Republic of the Philippines

University of Northern Philippines

Tamag, Vigan City, Ilocos Sur
College of Nursing

A CASE STUDY ON
DENGUE FEVER

In Partial Fulfillment of
the Requirements for the Course

Presented by:
GABIA, REY T.
BSN 3E

Presented to:
Marissa Ruelos, RN
Clinical Instructor

2023
I. INTRODUCTION AND OBJECTIVES

INTRODUCTION

Dengue is the foremost cause of arthropod-borne viral disease in the world and due to
severe muscle aches. It is transmitted through Aedes mosquito and commonly found in
tropical and subtropical parts of the world. The incidence of dengue has
substantially increased over the past few decades. It was estimated in a study that 3.9 billion
people are at risk of infection with dengue viruses in the world and Asia is the most affected
part. A seasonal pattern of dengue linked to climate. In Pakistan, the highest dengue cases
are reported during July-September due to more rainfall, optimum temperature, and
humid environment which are ideal for breeding of Aedes mosquitoes. Last year, the
outbreak was first reported on 8 July 2019 in Peshawar city. A total of 47,120 confirmed
cases of dengue fever, including 75 deaths, were reported during the outbreak period in the
entire country.

Dengue fever is caused by one of the four distinct serotypes (DENV 1-4) of single-
stranded RNA Flavivirus genus. Infection caused by one serotype results in lifelong
immunity to that serotype, but not to others. Dengue fever (DF) presents with high fever,
headache, rash, myalgia, and arthralgia, and case fatality is less than 1%. Severe
dengue, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) are
accompanied by thrombocytopenia, vascular leakage, and hypotension. DSS is
characterized by systemic shock, which can be fatal with case fatality high as 12% to 44%.

A case of 23 years old, female, from San Antonio, Narvacan, Ilocos Sur. Was referred
here at Metro Vigan Hospital Ward 3, 7-15-2023 at 12:15pm. Because of intermittent fever
for 10 days and neck mass (enlarged lymph nodes).

OBJECTIVES

A. General Objectives

At the end of this study, I will be able to identify the signs and symptoms of Dengue Fever and

be able to understand it’s disease process and manage the patients accordingly.

B. Specific Objectives

At the end of this case study, I will be able to

 To create a dengue technical working group;

  To develop an integrated vector control approach for prevention and control

 To develop capability on diagnosis and management;

 To intensify health education/IEC activities, and

 To operationalize an effective surveillance system and to develop a dengue

epidemic contingency plan for emergency response.

Knowledge

• To build rapport with the patient.

• To learn more about the condition.

• Using the nursing process to create nursing care plans for the patient.

• Conduct a thorough examination of dengue fever.

• To list of signs and symptoms of dengue fever.

• Provide health education to patients and family members in order to care for dengue

fever

• To become acquainted with effective interaction strategies for promoting health and

preventing illness.

STUDENT-NURSE CENTERED

The ultimate goal of treatment is to limit the progression of the AAA by modifying risk

factors like controlling blood pressure, discontinuing smoking, and lowering levels of lipids.

When the patient is admitted, the following assessments are necessary:

  Check by palpation for a pulsating mass in the abdomen, at or above the

umbilicus.

 Auscultate for a bruit over the abdominal aorta.

 Determine if there is tenderness on palpation (do not palpate too deep as there is a

risk of rupture).

 Ask if the patient has abdominal or lower back pain.

 Check blood pressure to determine if a rupture has occurred.

 Check distal leg pulses to ensure tissue perfusion.

 Strict blood pressure control if high (may need oral or IV medications).

Attitude

• Establish rapport and a positive relationship with the patient and important people.

• Encourage a positive attitude toward the patient and significant individuals.

PATIENT CENTERED

• The patient and his or her family will be informed about the condition.

• The patient and family will talk about the various relaxation methods and treatment

regimen.

• Actively participate in both nursing and medical treatment of the patient.

II. PATIENT’S PROFILE

A. Biographic Profile

Name: Schubert R. Soliven

 Age: 60

Sex: Male

Address: San Vicente, Mangsingal, Ilocos Sur.

