5.12 Aneurysm

Overview

An aneurysm is a dilation or bulging of a blood vessel caused by weakened vessel walls. This vascular condition poses a significant threat to client health due to its potential for rupture or dissection. An aneurysm rupture is a bursting of the aneurysm that can lead to life-threatening hemorrhage. An aneurysm dissection happens when there is a tear in the inner wall of the vessel, creating a false lumen. This leads to bleeding occurring inside the wall of the artery and can also be life-threatening. Aneurysms can occur in several vessels throughout the body but are more commonly found in arteries due to the increased pressure in these vessels. Aneurysms can be caused by a variety of factors, including fatty plaque buildup in a vessel, hypertension, trauma, or infection within a vessel, which subsequently weakens the vessel tissue. Risk factors for aneurysm development include the presence of hypertension, atherosclerosis, smoking, and age.^[1],[2] See Figure 5.34^[3] for an illustration of aortic and abdominal aneurysms.

Assessment

Physical assessment findings for an aneurysm can be challenging to identify because most manifestations of an aneurysm do not occur until they reach a significant size or rupture. Many aneurysms are found incidentally when diagnostic tests are performed for other conditions. See Table 5.12 for potential clinical manifestations of an aneurysm, based on its size and location.

Table 5.12. Potential Clinical Manifestations of an Aneurysm^[4],[5] 

Diagnostic Testing

Diagnosis of an aneurysm may include these diagnostic imaging studies^[6],[7]:

• Ultrasound often is an initial helpful screening tool used to provide information about the size, shape, and location of an aneurysm.
• Computed Tomography Angiography (CTA) utilizes radiological cross-section images to provide a more detailed image of an affected vessel.
• Magnetic Resonance Angiography (MRA) may also be used to visualize aneurysms by employing a magnetic field and radio waves to create images.
• Angiography may be utilized to identify the extent of the vascular compromise.

Nursing Problems and Diagnoses

Nursing problems and diagnoses for aneurysm focus on minimizing the risk of complications. Common nursing diagnoses for clients with an aneurysm include the following48:

• Risk for Deficient Fluid Volume. Risk factor: potential hemorrhage
• Anxiety R/T serious disease process
• Readiness for Enhanced Knowledge

Outcome Identification

Outcome identification involves setting short- and long-term goals and creating expected outcome statements tailored to the client’s specific needs. These outcomes should be measurable and responsive to nursing interventions. Sample outcomes are as follows:

• The client will verbalize three symptoms of a worsening aneurysm requiring notification of the health care provider.
• The client will verbalize three methods to decrease aneurysm progression, such as stopping smoking, reducing stress, and taking medications as prescribed.

Interventions

Medical Interventions

Medical interventions for an aneurysm aim to manage the size and location of the aneurysm and may include watchful waiting and monitoring, medication therapy, and surgical management.

Watchful Waiting and Monitoring

Clients with small aneurysms may be regularly monitored with imaging studies (e.g., ultrasounds or CT scans) to track the aneurysm’s size and growth rate. Lifestyle modifications to control risk factors, such as blood pressure and smoking cessation, are often recommended.

Medication Therapy

Medications such as beta-blockers and ACE inhibitors are commonly used to control blood pressure and reduce force on the vessels that can worsen the aneurysm.

Surgical Interventions

Several types of surgeries may be performed on an aneurysm, based on its size, symptoms, and the client’s hemodynamic status.

• Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure where a stent graft is inserted into the aneurysm through small incisions in the groin or other access points. The graft reinforces the weakened artery wall and redirects blood flow, reducing pressure on the aneurysm and minimizing the risk of rupture.
• Open surgical repair occurs through an operation where the aneurysm is directly accessed, and a graft is sewn into place to replace the weakened section of the artery.
• Coiling is a minimally invasive procedure involving the insertion of tiny coils into the aneurysm through a catheter to promote clotting within the aneurysm and prevent blood flow.
• Clipping is a surgical procedure involving the placement of a small metal clip at the base of the aneurysm to block blood flow into it and prevent rupture.^[8],[9] 

Nursing Interventions

Nursing interventions for clients with aneurysms treated with watchful waiting and monitoring focus on blood pressure control with medications and lifestyle modifications, health teaching, and psychosocial support.

Blood Pressure Control

Nurses safely administer prescribed antihypertensive medications and teach clients about their purpose in reducing the risk of aneurysm enlargement. Lifestyle modifications are also encouraged for blood pressure control.

Health Teaching and Emotional Support

Nurses actively listen to the client’s concerns about an aneurysm, encourage open communication with the health care provider, and promote psychosocial support. Clear and comprehensive information about aneurysms, risk factor modification, follow-up care, and signs of complications is provided.

Evaluation

During the evaluation stage, nurses determine the effectiveness of nursing interventions for a specific client. The previously identified expected outcomes are reviewed to determine if they were met, partially met, or not met by the time frames indicated. If outcomes are not met or only partially met by the time frame indicated, the nursing care plan is revised. Evaluation should occur every time the nurse implements interventions with a client, reviews updated laboratory or diagnostic test results, or discusses the care plan with other members of the interprofessional team.