 What comes to nursing school explain in this video on aortic dissection? Before we dive into it, remember that the aorta consists of two different parts which are the ascending and the descending aorta. And if you think about the heart being in the middle of your chest, the ascending order is anything that goes up from the heart and then the descending is the one that goes down. So the ascending order is where that aortic arch is located where the blood vessels then branch off into the brain as well as the upper extremities. And then the descending is anything thereafter whether it's an atheracic or in the abdominal area. And so if we look at this, 67% of aortic dissections occur in the ascending aorta which makes them acute because symptoms usually last less than 14 days. And so the 3% are in the descending aorta and they can be chronic which means greater than 90 days. Now neither one is good but of course the acute has more risk for rupturing than the the chronic one or the descending one. And so what really happens here, there is a tear of the blood vessel between the layers of the intima and the media layer. And remember that every artery has three layers which is the innermost, the intima, then the media, and then the external. So there's these three layers that allow for the elastic recoil and also kind of protect the blood from flowing through by these three different layers kind of holding the whole blood vessel together and then allowing for expansion as the blood pressure fluctuates. So risk factors for developing this aortic dissection, this tear between these two layers is just a degeneration of vessels over time. History of chronic hypertension where that pressure is constantly elevated that eventually it kind of peels apart the between the innermost and the media layer here. And then males are more affected than females and typically in the 60s and 70s is when this occurs. But it can also happen in patients less than 40 years old and those that have Marfan syndrome which is a connective tissue disorder that puts patients at higher risk for this aortic dissection. Any kind of inflammatory disorders as well as atherosclerosis put the patients at risk for aortic dissection. And then certainly if there's a traumatic injury let's say a motor vehicle accident where the seatbelt goes off and there can be so much pressure on the chest or even the abdominal area that that innermost layer of the blood vessel just ruptures. Smoking is a big big risk factor here as well as cocaine and methamphetamine abuse. Patients with congenital heart disorders especially that those that concern the heart valves are at higher risk. If there's a family history as well as pregnancy puts patients at higher risk for developing aortic dissections. And so these risk factors just always tell us that when the patient presents with certain signs and symptoms and if any of these risk factors apply then we have to really think about could this be an aortic dissection. So signs and symptoms will be excruciating chest pain if it's in the ascending order in this aortic arch area or if it's in a descending order it'd be more like abdominal back and leg pain as things start to kind of open up on the on the insides here as the this artery starts to peel open from the inside. And the patients generally describe this as ripping, tearing and stabbing. So these are some major major words that the patients can use here for describing this which is why our PQRST pain assessment is so important while we ask them about the characteristics of this chest pain and literally the patient can feel the the the blood vessel they order ripping and tearing open from the inside. And as that happens the patient will lose their blood pressure as the blood volume drops and that will increase their heart rate with the response of the sympathetic nervous system. And if it is that the section occurs in the aortic arch in this upper chest area remember we said the first branches feed the brain as well as the upper extremities the patient can have neural symptoms because now the blood flow to the brain is limited so they might feel dizzy they might have a syncopated event they might have headaches or present with altered level of consciousness. So as you all can already see these patients are probably going to be very very sick and complications that can occur from aortic dissection is a cardiac tamponade where now the blood kind of flows back and fills up the pericardium the sac that surrounds the heart and then puts pressure on the heart where the heart is tamponadoid cannot expand and contract like it usually does. And signs and symptoms here would be a decrease blood pressure because the heart muscle cannot expand there will be a narrowed pulse pressure that might be some JVD as that blood is starting to back up the patient might have muffled heart sound as well as a pulses paradoxes. Now if the these layers continue to peel off that whole blood vessel may rupture and then the patient will hemorrhage and this can quickly lead to death because there's high pressure here in the order because it's the main blood vessel and if it ruptures the patient will will bleed out very quickly unfortunately. So treatment for aortic dissection is to decrease the risk factors and educate our patients about all these things that we talked about here so if there are chronic smoke or a drug abuser we need to inform them that this is a high likelihood that they might develop something like this as well as with atherosclerosis and chronic hypertension. These are some very easy targets for our education I want to say because these are certainly patients that we encounter almost on a daily basis and hopefully by educating them we can reduce the risk of developing this serious condition. And then the treatment is an endovascular repair where they go in and through the inside endovascular of the blood vessel repair this with a graft where basically the graft replaces the different layers of the blood vessel. If the dissection is in the ascending order this is definitely a surgical emergency because it is the location where the blood just leaves the heart and there is a 50% mortality if the patient comes to the hospital within 48 hours of symptom onset. So again very very serious here. Nursing care so these patients are critically ill because they come in something is going on with the major blood vessel in their body so their perfusion might be altered and we need to make sure that we keep the blood pressure up as these these dissection starts to expand. And so we need to manage the blood pressure and heart rate with crystallites maybe blood products and maybe even vasoactive drugs to perfuse the organs so that we can keep their kidneys their brain and all their other organs alive and then many times the patient will be intubated so we'll also have to manage that as well as the ventilator of course in collaboration with our respiratory therapists. Certainly we'll might need to manage these IV vasoactive medications to maintain the blood pressure and heart rate frequent vital signs this might be somebody that you have an arterial line or at least check the blood pressure every five minutes if that is not the case yet. They need to be on a cardiac monitor and then we need to check their perfusion because their major blood vessel is impaired so we need to make sure do they get enough perfusion to the periphery to their kidneys as well as their brain. So we'll check the five P's check the extremities for pallor check their pulses as well as for the Reno condition check in hourly urine output as well as their eyes and nose and then cerebral perfusion with neural checks to see if they are perfusing and maybe if they are having an aortic arch dissection these this will be very evident in these neural checks. So thank you very much for watching this video on aortic dissection I also have a different video that goes into explaining aneurysms which are similar but different so I encourage you to go ahead and look at that video also. 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