Dissection of the aorta occurs when the aortic wall dilates and allows blood to flow between the walls of the artery. The aortic wall has three layers. A dissection is a medical emergency that requires treatment. If the dissection tears the aorta completely open, it can cause rapid, massive bleeding that can lead to death.
Symptoms
According to "Essentials of Critical Care Nursing," patients with a dissecting aortic aneurysm will complain of sudden intense pain in the chest or back, shortness of breath and extremity weakness. Speech and visual disturbances along with a feeling of dizziness will also be experienced by the patient.
Goals in Treatment
The goal in treating a dissection is to relieve the pain and anxiety, educate the patient about the problem, surgical repair and preventing complications. Relieving pain and anxiety for the patient will help to decrease additional pressure on the artery wall.
Medication Management
According to "Current Treatment & Diagnosis Emergency Medicine," keeping a patient's blood pressure as low as possible without compromising the patient is an essential treatment to help reduce pressure on the artery. Patients will be given medications to control their blood pressure. Limiting fluids is also important in reducing arterial pressure. The patient will be given medications that will increase the amount of urine produced to help rid the body of excess fluids.
Surgical Treatment
If surgery is the necessary, a graft will be placed at the area of the weakening. The aortic wall might be also be wrapped with a graft to give additional support. After the surgery, patients will be monitored closely, usually in the intensive care unit. Keeping the patient comfortable and reducing the pain are important during the recovery period to reduce stress to the surgical site. Because the aortic is a major artery, there is a risk of bleeding. Bleeding could happen quickly and the patient could require blood transfusions and blood pressure support. Observing for any abnormal heart arrhythmias is essential during the first couple days. The patient is usually placed on a continuous heart monitor with frequent electrocardiograms.
Patient Teaching
Patient teaching is an important aspect of management for aortic dissection. The "Essentials of Critical Care" notes the importance of diet modification and smoking cessation for patients. Patients might be placed on a low-sodium diet and will require education regarding the need to reduce stress and understand activity limitations. Followup appointments that might include chest X-rays and computerized tomography scans will be necessary to monitor for any recurrence or complications. If the patient is discharged on medications, it is critical that patients follow the medication regimen until they are instructed otherwise by their physician.
References
- "Essentials of Critical Care Nursing"; McGraw Hill; 2006
- "Current Treatment & Diagnosis Emergency Medicine"; McGraw Hill; 2010
