Question

Scenario

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 benazepril (Lotensin) 5 mg/day, fluoxetine (Prozac) 40 mg/day, furosemide (Lasix) 20 mg/day, potassium chloride (KCl) 20 mEq (20 mmol) bid, and atorvastatin 40 mg each evening.

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 to 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 all 2+. His lungs are clear, and he is awake, alert, and oriented. There are no abnormal physical findings; however, he has not 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 (90 g/L).

1. A.H. has several common risk factors for AAA in his health history. Name and explain 3 factors.

2. How is testing used to diagnose an AAA?

7. During your assessment, you note a pulsation in A.H.’s upper abdomen, slightly left of the midline, between the umbilicus and the xiphoid process. True or False: You must palpate this mass as part of your physical assessment. Explain your answer.

CASE STUDY PROGRESS

A.H.’s aneurysm resection is successful, and he maintains normal leg movement and sensation. However, for the first 2 postoperative days he is delirious and needs one-to-one nursing care in the intensive care unit. After he becomes coherent and oriented again, he is transferred back to your floor.

9. What assessments do you need to make specific to his postoperative care?

10. List 6 problems that are high priorities in A.H.’s postoperative care.

11. When you perform A.H.’s abdominal assessment, you do not hear any bowel sounds when auscultating his abdomen. What should you do?

Answer 1

1.The risk factors of AH are

• Age : The individuals who are elderly or above 65years of age are at common risk
• Gender :Male are highly prone for this condition due to various life style factors
• High cholesterol levels can cover the arterial layers and causing aneurysm
• Increased blood pressure is one of the main risk factors to develop due AAA. This happens due to continious high pressure on the arterial wall leading to aneurysm.

2.Ultrasound Abdomen is main used to diagnose AAA

The CT Abdomen to confirm and read it more accurately

The Angiography to rule out how the artery are and where the problem is .

7 .The statement is true because in AAA ,on physical examination pulsating aorta can be felt in palpation .This enables to identify the protrusion, the intensity of pain ,it's nature and any radiation and plan for care.

9.The assessment which has to be made in specific to post operative period are as following

• Monitoring vital signs ,to get baseline status
• Assess the surgical site for any pain ,tenderness ,oozing ,odour to rule out healing stage of wound and for any sign of infection
• Assess for pain after surgery
• Maintain intake and output chart.