AAR Repair Post Op Nursing Care

aar repair post op nursing care

aaa repair post op nursing care

After major surgery, nursing care is complex. It involves the holistic management of patient wellness in the face of many challenges to health. This essay will focus on the care of one such patient after surgery to repair an abdominal aneurysm. Nurses need to have a solid knowledge base in order to tackle the issue and provide personalized care. They must also be trained and updated regularly. This essay will examine how nursing knowledge can be applied to practice. The focus should always be on the patient and the underlying physiology that relates to it.

Knowledge and experience are key to nursing skills. These include the experience of nurses as well the experience of others who have learned from them, worked with them and collaborated in providing care. While the focus of this essay is on the nurse’s role with regard to the case and client, it is important not to forget that nursing care does NOT take place in a vacuum. This essay will refer to those with whom the nurses must interact and engage.

Following surgery to repair an abdominal aortic aneurysm, the patient’s care should be based on the following principles: general postoperative care and specific interventions, monitoring, support, and support as a result of the situation and nature of the operation. This case requires holistic care. It must be considered in light of the potentially life-threatening nature and complications.

Abdominal Aortic Aneurism Case Study

David Grainger, a 65-year-old man, is now retired and plays golf to keep fit. For the past month, he had experienced recurrent pain under his rib cage and had tried to treat his indigestion but with little success. David visited his GP after his friends began to worry about him. The local hospital sent him for testing, which ultimately led to the diagnosis of an abdominal aneurysm. David was admitted to the hospital for treatment of the aneurysm.

David underwent a blood transfusion and had a Redivac (wound drain) removed from his abdomen. An intravenous Foley catheter was used with an hourly waste bag. It was then changed to free drainage 12 hours later. The patient also received a local PCA (patient-controlled opioid) device. A mepore dressing has been applied to the wound site at his abdomen.

David has one IVI site in each hand. The blood transfusion was done via the left hand. Normal saline (0.9%) was being administered in the other on a three-way tap. David’s temperature was 39.6c the day after surgery. His pulse rate was elevated to 90 beats per minute. David complains repeatedly of feeling cold. David may be experiencing pyrexia, according to the SHO and his senior sister.

AAA: Abdominal Aortic Aneurism

Abdominal Aortic aneurysm is quite common (the 14 most fatal cause of death in the US according to Upchurch and Birkmeyer, 2007). It can be life-threatening (Isselbacher and colleagues, 2005). AAA poses the greatest risk, with a high mortality rate (Birkmeyer & Upchurch, 2007). It’s defined as abnormally localized arterial dilation or ballooning, that exceeds one-half of the normal circumference of an artery and must affect all three layers (Irwin 2007). Abdominal aneurysms, which occur below the diaphragmatic boundary, account for 75% of aortic and other aneurysms. The condition is more common in men than it is in women. Risk factors include smoking, hypertension, dyslipidemia, cell changes in the tunica media, and diseases like Marfan syndrome, inflammation, or blunt trauma. The risk factor for AAA is also linked to family history (Irwin 2007). Atherosclerosis is another risk factor, though someone with this condition may not develop an aneurysm. (Irwin 2007).

The procedure can be performed either openly or through a large, midline incision (Irwin 2007, 2007). Major surgery is required. The aorta can be cross-clamped to allow for the placement of a synthetic transplant. This graft is attached to the proximally as well as the distal portion of the healthy aortic tissue. A percutaneous vascular device stent can also be used for endovascular repairs (Irwin and Beese-Bjustrom 2004, 2007). A woven polyester tube is covered by a catheter and placed in the aneurismal area of the abdominal organ. This reduces the chance of rupture or dissection. David was subject to open surgery.

