quick AAA question

Daytonite, BSN, RN · Mar 29, 2009

let me demonstrate how you can use the nursing process, which is our tool for solving problems, to help you solve your problem (explain why this patient's belly was very firm).

step #1 - assessment - learn as much as you can about what is going on. read about aaa's. this page in the merck manual does that http://www.merck.com/mmpe/sec07/ch079/ch079b.html. this website has a nice anatomic drawing of a aaa that shows you its location in the human body: http://www.drugs.com/cg/abdominal-aortic-aneurysm-repair-precare.html. now for some physiology. . .something that happens is that the surgeon must touch and move some of the intestines to get to the site of the aneurysm to repair it. peristalsis is a constant muscular activity that occurs all along the gi track that is responsible for keeping things moving along. in fact, the moment a human hand touches intestines, all peristalsis halts. it takes days for it to restart. for that reason, one of the complications of all abdominal surgeries is ileus. when peristalsis stops nasty things start to happen in the intestinal track. gas and fluids start to collect and have no where to go and just sit around. the longer the peristalsis lasts the worse the symptoms get. the abdomen can start to become distended. it is why patients are kept npo after surgery and why we assess them for return of abdominal sounds and ask if they are passing any flatus. we want to know if things have gotten moving yet. see and read about ileus and its signs and symptoms here: http://www.merck.com/mmpe/sec02/ch011/ch011g.html. abdominal distension because of gas or fluid collection in the intestines temporarily not moving things along is because of an ileus. now, lets talk a bit about tissue trauma. . .when a surgeon cuts into any tissues of the body, he is creating trauma and cutting through skin barriers designed to protect the body from invasion by microbes, right? how does the body respond to this? by immediately calling protective responses into play. we're talking about the inflammatory response. mast cells in the immediate area of the tissue trauma, and where ever the surgeon has put his instruments and hands is an area of tissue trauma rupture, release histamine which begin this response. see https://allnurses.com/general-nursing-student/histamine-effect-244836.html for a more detailed explanation, but each step of this inflammatory process produces the following cardinal signs: redness, heat, swelling and pain. if a microbe happens to enter into the process an infection results along with it which is why prophylactic antibiotics are given moments before the surgeon made his first incision into this patient (check the surgical record and you will find this was done) as well as afterward. however, the inflammatory response is something the body is going to engage in and really can't be stopped. the inflammatory response will contribute to some of the patient's abdominal firmness along with the ileus.
step #2 - problem determination - why does this patient have such a firm belly? after some review of principles of anatomy and physiology, can you answer that question now? it is because of the complication of surgical ileus and to some extent tissue swelling from inflammation. now, you should be able to completely explain this to your instructor.

sleepy1010 · Mar 29, 2009

Thank you so much!