Date of Birth: February 24, 1963

Civil Status: Married

Religion: Roman Catholic

Nationality: Filipino

Occupation: Teacher

B. Family Profile

Mother’s Name: N/A

Father’s Name: N/A

Family Type: Nuclear family

C. Medical Profile

Date of Admission: February 28, 2023

Time of Admission: 1:20am

Institution: Metrovigan Hospital

Chief Complaint: Chest pain radially to the left arm

Admission Diagnosis: Abdominal Aortic Aneurysm Intraluminal with Thrombosis

 Final Diagnosis: Abdominal Aortic Aneurysm Intraluminal with Thrombosis

Date of Discharge: February 29,2023

Time of Discharge: 1:00pm

Attending Physician: Dr, Bilgen

III. NURSING HISTORY OF PAST AND PRESENT ILLNESS

A. History of Present Illness

A 60-year-old male identified as Schubert R. Soliven was rushed to the emergency room

in ISDM-MAGSINGAL accompanied by his wife experiencing chest pain 6/10 radially to the

left arm. Patient was admitted at ISDM-MAGSINGAL then transferred in our institution for

further assessment.

B. History of Past Illness

(+) Fatty Liver

C. Physical Assessment

Vital Signs:

 Pulse Rate: 83

 BP: 130/80

 Respiratory Rate: 20

 Temperature: 36˚

General Appearance and Mental Status:

  Conscious

 Awake and Alert

Head, Hair, and Scalp:

 Head is Symmetrical and held upright and midline in the trunk

 Hair is black, fine and straight

 Normally smooth

 Absence of dandruff

Skin and Nails:

 Skin is smooth

 Normal in skin temperature

 Good skin turgor

 Free of lesions

 Nails are transparent, smooth and convex

Eyes, Nose, and Ears:

 Eyeballs are symmetrical and alignment

 Eyeballs are the same plane as eyebrows or maxilla

 Nose has no discoloration

 Nose is patent with good air flow

 The nasal mucosa is pinkish in red in color with no discharge or bleeding

 Ear canal is skin-colored and lined with small hair

 The tiny hair in the era can be seen

Mouth, Throat and Sinuses:

 Gums are pink in color with no swelling, bleeding, or pain, soft palate and uvula

 Throat is pink in color

 No swelling or lesions

 Changes of taste

 No sinus pain noted

Thorax and Lungs:

 Spinal vertically aligned

 Normal in breathing

Heart:

 Normal rhythm and pattern of heart rate

Back:

 Straight Posture

Extremities:

 Upper and lower extremities are normal.

IV. PEARSON ASSESSMENT

ASSESSMENT Hospital Date: Hospital Date:

February 28,2023 February 29, 2023

PHYSIOLOGICAL  Schubert R. Soliven 60  Patient relieved more than

years old, male, from San

 Vicente, Magsingal, Ilocos yesterday.

Sur. Born on February 24,  Patient was conscious and

1963. Was admitted active.

ISDM-MAGSINGAL,  Patient is now more

then transferred at out comfortable.

institution  Vital signs were stable.

 He was admitted on

February 28, 2023 with

complaint chest pain 6/10

radially to the left arm.

 Attending Physician: Dr.

Bilgera

 Awake and Alert

ELIMINATION  No vomiting noted.

ACTIVITY AND  Patient’s rest periods are  Patient’s rest periods are

REST sometimes interrupted by sometimes interrupted by the

the nurse for giving nurse for giving medicines

medicines from time to from time to time resulting to

time resulting to inadequate sleep hours.

inadequate sleep hours.  Patient is now less tired and

 Patient is tired and sleepy. sleepy.

 Patient seems more relaxed.

SAFETY AND  Patient has no known  No body weakness reported.

SECURITY allergies to foods and  No presence of redness and

medicines. swelling on IV insertion site.

 Body weakness reported.  VS are getting normal

 No presence of redness

and swelling on IV

insertion site.

