear like small berries on branches. Ruptures of these berry aneurysms can cause death within 24 hours; 40% of ruptures being fatal and 66% resulting in permanent neurological damage. These are the most common type of stroke: subarachnoid hemorrhages (SAHs)

Peripheral Aneurysm

Less likely to rupture, but still occur.

  • Popliteal Aneurysm: behind the knee. The most common peripheral aneurysm.
  • Splenic Artery Aneurysm: near the spleen.
  • Mesenteric Artery Aneurysm: the artery supplying the intestines.
  • Femoral Artery Aneurysm: the femoral artery by the groin.
  • Carotid Artery Aneurysm: the major neck artery.
  • Visceral Aneurysm: arteries that supply the bowel or kidneys.

Intracranial Aneurysm Care

  • Nursing Assessment: Complete neurologic assessment, pupillary reaction, motor and sensory function, speech, ocular, etc. Detect subtle changes, especially changes in LOC.
  • Nursing Diagnoses:
    • Ineffective tissue perfusion (cerebral) related to bleeding or vasospasm.
    • Disturbed sensory perception due to the restriction of aneurysm precautions.
    • Anxiety due to illness or restrictions of aneurysm precautions.
  • Complications: vasospasm, seizures, hydrocephalus, re-bleeding, hyponatremia.
  • Nursing Interventions:
    • Tissue Perfusion: assess regularly, avoid clotting, avoid increases in intracranial pressure (elevate head, don’t strain, no caffeine, etc.)

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