Case Study: AAA
J.M. 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 CHF, quit smoking 5 years ago; current
c/o of deep visceral pain, dyspnea, hypertension,
and depression. J.M. has just been admitted to the
hospital for surgical repair of a 6.2-cm abdominal
aortic aneurysm (AAA), which is now causing him
constant pain.
Upon arrival on your floor, his VS are 109/81, 61, 16 and 98.3 F.
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 A & O X 3 . There are no abnormal physical
findings; however, he hasn't had a bowel movement for 3 days. His
electrolytes and other blood chemistries and clotting studies are
within normal range, but his Hct is 30.1% and Hgb 9.0 g/dL.
J.M. has been depressed since the death of his wife 9 years ago. He
has no children. His height is 6'2" and weight 160 lb. His chronic
medical problems have been managed over the years by
medications: benazepril 40 mg PO qd, Propranol 20 mg qd;
warfarin 5 mg po qd; 40 mg PO qd, furosemide 40 mg PO qd,
trazodone 50 mg PO qhs, KCl 20 mEq PO bid, and lovastatin 40 mg
PO qhs.
1. J.M. has several common risk factors for AAA, which are
evident from his health history. Identify and explain three
factors.
Expert Response: Risk factors: age (70), HTN, probable atherosclerosis, hx smoking
2. While J.M. awaits his surgery, it is important that you monitor
him carefully for decrease in tissue perfusion. Identify five things
you would assess for, and state your rationale for each.
Expert Response: Assessments: Major risk: (1) vital signs: impending rupture and/or
dissecting aneurysm with increasing pain and no BM in 3 days (2) H & H as he may have
dissecting aneurysm; (3) renal output; most AAA occur below kidney, however may have
dissecting AAA; (4) peripheral pulses due to AAA (5) Pain level, increasing may indicate
impending rupture; (6) neurovascular integrity/motor function of lower extremities; (7) bowel
sounds, had nausea (8) inspect for signs bleeding ie scrotum, etc
3. What is the most serious, life-threatening complication of AAA,
and why?
Expert Response: Most serious: Impending rupture of aorta; has had increasing pain; size is
6.2
4. What single problem mentioned in the first paragraph of this
case study presents a risk for AAA rupture? Why?
Expert Response: He has constant pain and no BM is 3 days.
5.The resection of J.M.’s aneurysm was successful, but for the first
3 post-op days he was delirious and required one-to-one nursing
care and soft restraints before he became coherent and oriented
again. He was still somewhat confused when he was transferred
back to your floor. What nursing assessments should be made
specific to his aneurysm?
Expert Response: Nursing assessments: vital signs and fluid replacement: careful monitoring
of output!; make sure no less than 30 ml per our; check peripheral pulses and motor function;
potential for bowel ischemia due to embolism, check for bowel sounds; check for
hemodynamic stability