LESSON PLAN ON ANEURYSM

SUBMITTED TO: SUBMITTED BY:

Miss Ranjita Beura Miss Barsha rani Behera

Clinical instructor MSc Nursing1st year

MSc in Medical Surgical Nursing

SUBMITTED ON:_____/____/________
SUBJECT MEDICAL SURGICAL NURSING

UNIT

TOPIC Aneurysm

GROUP Post Basic 1st year

STRENGTH 60
VENUE Post Basic 1st year

DATE & TIME

TEACHING METHOD Lecture-cum-discussion

AV AIDS Poster, Flash Card, Flannel, BB cloth, Black board
PREVIOUS KNOWLEDGE OF The student have some knowledge regarding Aneurysm.
THE GROUP
GENERAL OBJECTIVE At the end of the class, the students will be able to know about types, classifications, etiology, risk factors, clinical
manifestation, diagnostic evaluation and management of aneurysm .
SPECIFIC OBJECTIVE At the end of this class, the student will be able to-
1. Define aneurysm.
2. Narrate the incidence of aneurysm.
3. Enumerate the etiological and risk factors of aneurysm.
4. Differentiate various types of aneurysms.
5. Describe the pathophysiology of menopause.
6. Identify the clinical Manifestation of menopause.
7. List out the diagnostic evaluation of menopause.
8. Elaborate the management protocol of aneurysm.
9. Highlight the complication of aneurysm.

1
INTRODUCTION:-

SL TIME SPECIFIC CONTENT TEACHING EVALUATION

NO OBJECTIVE LEARNING
ACTIVITY
1 2 min Define Defination- T: Defines
with the help What is the
Aneurym.
“An aneurysm is localized sac or dilation formed at a weak point in the wall of of black meaning of
artery”. aneurysm?
board.
Aneurysm are out-pouching or dilation of arterial wall and common problem
involving in aorta”. S: Listen

2 1 min Aware the Incidence- T: Narrate What is the

incidence of incidence with incidence of
aneurysm.  This occurs most frequently in man between the ages of 50-70 years of age. aneurysm?
the of black
 It is estimated to affect 10 of every 100,000 older adults.
 It occurs more in man as compare to female. board.
S: Aware and take
notes.
3 5 Enumerate the Etiology- T: Enlist the What are the
min etiological etiology with etiological
Congenital-Marfan syndrome, Turner syndrome, Menkesy factors that
factors and syndrome the help of BB
contribute
risk factors of cloth.
Mechanical(hemodynamical)-Arteriovenous fistula, amputation for
aneurysm. S: Listen aneurysm?
Traumatic-Penetrating arterial injury, blunt arterial injury carefully and
participate
Inflammatory-Takayasu disease, giant cell arteries, systemic
lupus erythematosus, Periarterial inflammation. actively

Infectious-Bacterial, spiral, Fungal

Pregnancy related degenerative-Non specific
Post arteriotomy and graft aneurysms-Infection, arterial wall

2
 failure, graft failure.

Risk Factors-
o Genetic predisposition
o Smoking
o Old age
o Tobacco use
o Alcoholism

4 3min Differentiate Classification- T:Categorizes What are the

various types by using flannel various
Based on cause- types of
of aneurysms. graph.
 True aneurysm- aneurysm?

 It is one in which the wall of the artery forms the aneurysm,

S:
which at least one vessels layer still intact.
understand
 Result of slow weaking of arterial wall caused by long term
hypertension, atherosclerosis.
 True aneurysm is further subdivided into fusiform and saccular.
 Saccular- A saccular aneurysm is pouchlike with a narrow neck
connecting the bulge to one side of arterial wall.
 Fusiform- If entire arterial segment become dilated, a fusiform
aneurysm develops. It is circumferential and relatively uniform in
shape
 False aneurysm- Also called as pseudoaneurysms caused by traumatic
break in arterial wall. It is not an aneurysm but a disruption of all arterial
wall layers with bleeding that is contained by surroundings anatomic
structure.
Based on Size-
o Saccular- A saccular aneurysm is pouchlike with a narrow neck connecting
3
 the bulge to one side of arterial wall.
o Fusiform- If entire arterial segment become dilated, a fusiform aneurysm
develops. It is circumferential and relatively uniform in shape.
o Dissecting-Haemorrhage or hematoma separating arterial wall

