1-Assess the client’s anxiety level (mild, severe). Note signs and symptoms, especially nonverbal communication.

(rational)Aortic dissection and/or rupture can result in an acute life-threatening situation that will produce high levels of anxiety in the client as well as in significant others.

2-Instruct medically treated clients about the following:

• Goals of therapy (avoidance of excess BP and strain on the disease arterial wall)
• Importance of follow-up computed tomography scanning
• Signs and symptoms to report
• Side effects of the drug
• Use of antihypertensive medications as prescribed; importance of compliance.(rational) Clients treated medically need to maintain goal BP levels and comply with scheduled CT scans to monitor the size of the aneurysm. Knowledge of early warning signs facilitates rapid treatment. These may include pain in the chest, back, groin, abdomen; decreased urine output; cool, pale extremities. 3- Assess the client’s hemodynamic status. Monitor for signs of decreasing cardiac output, such as tachycardia, decreased urine output, and restlessness.(rational)A dissecting abdominal aortic aneurysm (AAA) is the most common catastrophe involving the aorta, and it has a high mortality rate if not detected early and treated with surgery. Clients with decreasing or rupturing aneurysm are hemodynamically compromised. Early evaluation of warning signs facilitates prompt intervention. 4-If decreased cardiac output is related to further dissection (severe aortic insufficiency) or ruptured aorta, anticipate emergency angiography and surgery. (rational)Rapid, efficient intervention is critical to preserve circulation and life. Management : Surgery

Repair is generally recommended if your aneurysm is 1.9 to 2.2 inches (4.8 to 5.6 centimeters) or larger or if it's growing quickly. Also, your doctor might recommend surgery if you have symptoms such as stomach pain or you have a leaking, tender or painful aneurysm.

Depending on several factors, including location and size of the aneurysm, your age, and other conditions you have, repair options might include:

• Open abdominal surgery. This involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. Full recovery is likely to take a month or more.
• Endovascular repair. This less invasive procedure is used more often. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded into your aorta

To build on Ihab Ahmed Rzaij's answer, open abdominal repair of AAA is much more difficult of a recovery, with the abdominal incision requiring more post operative pain management than endovascular repair. Also, patients will sometimes have a post op EVD which nursing will need competency in to monitor and drain to decrease chance of post op spinal cord ischemia.

Briliant answers by Ihab Ahmed Rzaij and Sarah Watkins. To my understanding those mentioned are the key requirements for the managemnet of the AAA patient.

Estimados compañeros,

Desde mi modesta opinión como enfermera del área quirúrgica y en la actualidad enfermera comunitaria, ante una situación de posible rotura de la aorta, con independencia de la zona donde se produzca la ruptura, lo prioritario es mantener la calma y sobre todo monitorizar al paciente, disminuir su umbral de dolor y derivar de forma inmediata al centro de referencia donde se encuentre la unidad de cirugía vascular y/o cardiaca.

Disminuir el umbral de dolor producirá una sensación de calma al paciente, reducirá su nivel de ansiedad y por lo tanto su PA. Monitorizar los signos vitales, analizar su comunicación no verbal y sobre todo estar al lado del enfermo en todo momento, es anticiparse a la ruptura de la aorta, es descubrir los síntomas de alerta en el momento que se producen y cabe la posibilidad de evitar que se produzca la disección de la aorta, hecho que preservará la vida de la persona.

El reconocimiento de los signos de alerta temprana, tales como dolor en el pecho, espalda, ingle, abdomen, miembros inferiores fríos y pálidos, nos alertan para tener preparados fármacos que estabilicen el estado hemodinámico del paciente, ya que una disección de aorta es una emergencia, donde los segundos cuentan y una falta de pericia puede conducir al desastre en un minuto.

Un saludo

The management,will strictly depend upon the stage and siverity of the AAA,,,,,If a bypass or a resectioning of the blood vessels was conducted,then the nursing manage will involve,pre,intra and post operative care,while the medical management will involve prescription of analgesic,profilactic, antibiotics and some other medical classes without excluding surgical intervention

Interested

It was interesting to read the detailed response of Ihab Ahmed (nursing, medical & surgical management) and the additional points by Sara Watkins. enlightening