AAA open repair help

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We are doing a sims on monday - our pt is 72 3 day post op, NPO, w/faint pedal pulses, faint bowel sounds- all vs wnl -

doing my nursing asessment what should i focus on?

what are the possible complications?

why are his pedal pulses & bowel sounds faint is that normal post op -

I was think parayltic illeus w/ faint bowel sounds but what could be my interventions if he is hooked up to ng tube he cant get up and walk any help would be great -

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Specializes in med/surg, telemetry, IV therapy, mgmt.

i would read everything i could find about aaas, their treatment and complications including reviewing complications of major anesthesia because you have no idea what will be presented in that scenario. these patients usually have a history of heart problems and/or a smoking history to begin with so their heart and vessels are not pristine. look up the signs and symptoms of ileus before diagnosing it:

manipulation of the intestines during a surgical repair of a aaa is a normal occurrence, so the patient will be npo because peristalsis wouldn't be expected to start back up right away. the nurses would be assessing bowel sounds frequently waiting for the return of them which would indicate that peristalsis had started again. it sometimes takes 3 to 4 days for this to occur. until then, the patient remains npo. rule of thumb with abdominal surgery patients is that they don't get solid food until they start passing gas (farting) or poop. passing gas or pooping indicates that peristalsis has resumed. an ng tube is put in place to drain secretions from the stomach because of the expected peristalsis. these secretions have no where to go so they build up in the stomach making the person sick and eventually vomiting them out. vomiting is risky in post op patients because if they are drowsy they can aspirate the vomitus into their lungs and that can lead to pneumonia. the ng tube is a preventative measure. complications of anesthesia are:

  • breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
  • hypotension (shock, hemorrhage)
  • thrombophlebitis in the lower extremity
  • elevated or depressed temperature
  • any number of problems with the incision/wound (dehiscence, evisceration, infection)
  • fluid and electrolyte imbalances
  • urinary retention
  • constipation
  • surgical pain
  • nausea/vomiting (paralytic ileus)

assessment consists of:

  • a health history (review of systems) - since this is a simulation and you can't interview the patient, you should be aware from your reading about abdominal aortic aneurysms what risks factors, behaviors, lifestyles can contribute to a person having a aaa (for example, men are more likely to have a aaa than women)

    [*]performing a physical exam - know the signs and symptoms of a aaa as well as any underlying disease as the cause of it

    [*]assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)

    [*]reviewing the pathophysiology, signs and symptoms and complications of their medical condition - a aaa is a surgical treatment for a medical problem. both it and anesthesia have side effects and complications which you need to be aware of:

    [*]reviewing the signs, symptoms and side effects of the medications they are taking

you are in nursing school. concentrate on the nursing problems that this patient is going to be having.

  • acute pain
  • risk for ineffective breathing pattern
  • (risk for) ineffective tissue perfusion, peripheral or renal
  • (risk for) deficient fluid volume - due to potential hemorrhage which would be a postop complication
  • risk for infection

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