Case Study Abdominal Aortic Aneurysm Health And Social Care Essay

Case Study ab aortal aneurism wellness And Social Care EssayA 72 form old male patient, smoker and family history of AAA, was referred by his GP to roentgen ray de fictional characterment. With clinical indication of fall at stairs 2 weeks past and pain in lower back and right hip, to have an roentgen ray of lumbar spine and pelvis. After justifying the request card and envision his details, they did AP and asquint of his lumbar an AP examination of pelvis. And they send him back to have a issue by his GP aft(prenominal)(prenominal) 10 days. Radiologist reported on his x-rays and sends it back to the GP. There was an evaluation of the classification in the abdomen and suspect abdominal aortal aneurism. So GP asked him to attend the performance to discuss the x-ray expiry, and request an ultrasound of abdomen to have a relegate result and rough indication of the indwelling diam and accurate sound judgement .Gp asked him to wait until he received appointment lette r from infirmary.After 4 weeks he had his appointment. clinical indication was classification on lumbar x-ray, enquiry abdominal aneurysm. Before he goes to do the application he was fasting for eight hours because food and liquid in the stomach and urine in the bladder peck make it difficult to a get reform picture of the aorta for the ultrasound technician. He changed into a gown. Radiologist asked him to lie on his back and whence he applied small cadence of inhuman gel in his abdomen because the air between the fur and aorta leave help to reduce by using the gel, by pressing the transducer against the skin over the abdomen. Radiologist monitored billet flow through the abdominal aorta to check for an aneurysm (Myo clinical staff 2010 and NHS web aim 2010). After procedure he discussed the result with patient. And reported the say to his GP. The evaluation of ultrasound s great deal was an abdominal aortic aneurysm which was 4.5 cm. Heart was in normal size. No evidenc e of ein truth featureificant mediastinal mass or lymph node enlargement. Kidneys were in normal sizes.The map mea surements and protocol areLongitudinally, pull up stakes examine the aorta from diaphragm to bifurcation, and will memorial the length of the aneurysm and quantity the anteroposterior (AP) diameter from bug outside wall to satellite wall, and as well will examine the iliac arteries to the iliac bifurcation and measure aneurysm from outer wall to outer wall.Transversically will Document the maximum diameter of the aorta at the diaphragm, superior mesenteric artery (SMA), and distally, and Measure AP and transverse diameters from outer wall to outer wall, also will Visualize the iliac arteries and measure aneurysms (Vikram and Deborah 2004).GP reoffered him to vascular surgeon, by and by 3 weeks he met the surgeon, He reviewed his checkup history and discussed the x-ray and ultrasound result with him And rerecommend him watchful waiting, it means that the if an eurysm was smaller than 2 inches (5 centimetres) in diameter, it is non serious enough to beseech operating theatre. In this case, his doctor will check his condition every 6 months using additional ultrasound exams or other imaging tests until aneurysm reaches to 5.5cm (Medline Plus 2004). He also asked him to quit smoking, because Smokers are approximately 5 time as likely as non-smokers to develop AAA (Hafez 2008).Six month after In Dec 2007 he received his second appointment for scan of his abdomen. He attends his appointment with same procedure. There was a small amount of increase in his aneurysm. Therefore report was send to Gp. Evaluation was 4.7cm aortic aneurysm.In April 2008 he had another scan with aneurysm with 5.2cm aneurysm. He could not part with smoking, but his GP strongly advised him to stop smoking. In March 2009, it was 5.6cm aneurysm and if the abdominal aortic aneurysm expands by more than than 0.6 to 0.8cm per year, repair is normally recommended ( fi lchert et al 2008).http//www.e-radiography.net/radrep/Vascular/Vascular_AAA_US_55mm/Vascular_AAA_US_55_long.jpgRadiological Report US group AB Aorta The maximum A.P. internal diameter of the abdominal aorta is 5.6 cms. Mural thrombus reduces the internal diameter to 2.0cms (x-ray 2000).Vascular surgeon discussed with patient that he need a surgery as soon as