Assessment for aaa repair post op

The goal of the assessment in the first 24hrs is to establish physiological equilibrium, manage pain, and support the patient toward self-care (Watson Miller 2005). These are typical post-operative observations. Care for an individual who has had abdominal aortic and pulmonary aneurysm surgery may be more specific. These areas will be discussed in detail, taking into account the evidence and nature of the nursing knowledge. The assessment process uses nursing knowledge that has been acquired through training and study and from the experience of applying theoretical knowledge in practice. If the nurse has ever cared for patients with this type of condition before, she will use that knowledge in this case. If not, the combination of clinical, theoretical, or other knowledge, as well as a deep understanding of physiological principles, will result in appropriate and effective care.

Pyrexia in aaa repair

Once you have identified a problem with temperature regulation, it’s important to plan for continuous monitoring, identification, and treatment of the source of the temperature rise, as well as relief from symptoms. Most likely, the cause of the temperature is an infection. Nosocomial infections are a concern following surgery, particularly if the incision involves any part of the vascular system. (Irwin 2007). David will receive IV antibiotics to help prevent wound infection. These antibiotics will then be switched to oral antibiotics as needed (Irwin 2007). Paracetamol can be administered PR to relieve symptoms of pyrexia. The nurse will ensure that paracetamol was given as directed and is not incompatible with David’s medications. David’s elevated temperature could also be caused by ischaemic colitis, which can be a result of abdominal aneurysm repairs. White cell counts should be checked as this may indicate that there has been an increase in white cells (Beese and Bjustrom, 2004). Although we expect it to develop earlier, the pyrexia could be due to blood transfusion (Jones & Pegram 2006).

David’s pyrexia was a sign of a possible problem. Paracetamol and fan therapy may not be required. It may be enough to prevent infection and remind him that the feeling of being cold could be caused by a raised temperature.

Blood pressure management and fluid balance in aaa repair

In order to maintain end-organ perfusion, it is essential that David’s blood pressure remains within the normal range. David may be prescribed IV beta-blockers in order to prevent hypertension. Any cardiovascular changes, including ST-T waves changes, chest discomfort, or dysrhythmias will be monitored (Irwin 2007. If he is stable 24 hours postoperatively, he could be transferred from ITU or a standard surgical ward to high dependency. Telemetry may then stop.

Monitoring means arterial pressure can ensure proper perfusion. A reading of 70 mmHg or more can be achieved by monitoring it. Careful intravenous fluid infusions can also help (Irwin 2007, 2007). For fluid balance (and the continued functioning of organs), a urine output of around 50ml/hour would indicate adequate kidney perfusion and glomerular filtration rate (Irwin 2007). Any deviations will be noted and reported to the appropriate team members promptly (Irwin. 2007).

Pain management in aar repair

David’s pain can be managed with the Patient Controlled Analgesia Device (PCA), however, it is not a long-term method of pain management. David’s pain management plan should include a collaborative plan. This can be done in collaboration between the medical team, anesthetist, or David. David can choose from a number of medications once he’s able to manage without the PCA. However, it is crucial that David’s pain be managed properly in the postoperative period. David will be better able to move and less likely to develop pressure sores.

Prevention of atelectasis should also be addressed. Whatever type of surgical procedure was used, at least 90% of patients who were given a general anesthetic experience some degree of atelectasis during the recovery period (Irwin and Pruitt, 2007). Another risk is pneumonia (Irwin (2007). David is at higher risk for postoperative hypoventilation than he would be if he had an anesthetic. Post-abdominal surgery can also cause pain that prevents him from deep breathing. David can learn to use a pillow and a roll of a blanket to support the surgical site. He then can practice these breathing exercises (incentive spirometry as well as coughing and deep breath) to maintain his lungs. A good upright posture will help to increase lung capacity (Pruitt (2006)), and encourage deeper breaths (Irwin (2007)). It is crucial to maintain graft integrity that you have adequate pain control. Uncontrolled pain can trigger the release of epinephrine, norepinephrine, or other hormones that activate fight or flight (Bryant et. al. 2002). Vasoconstriction, which reduces blood flow through the Graft, can lead to an increased risk of thrombus (Bryant et. al. 2002).