Based on location-

Aortic Cerebral Renal

Thoracic Abdominal
Aortic aneurysm-
One of the most common problems affecting the aorta is an aneurysm. It can occur
in kore than one location.
Abdominal aortic Aneurysm-
The most common cause of abdominal aortic aneurysm is atherosclerosis. This
condition affects men 2 to 6 times more than women. Most of these aneurysms
occur below the renal arteries.
Thoracic Aortic Aneurysm-
 Three fourth of aortic aneurysm occur in abdominal aorta.
 Most abdominal aortic occur below the renal arteries.
 An abdominal aorta larger than 3 cm in diameter is considered aneurysmal.
 Growth rates are unpredictable, but the larger the aneurysms, the greater the
risk of rupture.
Cerebral Aneurysm-
4
 It is a weakness in the wall of cerebral artery causes a localized dilation or
ballooning of the blood vessesl.
Renal aneurysm-
A renal artery aneurysm is dilated segment of renal artery that exceed twice the
diameter of renal artery.

Describe the Pathophysiology- T:Explain How

5 pathophysiolo Due to etiological factor pathophysiology pathological
with the help of change
gy of
occur in
aneurysm. poster.
menopause?

Weaking and degeneration of blood vessels wall

S: Understand
and take notes.
Hypertensive Injury may compound their denegation and
accelerate the expansion of aneurysm

As the aneurysm expands the wall tension increases

Further weaking of vessels walls

If not treated then rupture

6 8min Identify the Clinical Manifestations- T- Explain with Which are

the help of the clinical
5
clinical Thoracic aortic aneurysm handout. manifestatio
manifestation S-Identify and ns of
o Asymptomatic aneurysm?
of aneurysm. o Pain over jaw, neck, chest, upper back, left shoulder. take notes.
o Dyspnoea
o Cough
o Weakness or complete loss of voice
o Dysphagia
Abdominal aortic aneurysm-Only about 40% of patients with abdominal
aortic aneurysms have symptoms.
o Heart beating in their abdomen when lying down
Renal Aneurysm-
o Flank pain Tenderness
o Hypertension
o Haematuria
o Sign of hypovolemic shock
Cerebral aneurysm-
o Severe headache
o Nausea
o Vomiting
o Vision and speech impairment

6
7 6min List out the Diagnostic Evaluation- How to get
diagnostic T: Highlights confirm
evaluation for  History taking and physical examination about a
the different
aneurysm.  Chest X-ray patient is
diagnostic
 Computed Tomography angiography having
method
 Transoesophageal echocardiography aneurysm?
available with
 MRI
the help of
 Echo
Black board..
 Ultrasound
 Pulsatile mass in the middle and upper abdomen. (Abdominal aorta)
 Duplex ultrasonography S: Watch and
Observe

7
8 6min Elaborate the Medical Management- How a nurse
management T: Explains with can manage
Treatment is based on whether the aneurysms is symptomatic, is expanding in size is a patient
protocol of the help
caused by an iatrogenic injury., contains a dissection and involves branch vessels. with
aneurysm. Flash card
The management of Bp is very crucial in aneurysm. Prolong hypotension can cause aneurysm?
stricter of that aneurysm wall. MAP (65-75mm Hg) S: listen &
participate.
The medications are-
.
 Beta blockers-
e.g.- Atenolol, metoprolol carvedilol
 ARB blockers-
e.g.- losartan, valsartan, irbesartan.
 Occasionally antihypertensive medications
 Sodium nitroprusside-
It is the most established drug used in this.