possible, also explained the existence of 2 possible methods of repair and to outline the major jeopardys and benefits of each. The traditional ( apply) working(a) surface involves direct exposure of the aneurysm followed by replacing the aneurismal part of the aorta with a synthetic graft.Endovascular aneurysm repair (EVAR) is a more modern font and less invasive technique which is becoming widely utilize (Hafez 2008). patient preffered to have EVAR operation, but everybody is not suitable for EVAR, because of the shape of their aneurysm. So he was asked to have a CT angiogram to check if he is suitable for EVAR, other than he should have open surgery (NICE 2006). Surgeon request CT angiogram for him with clinical indication of EVAR 5.6cm in ultrasound scan.The week after he had a CT angiogram aorta. The technologist asked him if he has allergy to some(prenominal)(prenominal) blood line media, then positioned him on the CT examination table, lying flat on his back. He inserted an intravenous (IV) line into a small vein in his arm. A small dose of contrast material injected through the IV to determine how long it takes to reach the area under study.Week after the surgeon received the report from Radiologist. Evaluation of CT scan was a 6.2cm infrarenal AAA with a satisfactory neck andgood potential familiar iliac landing zones suitable for EVAR ( Bhattacharya ).He asked to attend a pre-operative legal opinion clinic to meet his surgeon and other members of clinical team.They took his medical history and carried out a material examination. The functional team carried out a be of tests to mak e sure that he is wellnessy enough to have an anaesthetic(a) and surgery.The tests were includedArterial Blood Gas (ABG) levels, to monitor oxygenation, ventilation, and acid domicile status.Complete blood weigh to monitor Red blood cell, bloodless blood cell(WBC), and platelet counts altered haemoglobin levels and hematocrit reflect any blood loss and the oxygen carrying ability of the blood. An elevated WBC count reflects an inflammatory response. blood serum electrolyte panel-monitors fluid ,electrolyte, and acid base statusSerum creatinine and blood urea nitrogen (BUN) levels, to monitor renal hunt.Blood clotting studies to monitor clotting.Urinalysis to monitor renal status including secretion and duckingBlood crossmatching necessary for blood replacementElectrocardiography (ECG) may find cardiac changes associated with ischemiaChest X-ray may reveal abnormalities of the chest, center field and lungs (Holloway 2004).his RWS was 4.6 M/mcL, WBC 6 K/mm, haemoglobin lev els 11 g/dL, Hematocrit 44%, Blood urea nitrogen 13 mg/dL, Bilirubin, direct 0.2 mg/dL, Bilirubin, total 0.2 mg, Creatinine 0.8 mg/dL,( GAIL thug 2007).The surgical team gave him advice about what he can do to prepare for surgery, and they also asked him about his home circumstances so that his discharge from hospital can be planned. If he still smoker, he strongly advised to stop smoking as soon as surgery is required. query has run aground that people who stop smoking for at least two months in the beginning having surgery are four times less likely to commence complications following surgery compared with those who smoke. He already stopped smoking. Surgeon discussed him what will happen before, during and after his procedure, and any pain he might have.On admission day which was the week after, he was seen by one of the younger doctors who was obtained a detailed medical history and did a full physical examination. Blood tests were repeated and any pending investigations (f or example heart scan) performed. whiz of the more senior doctors took through the consent form which you was required to sign before they can proceed with surgery. He was fasting from midnight before the procedure. nursing care was focused on restoring and maintaining hemodynamic stability. Administer supplemental oxygen, monitor the patients cardiovascular status, insert two large-bore I.V. devices, and fluid resuscitate with 0.9% sodium chloride or lactated Ringers resultant role if hes hypotensive (Raymond 2006).He was taken to the theatre complex in his bed, In the anaesthetic room. the anaesthetist gave him an epidural and involves a needle puncture into his back. He also had a tube in his bladder, so that they could monitor the function of his kidneys a tube in his