A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?
A. The patient will be admitted to the medicine unit for observation and medication.
B. The patient will be admitted to the day surgery unit for sclerotherapy.
C. The patient will be admitted to the surgical unit and resection will be scheduled.
D. The patient will be discharged home to follow-up with his cardiologist in 24 hours.
Correct Answer: C. The patient will be admitted to the surgical unit and resection will be scheduled.
A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. Abdominal aortic aneurysm (AAA) is a life-threatening condition which requires monitoring or treatment depending upon the size of the aneurysm and/or symptomatology. AAA may be detected incidentally or at the time of rupture. An arterial aneurysm is defined as a permanent localized dilatation of the vessel at least 150% compared to a relative normal adjacent diameter of that artery
Option A: The patient should be admitted but not in the medicine unit. Rupture of an abdominal aortic aneurysm is life-threatening. These patients may present in shock often with diffuse abdominal pain and distension. However, the presentation of patients with this type of ruptured aneurysm can vary from subtle to quite dramatic. Most patients with a ruptured abdominal aortic aneurysm die before hospital arrival.
Option B: The patient should undergo resection instead of sclerotherapy. Open surgical repair via transabdominal or retroperitoneal approach has been the gold standard. Endovascular repair from a femoral arterial approach is now applied for a majority of repairs, especially in older and higher risk patients. Endovascular therapy is recommended in patients who are not candidates for open surgery. This includes patients with severe heart disease, and/or other comorbidities that preclude open repair.
Option D: The patient should not be discharged because the aneurysm may rupture. A ruptured abdominal aortic aneurysm warrants emergency repair. Endovascular approach for ruptured AAA has demonstrated superior results and survival compared to open repair if the anatomy is suitable, but the mortality rates remain high. The risk of surgery is influenced by the age of the patient, the presence of renal failure, and the status of the cardiopulmonary system.