 Hi and welcome to nursing school explained in this video on aneurysms. Now aneurysms can occur in any kind of blood vessel, but the most serious ones that we usually hear about are ones that occur either in the brain, so cerebral aneurysms or in the aorta, whether that's the thoracic or the abdominal aorta. And an aneurysm in general, what that term means, it's a permanent and localized outpouching or dilation of a blood vessel. So I've drawn out some graphs here so that you can kind of see what that means. Normally in a blood vessel, the blood flow just goes straight through as indicated in red here. When that blood vessel wall becomes, turns into an aneurysm, then there are two different forms, which is what's called a fusiform aneurysm, where the vessel wall becomes weakened and then it kind of forms this outpouching here. And then when the blood flows through, it doesn't go straight anymore. It kind of gets a little bit more turbulent here. Or the other type of aneurysm is a secular aneurysm, where the blood vessel wall kind of builds this sac-like protrusion here that then again causes the blood flow to go through and become more turbulent. What happens then, because there's so much pressure because of this turbulence, that the intima of the innermost layer of that blood vessel can become torn. And recall that there are several different layers that make an artery. And so when that gets torn, the vessel wall here becomes weaker and weaker. And then eventually this could actually burst and then the blood would basically just come out of that blood vessel, which is also called a dissection or a rupture, which of course can be life-threatening. So now that we have a better understanding of what an aneurysm really means, let's look at some risk factors. Risk factors for aneurysms include anything that's bad for your overall cardiovascular status. We have the typical suspects here, hypertension, family history, hyperlipidemia, peripheral artery disease, carotid artery disease, coronary artery disease being overweight and obese, but also it occurs in males more than in females and in white people more than any other ethnicity. In addition, people who have underlying inflammatory disorders or have suffered from infections such as HIV or STIs can be affected by those as well. And then smoking is a big one here. So people who are smokers have a much higher risk of developing aneurysms and therefore we need to always educate our patients and we'll get into that in a bit here. And then certain genetic disorders such as Marfan syndrome puts patients at higher risk for aneurysms as well. Now, signs and symptoms, often there are none. If this vessel wall just becomes a little bit weaker and the blood flow becomes turbulent, the patient might not have any symptoms and it might be detected during a routine exam. But when it becomes bigger, then many times the patient complains of certain symptoms. So then depending on where this aneurysm occurs is there are different symptoms that the patients will have. So if it's in a thoracic order, there might be chest pain that's radiating to the back because this outpouching here can create some pressure on some surrounding structures. If it's in the abdominal aorta, it can cause abdominal or back pain and the breweries. And recall that breweries are turbulent blood flow. And by just looking at these graphs here with this turbulent blood flow, this is how we can detect things. So that's why our exam is so important. And listening to our patients over the big blood vessels can give us an indication of whether or not there might be some pathology underneath. Now, in addition to the chest and the abdominal pain, patients might have signs and symptoms of angina, as well as those of a TIA, cough, shortness of breath, hoarseness or dysphasia, if it's up high in that aortic arch. Now, if it concerns a cerebral artery, the patient might have signs and symptoms of a stroke such as headache, dizziness, nausea, vomiting, altered level of consciousness, all those things that we think about with increased intracranial pressure. Now, for diagnostic tests, we can always do x-rays, CTs and MRIs with contrast to take a look at the inner lining of those blood vessels. Of course, an echocardiogram, if it's in the thoracic aorta, to check out the heart chambers and any kind of function. Certainly an EKG, if we suspect there might be something cardiac going on. And then as for blood tests, CBC and CMP, as well as troponin, because the patient might present with signs and symptoms of angina. So we kind of have to rule out NMI or acute coronary syndrome. Now, complications from this, very, very important like we discussed here, a dissection or a rupture. And this, there's a definitely an increased risk in smokers, as we said. So smokers not only have a risk factor of developing aneurysm, but they also have a higher risk of that aneurysm to rupture. And if it ruptures, then usually there's severe back pain involved. And there's also great Turner's sign. And that is that purplish discoloration that the patient will have over the flanks. And just think about it. If a major blood vessel in your torso, anywhere ruptures, you're going to be bleeding out internally. And most likely the patient is going to be in bed on a gurney. And that blood will sink down with gravity so that blood pulling, they will have this hematoma forming over their flanks, which is this great Turner sign. And then certainly because