hand, so that they could monitor his blood pressure. and then he transferred to the recovery area in the theatre complex, where he was taken care of by one of the recovery nurses pending transfer to the high- pitched Dependency Unit or the Vascular Ward. entirely the above mentioned tubes pinched in till the next morning, when all the tubes are removed and was encour mountd to root mount up walking and moving around. They gave him aspirin and cholesterol-lowering medication. He strongly advised to stay on these for life to reduce the gamble of developing heart problems or having a stroke as he grow older. During his hospital stay, he was getting a mini-injection of heparin (Fragmin). This will thin his blood and counteract him from getting clots whilst he is in hospital (Inglott 2007).So surgeon graduation elective surgery to repair an aorta. He made small slip in his groin and passed up a catather inside an artery in his leg until it reached the area of the aneurysm. A compressed stent graft was fed to the site of the aneurysm. The procedure was guided using intensifier x-ray machine and radiographer took images tread by step. The stent graft is made of a tube supported by a met al mesh. The stent graft was placed across the aneurysm. The stent kept the aorta open and aneurysm was protected from further pressure. The stent graft is slowly released from the delivery dodge into the aorta. As the stent graft is released, it was expanded to its proper size so that it snugly fits into aorta both above and down the stairs the aneurysm The guide wire is then removed from theBody. The stent graft remained inside the aorta permanently. Imaging procedures wasPerformed to check whether the stent graft is right on placed. the cut was closed with stitches and a dressing was placed over the stitches. (Bupas Health education Team 2010).After the procedure, his breathing tube removed and he was taken to the intensive care unit for recovery. He received fluids and victual through his IV. The catheter in his bladder was remained in place for several days. The hospital stay was 5 days. During this time he was encouraged to get up and out of bed. Complete recovery was 3 m onths.In order to learn any complication he had need to follow-up carefully, particularly in the early stages. CT angiography was performed at day 2 after placement. No evidence of endoleak was detected during arterial phase scanning or after a 2-min delay. The patient was discharged without complication.Follow-up CT angiography was performed at 1 month and five month. Then every year after that, to make sure there are not any problems.DiscussionAorta is the main blood watercraft in body. This carries blood from heart to the rest of the body. The part of the aorta in the abdomen is called the abdominal aorta. It supplies blood to the stomach, pelvis and legs.An aneurysm is a clean area in a blood vessel. If a blood vessel weakens, it starts to bloat like a balloon and becomes unusually big. If an aneurysm forms on the abdominal aorta and grows too big, the aorta might tear or rupture (Upchurch and Schaub April 1, 2006, ling ko 2008).The most common of these aneurysms known as abd ominal aortic aneurysms AAA, is below the origin of the arteries to the kidneys. A more anatomically correct description would be infrarenal aortic aneurysms.In men, the maximum normal aortic diameter at this level should not exceed 2.5 cm. An aorta that is 3 cm or more in diameter at this level qualifies as being aneurismal. The prevalence of AAA varies according to ethnicity, age and gender. Men are six times more likely to be affected by this condition. At the age of 65 years, 3% of men will have an AAA. The popularity then increases with age to reach nearly 8% at the age of 80. AAAs represents nearly 98% of aneurysms of the whole aorta (Hafez 2008).The rate of growth and the risk of rupture increase exponentially with the diameter of the aneurysm, with a watershed level for serious risk at about 5.5cm. Therefore until the patient is gravely ill from other causes, any aneurysm wider than 5.5 cm should be operated upon electively (Raymond 2006 and Dillon et al 2010). abdominal mu scle aortic aneurysm is usually asymptomatic .smoking and high blood pressure, are most important risk factors (patient booklet 2009 and Hafez 2008)About 80% of patients who present with a ruptured