 VS:

PR – 83 bpm

RR – 20 cpm

Temp: 36ºC

BP: 130/80

OXYGENATION  Oxygenation noted 2-  No oxygenation noted

3L/min

 Telmisartan 80mg PO, OD  Telmisartan 80mg PO, OD

NUTRITION  Metoprolol 50mg 1 tab  Metoprolol 50mg 1 tab PO,

PO, BID BID

 Atorvastatin 40mg PO,  PNSS 1Lx16hrs

OD

 Metformin 500mg PO, OD

 Nafarin 50mg 1 TAB PO

 Warfarin 2mg PO

 ISDN 5mg PO, PRN

  PNSS 1Lx16hrs

V. DIAGNOSTICS

A. Ideal Diagnostics

Abdominal aortic aneurysms are often found when a physical exam is done for

another reason or during routine medical tests, such as an ultrasound of the heart or

abdomen.

To diagnose an abdominal aortic aneurysm, a doctor will examine and review

medical and family history. If the doctor thinks that they/you may have an aortic

aneurysm, imaging tests are done to confirm the diagnosis.

Tests to diagnose an abdominal aortic aneurysm include:

 Abdominal ultrasound. This is the most common test to diagnose abdominal aortic

aneurysms. An abdominal ultrasound is a painless test that uses sound waves to show

how blood flows through the structures in the belly area, including the aorta.

- During an abdominal ultrasound, a technician gently presses an ultrasound wand

(transducer) against the belly area, moving it back and forth. The device sends signals

to a computer, which creates images.

 Abdominal CT scan. This painless test uses X-rays to create cross-sectional images of

the structures inside the belly area. It's used to create clear images of the aorta. An

abdominal CT scan can also detect the size and shape of an aneurysm.
  During a CT scan, you lie on a table that slides into a doughnut-shaped machine.

Sometimes, dye (contrast material) is given through a vein to make your blood vessels

show up more clearly on the images.

 Abdominal MRI. This imaging test uses a magnetic field and computer-generated radio

waves to create detailed images of the structures inside your belly area. Sometimes, dye

(contrast material) is given through a vein to make your blood vessels more visible.

Screening for abdominal aortic aneurysm

Being male and smoking significantly increase the risk of abdominal aortic aneurysm.

Screening recommendations vary, but in general:

 Men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening

using abdominal ultrasound.

 For men ages 65 to 75 who have never smoked, a doctor will decide on the need for an

abdominal ultrasound based on other risk factors, such as a family history of aneurysm.

There isn't enough evidence to determine whether women ages 65 to 75 who ever smoked

cigarettes or have a family history of abdominal aortic aneurysm would benefit from abdominal

aortic aneurysm screening. Ask your doctor if you need to have an ultrasound screening based on

your risk factors. Women who have never smoked generally don't need to be screened for the

condition.
VI. ANATOMY AND PHYSIOLOGY OF ORGANS INVOLVED

AORTA

The aorta is a large, cane-shaped vessel that delivers oxygen-rich blood to your body. It starts in

the lower-left part of the heart and passes through the chest and abdomen. Along the way, blood

vessels branch off the aorta, extending to organs and supporting tissue.

What is the function of the aorta?

The aorta is the main vessel through which oxygen-rich blood travels from the heart to the rest of

the body. It also delivers nutrients and hormones. The aorta’s branches ensure these substances

reach internal organs and nearby supporting tissue.

WHY IS AORTA’S FUNCTION IMPORTANT

The aorta is the primary source of oxygen and essential nutrients for many organs. If disease or

injury affects blood flow through this vessel, life-threatening complications can occur in minutes.

These include:

 Aortic aneurysm.

 Internal bleeding (hemorrhage).

 Aortic dissection.

 Kidney failure.

 Stroke.

ANATOMY OF THE AORTA

The aorta has many sections, including the:

 Aortic root: Section that attaches to the heart. This is the widest part of the aorta.

 Aortic valve: Three flaps of tissue (leaflets) that snap open and shut to release oxygen-

rich blood from the heart.

 Ascending aorta: Upward curve that occurs shortly after the aorta leaves the heart.

 Aortic arch: curved segment that gives the aorta its cane-like shape. It bridges the

ascending and descending aorta.

