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]
| Body System | Description |
|---|---|
| Cardiovascular | – Pulsatile mass located over the affected artery
– Murmurs over affected artery – Hypotension – Syncope |
| Neurological | – Severe headache
– Visual disturbances – Weakness, numbness, paralysis, or slurred speech |
| Respiratory | – Dyspnea
– Cough |
| Gastrointestinal | – Abdominal tenderness
– Abdominal pain: deep, tearing, constant – Abdominal bruit or pulsatile bruit – Hematemesis (vomiting blood) or melena (dark, tarry stools) – Abdominal distension – Palpable mass |
| Musculoskeletal | – Back pain (dull, aching back pain in the lumbar region for abdominal aneurysms)
– Flank pain (pain in the flank or lower back for thoracic aneurysms) |
| Integumentary | – Cool, pale extremities
– Cyanosis – Pallor – Diaphoresis |
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 Diagnoses
Nursing diagnoses for aneurysm focus on minimizing the risk of complications. Co