22.18
动脉瘤 IV：护理管理
对于接受主动脉手术的患者，密切监测动脉瘤破裂情况至关重要。
术前护理管理
持续监测患者是否出现动脉瘤破裂的症状，如面色苍白、虚弱、心动过速、低血压、腹部、背部、腹股沟或脐周疼痛、意识变化及腹部搏动性肿块。定期评估患者的外周脉搏。
指导患者在手术前一天摄入清流质饮食，并给予处方口服泻药及灌肠。术前一天…
接受血管内手术患者的术前护理包括定期评估患者的外周脉搏，并监测动脉瘤破裂的征象，如心动过速、低血压、腹腔、腹股沟、背部或脐周区域疼痛，以及搏动性腹部包块。
指导患者在手术前一天进食流质饮食，并于手术前一晚午夜后禁食禁水。
根据医嘱在手术前一天给予口服泻药或灌肠，并使用抗菌剂进行皮肤清洁。
提供处方药物，例如抗生素。
术后护理管理中，应将患者置于仰卧位6小时，以减少对动脉穿刺部位的压力。
在最初几小时内，每15分钟监测一次生命体征，并进行外周脉搏的多普勒评估。
评估穿刺部位是否有出血、血肿以及形状不规则的发绀区域。
此外，根据医嘱给予氧气、静脉输液、血液制品和药物。
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Q1: What are the key signs of aneurysm rupture that nurses should monitor before surgery?
Nurses must continuously monitor for clinical manifestations and diagnostic indicators of rupture, including tachycardia, hypotension, pallor, weakness, abdominal or back pain, changes in consciousness, and a pulsating abdominal mass. Regular assessment of peripheral pulses is essential. Immediate reporting of these signs enables rapid intervention and prevents life-threatening complications.
Q2: How should patients be prepared the day before endovascular aneurysm surgery?
Preoperative preparation includes instructing patients to consume a clear liquid diet and remain NPO after midnight. Administer prescribed oral laxatives or enemas and perform skin cleansing with antimicrobial agents. Provide prescribed medications, including intravenous antibiotics. These measures reduce infection risk, prevent aspiration, and ensure optimal surgical conditions.
Q3: Why is patient positioning critical during the immediate postoperative period after aneurysm repair?
Positioning the patient supine for 6 hours reduces pressure on the arterial puncture site, typically the femoral artery, preventing bleeding and hematoma formation. After 2 hours, the head of the bed may be elevated up to 45 degrees. This positioning strategy protects the access site while maintaining hemodynamic stability during early recovery.
Q4: What postoperative assessments should nurses perform on peripheral pulses and access sites?
Nurses perform Doppler assessments of peripheral pulses every 15 minutes initially, assessing femoral, posterior tibial, popliteal, and dorsalis pedis pulses for descending aorta surgeries. Continuously monitor the access site for bleeding, hematoma, and irregularly shaped cyanotic areas indicating embolization. Report any changes in pulse quality, vital signs, swelling, pain, or pulsation immediately.
Q5: How do nurses monitor for postimplantation syndrome after aneurysm repair?
Postimplantation syndrome presents with spontaneous fever, leukocytosis, and transient thrombocytopenia. Nurses monitor laboratory results for elevated white blood cell counts and assess vital signs regularly. Understanding these expected inflammatory responses helps distinguish normal postoperative reactions from infection, guiding appropriate clinical decision-making and patient management.
Q6: What fluid and medication management strategies support postoperative aneurysm repair recovery?
Administer IV fluids, electrolytes, and blood components as ordered to maintain adequate blood flow. Monitor central venous pressure and urine output hourly to assess hydration and perfusion status. Provide prescribed diuretics, antihypertensive agents, analgesics, and antidysrhythmics. Maintain continuous ECG monitoring and oxygen therapy to enhance myocardial oxygen supply and prevent complications.
Q7: How should nurses manage nasogastric tubes and promote bowel function after aneurysm surgery?
Connect the NG tube to low, intermittent suction to decompress the stomach, prevent aspiration, and reduce pressure on suture lines. Record the amount and character of NG output. Assess bowel sounds every 4 hours and encourage early ambulation to restore bowel function. Six hours postoperatively, patients may roll side to side and ambulate with assistance.