it ruptures, there is not enough intravascular volume left. So the patient will go into hypervolemic shock. And then certainly they can die from that because it happens quickly. If it's a major blood vessel that ruptures five liters of blood a minute, a pump through the circulation. And that can happen pretty quickly. And even if the patient reaches the hospital, there's a 53% mortality. So these are very, very serious conditions that the patient has and needs to be acted upon very quickly. Now the treatment for this, early detection and decreasing of the risk factors. So all these things that we discussed over here, if the patient has any of these risk factors, we certainly want to talk to them about reducing these risk factors, particularly the smoking that we know is so bad for people with aneurysms. And then certainly if there are some genetic disorders, we also need to do some counseling and educate the patient about prevention. And then early detection. And if an aneurysm is detected, and if it's small and asymptomatic, many times it can just be observed. And that pertains to the thoracic and abdominal aortic aneurysm. So if it's less than five and a half centimeters, then the treatment is usually to decrease risk factors and monitor every six months, every three months, every year with a CT scan or an ultrasound to see if it becomes any bigger. If this out pouching in diameter becomes any bigger. But if it does cross that magical barrier of these 5.5 centimeters, then the recommendation is a surgical repair. And again, that pertains to thoracic or abdominal aortic aneurysms. So, and there can be an open surgery, which is an aortic bypass graft where basically the disease or that area of out pouching is removed and the graft is inserted sewn into the upper and lower ends of this, which of course you can imagine is major surgery. Or there can be an endovascular graft, which is basically a large stent that is inserted here inside this blood vessel. And then the blood flow will go through that graft and then eventually this secular or fusiform aneurysm will just kind of like seal itself off as the body responds to having that graft. If it is a cerebral aneurysm, it can sometimes be treated with coiling, where through an angiogram, the interventional radiologists will go in and they will insert a coil in this out pouching, which then again has the same purpose. It seals that area off, decreases that turbulent blood flow and then stabilizes that blood vessel. Nursing care for patients with aneurysms. So certainly we know that prevention is key here. So identifying risk factors and educating our patients, those especially that have some of these risk factors is going to be super important. And then definitely the quitting smoking is a major, major indication here. And then pre-op teaching, if it is detected that it's big or that something needs to be done about it surgically. And then post-op care. So if we think about anybody who has had any surgery to a major blood vessel, we need to monitor the vital signs frequently to check, make sure they're not losing blood and going into hypervolemic shock. Certainly they'll need to be on a cardiac monitor because it affects the patient's cardiovascular system. We need to see and make sure that they don't develop a post-op ileus because recall that the A-order kind of sits behind all, the abdominal A-order sits behind all these abdominal organs. So they kind of have to be removed or moved out of the way to perform the surgery. So when everything gets put back into place, that can be an ileus. So many times a patient will have an NG tube that will need to manage accordingly. And then if this was a cerebral aneurysm, definitely we want to do neuro checks frequently, probably every 15 minutes initially, just like we would do with a stroke patient. But also not only if it was a cerebral aneurysm, also if it was a thoracic or an abdominal A-order aneurysm because if the brain does not get perfused, the patient might have some neuro changes in case there's some hypervolemia in process. And then also we need to check the peripheral and renal perfusions. So if you think about that, there has been surgery to that major artery, the perfusion to the lower extremities. If something went wrong during the surgery or in the post-op period, then we might see signs and symptoms of inadequate perfusion to the lower extremities, such as weak pulses, you know, color changing, pallor developing and amnescent tingling. And then also renal perfusion because remember that we need to check urine output to check how well hydrated the patient is number one and then to make sure that they're perfusing enough that they don't have hypervolemia from this major surgery that could affect their kidneys and then put them into kidney failure. Thank you so much for watching this video on aneurysms. Remember that there are, they can occur in different locations, but the most common and the most serious ones are the thoracic abdominal and cerebral aneurysms. And then please also watch my video that goes into the aortic dissection which is this complication that can occur and what can be done about that. Thanks so much for watching my video. Also check out my Instagram channel for announcements of newest videos as well as NCLIC style questions and any kind of motivational quotes that I can come up with. I usually put that there for you as well. Thanks for watching Nursing School Explained. See you soon.