Surgical management-
 Open aneurysm repair (OAR)-
In which the surgeon involves a large abdominal incision cut into the
diseased aortic segment, removes any thrombus or plaque, sutures a
synthetic graft to the aorta proximal and distal to the aneurysm and
sutures the aortic wall around the graft to act as protective cover
 Endovascular graft procedure-
o It is the alternative to conventional OAR. EVAR involves the
placement of a suture less aortic graft into abdominal aorta inside the
aneurysm via the femoral artery.
o The graft, a Dacron cylinder consisting of several sections, is
supported with multiple rings of flexible wire.
o The main section of the graft is bifurcated and delivered through a
femoral artery catheter.
o When all graft components are in place, they are released against the

8
 vessel wall by balloon inflammation.
o The aneurysmal wall will shrink over time because the blood is now
o being diverted through the endograft.

Nursing Management-
Subjective Data-
o Pallor
o Weakness
o Pain
o Changes in level of consciousness
Objective Data-
o History taking and physical examination
o GCS
o Monitor the patient for sign of aneurysm rupture such as diaphoresis,
tachycardia, hypotension, pain.
o Look for sign of coexisting cardiac, pulmonary, cerebral problems.

ND1- Ineffective tissue perfusion related to inadequate blood supply.

Goal- To maintain the normal tissue perfusion.
Interventions-
 Assess the vitals of the patient.
 Elevate the head of the bed.
 Monitor the saturation level of the patient.
 Administered oxygen as per prescribed by the doctor.
Evaluation- The patient will improve the tissue perfusion.
ND2-Pain related to overgrowth of artery.

9
 Goal- To reduce the level of pain.
Interventions-
 Asses the level of pain.
 Provide comfort measures to subside the pain.
 Asses for any abdominal pulsation.
 Administered medications as per prescribed by the doctor.
ND3-Anxiety related to surgical interventions.
Goal- To reduce the anxiety of the patients
Interventions-
o Provide emotional support and teaching to the patient.
o Briefly explain the disease process, planned surgical procedures, pre
operative routines and usual post operative timeline.
o Allow the patient to do spiritual needs.
o Allow the patient to express his/her feelings.
ND4- Decreased cardiac output related to occlusion of blood vessels.
Goal-To maintain the adequate cardiac output.

Interventions-
o Asses the general conditions and the vital of the patient.
o Monitor the sign of hypoxia and early sign of circulatory failure.
o Notify the physician if the severe sign of decreased cardiac output is
observed.
o Administered fluid as per prescribed by the doctor.

Highlight the Complication- T- Enlists with What are the

complications the help of complication
of aneurysm. o Aneurysm rupture occur in
S- watch and
o Incisional site hematoma aneurysm?
1
0
 o Inscinal infection aware.
o Aneurysm growth above and below the old aneurysm

SUMMERY
Concluded the revision of definition, etiology, risk factors, pathophysiology, clinical manifestation, diagnostic management management and complication of
aneurysm.
CONCLUSION
An aneurysm is a localized, abnormal, weak spot-on blood vessels wall that causes an outward budging. It can be true or false. To prevent a potential complication, it
should be treated early.

ASSIGNMENT
Define aneurysm. Describe the etio-pathophysiology of aneurysm. Write down the nursing management of client with aneurysm.

EVALUATION-
A unit test of 25 mark after the end of this unit.
BIBLIOGRAPHY
 Linton. Introduction to medical surgical Nursing. 6th edition. Elsevier. Pp-758-760.
 Lewis. Dirksen. Heitkemper. Bucher. Lewis’s medical surgical nursing. South Asia edition. Elsevier. Pp-880-882.
 K Sharma, Madhavi S. Brunner and Suddath’s Medical Surgical Nursing. South Asia edition. Wolters Kluwer. Pp-656-658.
 https://en.wikipedia.org/wiki/Aneurysm.

1
1
1
2