Magazine article American Nurse Today

Patient on the Precipice: Can He Survive Aortic Dissection?

Magazine article American Nurse Today

Patient on the Precipice: Can He Survive Aortic Dissection?

Article excerpt

History and assessment hints

When Mr. Hamilton returns to his telemetry room after the CT scan, he's diaphoretic and breathing rapidly. You find him anxious, dyspneic, and complaining of severe pain in his chest and between his shoulder blades. You quickly obtain his vital signs: blood pressure (BP) 190/100 mm Hg; respiratory rate 36 breaths/minute, heart rate 120 beats/minute, and oxygen saturation 90%. You find his lungs clear and peripheral pulses strong.

Mr. Hamilton tells you his pain came on suddenly. He describes it as a tearing sensation in his chest radiating to his back. Concerned he could be experiencing an aortic dissection (AD), you immediately call the rapid response team (RRT).

On the scene

When the RRT arrives, you summarize your findings. The team administers 4 L oxygen by nasal cannula and begins infusing 0.9% normal saline solution. The physician orders a 12-lead ECG to rule out acute myocardial infarction, along with morphine 2 mg I.V. for pain and labetalol 20 mg I.V. to lower the patient's BP.

The radiology department reports Mr. Hamilton's CT scan shows an AD of the descending thoracic aorta. The RRT adds a second large-bore I.V. line, orders more blood work, and transfers the patient to the intensive care unit for aggressive BP control.

Education and follow-up

In AD, the aortic layers separate or tear longitudinally. This allows blood to flow between the layers, resulting in a dissection, or false lumen. Blood diverts from the circulation into the false lumen, causing an expanding mass that obstructs and reduces blood flow to the surrounding area and organs. Cardiac output and endorgan perfusion decrease.

Risk factors include hypertension, smoking, atherosclerosis, hyperlipidemia, and genetic disorders. Recognizing AD signs and symptoms early is crucial, as rapid progression can lead to an irreversible outcome. In about one-third of patients, aortic rupture causes death.

AD can be hard to diagnose because signs and symptoms may mimic those of other conditions, like acute coronary syndrome and stroke. Typically, patients present with sudden-onset chest or abdominal pain, which may radiate to the back; they commonly describe it as sharp, tearing, and severe. …

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