abdominal aortic aneurysm have no previous diagnosis. When rupture occurs, mortality is very high (Scot et al 2008 and Philip et al 2009).FebruaryOn physical examination, AAAs with 3 to 3.9 cm range are palpable 29% of the time, compared with those with an AAA more than 5 cm. which can be palpated 76% of the time (Gilbert et al 2008).The symptoms associated with AAAs are bleary-eyed abdominal or back pain, abdominal pulsatile and abdominal mass may be presentin obese patients, Palpation of aneurysm may be difficultEarly satiety, nausea or vomiting may occur due to duodenal compression.Ruptured or leaking aneurysms may present with thoroughgoing(a) back, abdominal, or flank pain that may radiate to the groinhypertension or tachycardiaSyncope abdominal mass on examSigns of retroperitoneal hematoma (Scott et al 2004 and Rosalyn 2006 and Louise and Anderson 2001).Compared with open surgery, EVAR has lower operative mortality, lower morbidity, and shorter length of hospital stay and greater likelihood of discharge to home than open surgery (Schermerhorn 2009)CT is the next step to help determine which treatment should be used (endovascular or open surgery) .Serial CT scans can be used tovisualise the proximal neck (the transition between the normal and aneurysmal aorta), the extension to the iliac arteries, and the patency of the visceral arteries. They can also measure the thickness of the mural thrombus.With three-dimensional imaging, helical CT and CT angiography can provide additional anatomical details, especially useful if endovascular procedure is considered.( Akalihasan et al 2011and Macari et al 2001)Informed consent for any AAA repair must include accurate information about the reason for recommending surgery (i.e. the risk of aneurysm rupture without surger y), the reason for recommending either open or endovascular surgery and about the likely outcomes. Warn about the site and size of the surgical scar, about wound infection and incisional hernia formation, about deep venous thrombosis and particularly about sexual dysfunction which, it appears, may be evenly common after open and endovascular repair (Brian 2008).If the patient is hypertensive, administer beta-blockers and nitroprusside as ordered. Manage pain with morphine sulfate or hydromorphone to come up him comfortable and to combat pain-induced increases in BP, heart rate, and oxygen demand (GAIL lout 2007).Gilbert R. Upchurch, Jr, MD Christopher Longo, MD John E. Rectenwald, MD,March 2008 slew 63. human activity 3 Geriatrics)Upchurch, Jr. G.R. (M.D.) and Schaub, T.A. (M.D.) (April 1, 2006) Abdominal aortic Aneurysm American Family Physician online. available from http//www.aafp.org/afp/20060401/1198.html Accessed 16/2/2011Heather, B. P. ( 2008 ) Abdominal aortic aneurysms , screening and the truthAvMA Medical Legal journal, slew 14 Number 2 online. Available fromMyo clinical staff,June 23, 2010, 1998-2010 Abdominal ultrasoundMayo Foundation for Medical Education and Research (MFMER).online, available at http//www.mayoclinic.com/ health/abdominal-ultrasoundWhat you can expect/,MY00076/DSECTION=what-you-can-expectaccessed 23/1/2011http//www.ruh.nhs.uk/patients/services/vascular/documents/Endovascular_Aneurysm_Repair_ long-suffering_Information.pdf, accessed 21st DEC 2010 ultrasound secrets,By Vikram Dogra, Deborah J. Rubens,2004 ,Philadelphia,PensilvaniaAbdominal aortic aneurysm. MedlinePlus Medical Encyclopedia. Available at http//www.nlm.nih.gov/medlineplus/ency/article/000162.htm. Accessed September 12, 2004Abdominal aortic aneurysm disease health risks,management and screeningHany Hafez Clinical chance 2008 14 208-210 DOI 10.1258/cr.2008.080076what is ct angiography aorta of abdominal aortic aneurysmStoeltings anesthesia and co-existing disease Robert K. Stoelting, Roberta L. Hines, Katherine E. Marschall 2008 676 pagesAbdominal aortic aneurysm disease health risks,,management and screening,Hany Hafez Clinical Risk 2008 14 208-210 DOI 10.1258/cr.2008.080076(http//www.healthcarerepublic.com/news/766641/ Abdominal aortic aneurysm is the cause of more than 6,000 deaths per year. By Mr Vish Bhattacharya)h ttp//www.radiologyinfo.org/en/info.cfm?pg=angioct(http//www.healthcarerepublic.com/news/766641/ Abdominal aortic aneurysm is the cause of more than 6,000 deaths per year. By Mr Vish Bhattacharya)Medical-surgical care planning,By Nancy Meyer Holloway, 2004, Lippincott William Wilkinshttp//www.nhs.uk/Conditions/repairofabdominalaneurysm/Pages/Preparation.aspxhttp//www.stent-graft.com/id11.html,Dr Ferdinand Inglott, consultant Vascular and Endovascular Surgeon at the Manchester Royal Infirmary,2007Bupas Health Information Team, July 2010. Endovascular aneurysm repair (EVAR),online at http//www.bupa.co.uk/healthinformation/di rectory/e/endovascular-repair, accessed 16/2/2011.