Nursing care of abdominal aortic aneurysm

If I had a patient with an abdominal aortic aneurysm that was scheduled for a repair but suddenly had worsening abdominal pain and flank pain, would I assess vital signs first or notify the doc? I know it's an emergency, but do we ALWAYS assess first?

Other options are re-assess in 5 minutes or provide analgesic. Goal in dissecting is to keep BP low and pain controlled, right?

Another question too:

You have a hypertensive client that is obese, lives a sedentary lifestyle and smokes 1/2 pack of cigarettes a day. Which behavioral mod. would you teach to have the most immediate positive impact on blood pressure?

A. Caffeine restriction

B. Regular exercise routine

C. Smoking cessation

D. Weight reduction

What do ya think? This one is driving me crazy cause I feel like it's smoking but smoking only temporarily raises BP??

[lovingtheunloved, ASN, RN]

Always assess first. If you have no assessment, you have nothing to report to the doctor anyway.

[PedRN86]

I would have a fellow nurse page the doctor while I stayed with the patient to do their VS and physical assessment, especially if they suddenly deteriorated. Then when the doctor comes/calls back I have all my information to present to them.

I would assess vital signs first as well. You need that info for the dr.

The second question my first guess is smoking cessation because weight gain takes a while and exercise wouldn't have an immediate impact.

[Esme12, ASN, BSN, RN]

We are happy to help with homework but we will not do it for you.......What do you think and we'll go from there. It helpds me to know how you draw you conclusions so I can point you on the right direction.

This isn't homework (It's thanksgiving break for heavens sake!)--quizzing myself with NCLEX style questions and just curious to see what other's thought processes are without tainting it with the 'ivory tower' answer. But thanks to those who answered kindly--I appreciate it!

Alliloop: so did you get the answer and also its rationale? Glad if you can share :)

Oops sorry I mistyped your name

ANSWER is always hidden in the question.....so ist answer definitely will be 1 because .use nursing process....you should have something to report to docter related to sign and symptom..... and 2nd answer is cessation of smoking ..question is asking about immediate action so you can quite smoke right now........ ......

[Esme12, ASN, BSN, RN]

This isn't homework (It's thanksgiving break for heavens sake!)--quizzing myself with NCLEX style questions and just curious to see what other's thought processes are without tainting it with the 'ivory tower' answer. But thanks to those who answered kindly--I appreciate it!

Well........ it isn't impossible unheard of to have homework on thanksgiving break. I am not in the ivory tower as I have humped it at the bedside for 34 years. I am one of the members who consistently assist the student membership.....but I ALWAYS request the membership to tell me what they think first....... so I may know how to best guide them and see where they may need assistance on how to best find the right answers by using good critical thinking skills. Or figure out how they went wrong.

As per TOS/policy......

This is the place for nursing students to consult the membership to share knowledge, ideas, and experience, and to explore ways to maximize success in nursing school. Feel free to seek assistance with difficult content, care plans, interviews, papers, study questions, dosage calculations, and other academic challenges you are facing. This is NOT the forum to ask someone to do your homework for you. When asking for assistance with an assignment, please show what you have done first.

Asking for your input is not begin unkind.....it is finding your base nursing knowledge so I may best help you. I want you to become the best nurse you can be.

So....what is your take on the questions and we can go from there.......

AAA's are just about the only surgical emergency left d/t advances in medicine. Have a colleague call the doctor while you are assessing. The worsening abdominal and flank pain can mean the aneurism has ruptured and the patient can die within minutes. It is worth the wrath of the doctor/surgeon to potentially save a life!

If you have someone with a known abdominal aortic aneurysm who's going to have it surgically repaired tomorrow, and all of a sudden develops new and sudden pain, what do you think is going on? That's your first thought. Hint: It is probably not the tacos he had for lunch yesterday.

While you're considering that, you are reaching for the BP cuff (not leaving the room to go find one, for gawdsakes), assessing his belly for increase in size, calming him, and calling for someone to call the surgeon and the OR, because sure as god made little green apples this man is dissecting his aneurysm some more and may be about ready to bleed to death in five minutes right in front of you. Yeah, you want to keep him pain free and calm, but those can take second position to "alive."

[Anoetos, BSN, RN]

Per Kaplan, in NCLEX-land, if you have enough assessment information and especially if the situation is emergent, you contact the doc.

You don't assess if you have enough information. In this case, if the Dx is AA these signs would be enough for me to call the doc. (I'd probably be collecting vital signs as I did so, but there may not be time for a lab draw). In such cases, the answer to assess further is wrong.

Let us know what you find out.