Non-drug pain management is an option. Respiratory depression can be caused by opioids used to treat post-operative pain (Irwin 2007). Non-drug pain management techniques have other benefits. They are easy to access, affordable, and do not cause side effects. However, the greatest advantage is that they encourage self-care and personal responsibility for one’s health (Tracy and colleagues, 2006). David has experienced a life-threatening condition and so self-care could have many positive effects. Some evidence suggests that patient outcomes can be improved by tailored education and support in these therapies (Tracy and al. 2006). However, this will require that the nurse is well-informed about these techniques and that all members are equally invested in the care plan.

Preventing risks associated with postoperative abdominal aortic aneurysm repairs

In addition to the usual risks associated with postoperative abdominal aortic aneurysm repairs, there are several potential complications. These complications include hemorrhage and graft rupture (Irwin 2007). Another reason to closely monitor David’s hemodynamic status is that a drop or increase in blood pressure, urine output, and possibly a change of mental status could indicate shock due to blood loss. (Irwin 2007). You should also examine your abdomen for signs of pain, distension, or increased girth. Irwin, 2007, graft occlusion can cause paralysis by causing coronary ischemia (MI), cerebral ischemia (stroke), ischaemic colitis, or spinal cord ischemia. Occlusion of an abdominal transplant can also cause renal blood loss, acute tubular necrosis, and renal failure. It might be prudent to calculate the ankle/brachial index frequently to assess lower extremity perfusion (Irwin 2007).

Nursing Care for abdominal aortic aneurysm repair patients

 Kozon et. al. (1998) conducted an empirical study on nursing in patients undergoing abdominal aneurysm surgery. They found that patients who had the open procedure required more intensive nursing care for a longer time to help them move up the illness-wellness continuum towards independence and self-care. Kozon and colleagues (1998) present a tailored model that is based on the nursing process. This allows nurses to predict each patient’s postoperative course. They also discuss the psychological aspects of patient care. This includes discussing patients’ fear, which can be either externally seen by nurses or expressed by patients (Kozon and al, 1998). This is crucial in order to ensure the holistic management and care of David. Kozon and colleagues (1998) recommend that further nursing research be done in this area to optimize nursing and allow for the recognition of individual patients’ nursing needs. This speaks volumes about the nature and evidence base of nursing knowledge on the topic. It remains focused on the medical and physical aspects of care. Kozon et. al. (1998) created a protocol for such cases. However, evidence is needed to support this. Both the repair and procedure carry high risks. (Bryant, 2002). Thorough knowledge of these issues is essential to support nursing practice. It will ensure prompt and appropriate prioritization, recognition of deviations, and prompt referral and treatment.

The evidence base also raises the issue of the documentation and monitoring for pain management. Idvall (2002) and Ehrenberg ((2002) conducted a retrospective, descriptive audit of nursing records and found many deficiencies in the content and completeness of nurses’ documentation and monitoring of pain management. This is especially important in relation to the postoperative care for patients who have had abdominal aortic aneurysm surgery. Because pain can be a sign of many complications, it’s crucial that this information is available.

The care of a patient with an AAA repair requires deep knowledge and skills on the part of the nurse. David presented with potential complications from his surgery. However, the complexity of his condition may mean that his potential pyrexia could be due to many causes. It is important to understand the physiology behind his condition so that all his needs can be met. Also, he is in a good health state for rapid recovery. This requires a holistic approach that considers his psychological and pain management, as well as his many medical and physical requirements. While the evidence base for care suggests that there is some nursing evidence to support care, it also points to the need for more detailed and thorough research to back up the practice. Myer, 1995. Nursing intervention and assessment can be critical to the survival of patients with this condition. To provide the best care possible for David, nurses must be able to draw on their knowledge and experience as well as the knowledge and understanding of their patients and their symptoms.