Polish up on client care

redness and oropharyngeal exudate, swollen

and tender cervical lymph glands, pain on
swallowing, a temperature of 101 to 104 F
(38.3 to 40 C), headache, and nausea to
prevent complications associated with delayed
treatment such as heart valve damage. Urge
the client to avoid people with respiratory
tract infections to prevent reinfection.
Make sure the client understands the need
to comply with prolonged antibiotic therapy
and follow-up care and the need for additional
antibiotics during dental surgery to prevent
reinfection.
Arrange for a visiting nurse to oversee
home care if necessary to promote compliance.

Teaching topics
Explanation of the disorder and treatment
plan
Medications and possible adverse effects
Watching for and reporting signs of heart
failure
Starting normal activities slowly
Taking prophylactic antibiotics during
dental surgery
Performing good dental hygiene to prevent
gingival infection

Thoracic aortic aneurysm

Thoracic aortic aneurysm is characterized
by an abnormal widening of the ascending,
transverse, or descending part of the aorta.
Aneurysm of the ascending aorta is most
common and most commonly fatal.
The aneurysm may be dissecting, a
hemorrhagic separation in the aortic wall,
usually within the medial layer; saccular, an
outpouching of the arterial wall, with a narrow
neck; or fusiform, a spindle-shaped enlargement
encompassing the entire aortic circumference.
Some aneurysms progress to serious
and, eventually, lethal complications such as
rupture of an untreated thoracic dissecting
aneurysm into the pericardium, with resulting
tamponade.

CAUSES
Atherosclerosis
Congenital disorders such as coarctation
of the aorta

313419NCLEX-RN_Chap03.indd 61

Fungal infection (infected aneurysm) of

the aortic arch and descending segments
Hypertension
Syphilis, usually of the ascending aorta
(uncommon because of antibiotics)
Trauma, usually of the descending thoracic
aorta, from an accident that shears the aorta
transversely (acceleration-deceleration
injuries)

61

For clients with

rheumatic fever, good
dental hygiene is
necessary to prevent
gingival infection.

ASSESSMENT FINDINGS
Ascending aneurysm
Bradycardia
Pain (described as severe, boring, and
ripping and extending to the neck, shoulders,
lower back, or abdomen)
Pericardial friction rub caused by a hemopericardium
Unequal intensities of the right carotid and
left radial pulses

Descending aneurysm
Pain (described as sharp and tearing, usually starting suddenly between the shoulder
blades and possibly radiating to the chest)

Transverse aneurysm
Dry cough
Dysphagia
Dyspnea
Hoarseness
Pain (described as sharp and tearing and
radiating to the shoulders)

DIAGNOSTIC TEST RESULTS

Aortography, the definitive test, shows the
lumen of the aneurysm, its size and location,
and the false lumen in a dissecting aneurysm.
Blood tests may show low Hb levels
because of blood loss from a leaking
aneurysm.
Chest X-ray shows widening of the aorta.
Computed tomography scan confirms and
locates the aneurysm and can be used to monitor its progression.
Echocardiography may help identify a dissecting aneurysm of the aortic root.
ECG helps distinguish a thoracic aneurysm from MI.
Transesophageal echocardiography
is used to measure the aneurysm in the
ascending and descending aorta.

Pain is the key

assessment finding
with thoracic aortic
aneurysm, but the
kind of pain depends
on the type of
aneurysm.

4/8/2010 7:01:52 PM