( familiar surgical operations Page 432Raymond Maurice Kirk 2006 723 pages Preview)Hany Hafez,2008, Abdominal aortic aneurysm disease health risks, management and screening, Clinical Risk, Volume 14 Number 6General surgical operations Raymond Maurice Kirk 2006 Page 432,Churchill Living rock candy ElsevierEndovascular treatment for ruptured abdominal aortic aneurysm,Dillon M, Cardwell C, Blair PH, Ellis P, Kee F, Harkin DW,The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 12, Copyright 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd..PATIENT INFORMATION BOOKLET ,Endovascular Stent GraftsA treatment for Abdominal Aortic Aneurysms,2009 Medtronic, Inc. alone Rights Reserved. Printed in USA. UC200805202aEN 4/092009 American Medical Association. All rights reserved. (Reprinted) JAMA, November 11, 2009-Vol 302, No. 18Abdominal aortic aneurysm disease hea lth risks,management and screeningHany Hafez Clinical Risk 2008 14 208-210 DOI 10.1258/cr.2008.080076Scott Davarn, MDRob Reardon, MDScott Joing, MD Academic Emergency MedicineVolume 14, Issue 4, Article number 1 published online 28 JUN 2008http//onlinelibrary.wiley.com/doi/10.1197/j.aem.2007.01.001/pdfPhilip E. bread maker Kumar V. Ramnarine,2009, Development and Application of an observational Abdominal Aortic Aneurysm Model, Ultrasound 200917(1)30-34 _ British Medical Ultrasound Society 2009 University Hospitals of Leicester NHS Trust, Department of Medical Physics, Leicester Royal Infirmary, Leicester LE1 5WW, UKULTRASOUND N February 2009 N Volume 17 N Number 1 URASOUND N February 2009 N Volume 17 N Number 1).- Abdominal aortic aneurysmGilbert R. Upchurch, Jr, MD Christopher Longo, MD John E. Rectenwald, MD, March 2008 Volume 63. Number 3 GeriatricsScreening programmes ,Abdominal Aortic Aneurysm , NHS Abdominal Aortic Aneurysm Screening Programme 2010 Produced by COI for the NH S ,401590/C 1p December 2010, http//aaa.screening.nhs.uk/Baker LAnderson E, 2010 May Abdominal aortic aneurysm simple screening could save lives, Primary care nurse practitioner, Generations Family Health Center, Norwich, CT, American Journal for Nurse Practitioners (AM J NURSE PRACT), 2010 May 14(5) 29-34 (27 ref), journal article pictorial, tables/charts.In a Page SurgeryBy Scott Kahan, John J. Raves,2004,Lippincott Williams Wilkins,PhiladelphiaRosalyn Gendreau , 2006, Is it a kidney stone or abdominal aortic aneurysm? 22-4 (journal article pictorial)Louise A. Anderson, MS, RN,2001, Abdominal Aortic Aneurysm,,THE JOURNAL OF CARDIOVASCULAR NURSING/,Article 1 5/21/01 1111 PM Page 1, J Cardiovasc Nurs 200115(4)1-14, 2001 Aspen Publishers, IncMarc Schermerhorn, MD, Discussant2009 American Medical Association. All rights reserved. (Reprinted) JAMA, November 11, 2009-Vol 302, No. 18 online available at http//jama.ama-assn.org/content/302/18/2015.full.pdf+html, accessed 14/2/2011.Roya l United Hospital Bath, NHS, Endovascular Aneurysm Repair Patient Information, http//www.ruh.nhs.uk/patients/services/vascular/documents/Endovascular_Aneurysm_Repair_Patient_Information.pdf, accessed 21st DEC 2010NICE 2006Abdominal aortic aneurysm ,N Sakalihasan, R Limet, O D Defawe,2011 at http//www.surgical-tutor.org.uk/default-home.htm?specialities/general/aaa.htmrightMichael Macari, MD, Gary M. Israel, MD,Phillip Berman, BA, Maria Lisi, BA, Anuj J. Tolia, BA, Mark Adelman, MD, Alec J. Megibow, MD, MPH, August 2001 Infrarenal Abdominal Aortic, Aneurysms at Multi-Detector, Row CT Angiography Intravascular Enhancement without a TimingAcquisition1,520 z Radiology Macari et al, Volume 220 z Number 2Abdominal aortic aneurysms, screening and the law ,Brian P Heather, AvMA Medical Legal Journal, 2008 Volume 14 Number 2 athttp//cr.rsmjournals.com/content/vol14/issue2/http//www.nursingcenter.com/prodev/ce_article.asp?tid=693846 (How to protect a patient with aortic aneurysmGAILHOODIRWIN RN, CEN, BSNNursing2007 ,February 2007 ,Volume 37Number 2,Pages36