AAA rupture

Elvish, BSN, DNP, RN, NP · Dec 10, 2008

DMBFAN, I don't think it's anyone's intent to frustrate you here. We have all been to nursing school and had those things that took us a while to 'get.' What I am getting from this thread is:

a) we know this has to be a question from nursing school because there is no way in the real world anyone would worry about WBC in the heat of a ruptured AAA. That's not meant as a knock to you. It's just that in nursing school and in the NCLEX-utopia, there is always enough time to figure out every last minute detail, and always enough staff to do everything needed in time. Frankly, when I read your question, I thought to myself, who flippin cares what the WBCs are doing when a vessel the size of a garden hose is ruptured and bleeding out internally??? Again, that's not an attack on you, nor the fact that you asked questions. That's just a statement of fact - ruptured AAA's are very rarely survived.

b) The other thing I'm seeing is that feeling that I remember oh-so-well from nursing school. That feeling that, no matter how much you think about it, you're never going to understand. But you will....you may need to step away from your books for a few minutes so you can come back and think clearly. You may need to draw yourself diagram after diagram, or talk to yourself til you figure out the pathophysiology. It will, however, benefit you in the long run to figure out why something is the way it is or does what it does, rather than have someone tell you the answer and you memorize it. Nobody's trying to antagonize you here, believe me.

Now, if you want to throw out some theories, that would be awesome for discussion.

Virgo_RN, BSN, RN · Dec 10, 2008

Agree with the others. You know a patient has had a AAA rupture when they experience sharp, tearing abdominal pain, a decreased level of consciousness, and decreased blood pressure.

However, assuming that it was caught in time, the patient rushed to surgery, and the AAA repaired, THEN what lab findings might we expect to see? Of course, we'd see the decreased H&H due to the blood loss, and what do you think the body's immune response to the presence of blood in the abdominal cavity might be?

leslie :-D · Dec 10, 2008

have you looked at http://www.labtestsonline.org yet?

if not, i suggest you do a little reading about wbc's.

you'll find your answer there.:)

leslie

MaryAnn_RN · Dec 10, 2008

The sad truth is most people with this condition do not live long enough to worry about WBCs.

Last one we had was thought to be leaking, and we were literally going out the door to theatre when it was very clear she had ruptured (massive brick hard abdomen) and she died very quickly afterwards.

ktwlpn, LPN · Dec 10, 2008

I care for have an elderly female diagnosed in the spring with an 8 cm AAA and she has refused surgery. I am not too sure that she and her family really understand what this means and every day I look at her in the am and wonder "will today will be the day" I've seen them blow while working in acute care-I know it will be fast for her.I hope the staff present at the time are supportive and not freaked out.I really hope it isn't me.

Elvish, BSN, DNP, RN, NP · Dec 10, 2008

I had a pt waaay back when I started out with a big AAA, can't remember how big. He was terminally ill with CA as well, was a DNR, and so refused to have anything done for the AAA. He was fairly emaciated, and you could see his whole abdomen pulsate. It was kind of freaky. He was a very nice man. I always prayed whichever he way he ultimately died, that it was peaceful.

leslie :-D · Dec 10, 2008

I had a pt waaay back when I started out with a big AAA, can't remember how big. He was terminally ill with CA as well, was a DNR, and so refused to have anything done for the AAA. He was fairly emaciated, and you could see his whole abdomen pulsate. It was kind of freaky. He was a very nice man. I always prayed whichever he way he ultimately died, that it was peaceful.

actually, bleeding to death is very peaceful.

think of our pts when they are profoundly hypovolemic...they go into shock.

nothing painful about a profound blleed for the pt.

i've watched many pts die this way...usually r/t an art bleed, but concept the same.

it's always harder on those watching.

leslie

twinmommy+2, ADN, BSN, MSN · Dec 10, 2008

I'm starting to think I never should have posted this question. As this is only making me more frustrated! Ughhh!

There is a response to pain that the body has that increases wbc's, you could go in that direction. A ruptured AAA is extremely painful (r/t abd pain from increased fluid in the abd, the patient writhes in bed) and I imagine if the patient lived long enough the pain could cause it to increase. Also the bodies natural clot fighting mechanisms... Look into that while you answer your question.

twinmommy+2, ADN, BSN, MSN · Dec 10, 2008

Its never enough to just answer the question correctly, you have to know the knowledge behind the correct answer to do well on the NCLEX.

Nightcrawler, BSN, RN · Dec 11, 2008

actually, bleeding to death is very peaceful.
think of our pts when they are profoundly hypovolemic...they go into shock.
nothing painful about a profound blleed for the pt.
i've watched many pts die this way...usually r/t an art bleed, but concept the same.
it's always harder on those watching.
leslie

I don't know. The one patient that I saw that died of a ruptured AAA was in a huge amount of pain and very, very anxious for the 5 or so minutes that it took for him to lose consciousness. Granted, he was out of it for the end, but I would not discount the experience leading up to that.

I was not even taking care of that patient and I will never forget him

Andrew, RN · Dec 11, 2008

Questions like this are ridiculous for a test.

PiPhi2004 · Dec 11, 2008

Questions like this are ridiculous for a test.

10000% agree with you on this one. I can't believe they don't spend time on more important things. It kind of annoys me, there are a million things to learn in nursing school and this is something they obviously want you to know? Next time I have a pt with an AAA rupture I'll say "quick, whats his WBC!" lol see how many blank stares I get.