 Descending aorta: Long, straight segment that runs from your chest (thoracic aorta) to

your abdominal area (abdominal aorta).

AORTA’S BRANCHES

Many smaller blood vessels branch off from the aorta, including:

Ascending aortic branches

  Coronary arteries supply blood to muscle tissue in your heart.

Aortic arch branches

 Brachiocephalic trunk, which branches into the right subclavian artery (supplies the right

arm) and right carotid artery (supplies the brain and right side of the head and neck).

 Left subclavian artery supplies your left arm and the back of your brain.

 Left carotid artery supplies your brain and the left side of the head and neck.

Descending thoracic aortic branches

 Bronchial arteries supply the bronchioles, structures deep within the lungs.

 Mediastinal arteries supply the mediastinum, a space between the lungs that houses the

windpipe, esophagus and more.

 Esophageal arteries supply the esophagus, a tube that connects the throat to the top of the

stomach.

 Pericardial arteries supply the pericardium, a protective sac that lubricates the heart.

 Superior phrenic arteries supply the thoracic vertebrae, spinal cord and muscles, joints

and skin of the middle back.

Descending abdominal aortic branches

 Inferior phrenic arteries supply your diaphragm.

 Celiac trunk arteries supply organs of your gastrointestinal system, including the

stomach, liver, spleen and pancreas.

 Superior and inferior mesenteric arteries supply your intestines.

 Renal arteries supply your kidneys.

 Gonadal arteries supply ovaries in women and testes in men.

 Lumbar arteries supply the lumbar vertebrae, spinal cord, muscles, joints and skin of your

lower back.

 Median sacral arteries supply the lowest part of your spine (tailbone) and top of your

pelvis.

 Iliac arteries supply the lower extremities.

VII. PATHOPHYSIOLOGY
PATHOPHYSIOLOGY OF ABDOMINAL AORTIC ANEURYSM

Abdominal aortic aneurysm (AAA) is a serious condition that can lead to life-threatening

complications if left untreated. AAA occurs when the aorta, the main blood vessel supplying

blood to the abdomen, pelvis, and legs, becomes dilated or enlarged. This weakening of the

aortic wall can cause the vessel to bulge out, leading to a risk of rupture.

Modifiable risk factors for AAA include smoking, hypertension, atherosclerosis, obesity, and

high cholesterol. Smoking is the most significant modifiable risk factor for AAA, and it also

causes more rapid progression of the aneurysm. High blood pressure can also increase the risk of

AAA, while atherosclerosis, the buildup of plaque in the arteries, can contribute to the

development of the condition. Obesity and high cholesterol are also risk factors for the

development and progression of AAA.

Non-modifiable risk factors for AAA include age, gender, and family history. AAA is more

common in people over 60 years of age, and men are more likely to develop AAA than women.

Individuals with a family history of AAA have an increased risk of developing the condition,

suggesting a genetic component.

The exact cause of AAA is not known, but it is thought to be due to a combination of genetic and

environmental factors. The condition typically develops over time, and it progresses through

several stages.

The first stage is damage to the aortic wall, which can occur due to various reasons, such as

atherosclerosis, infection, inflammation, or trauma. The second stage is the weakening of the

aortic wall, which makes it susceptible to dilation or aneurysm formation. The third stage is

aortic dilation, where the weakened aortic wall begins to bulge out, forming an aneurysm. The

aneurysm can slowly increase in size over time, leading to the final stage, which is rupture. If the

aneurysm continues to grow and weaken, it can eventually rupture, leading to life-threatening

bleeding.

The symptoms of AAA depend on the stage of the disease. The damage to the aortic wall and

weakening of the aortic wall stages are typically asymptomatic, and individuals may not

experience any symptoms. However, as the aneurysm grows, individuals may experience

symptoms such as abdominal or back pain, pulsating sensation in the abdomen, and a feeling of

fullness or bloating. A ruptured AAA is a medical emergency and can cause severe symptoms

such as sudden, intense pain in the abdomen or back, dizziness, fainting, or shock.

In conclusion, AAA is a serious condition that can lead to life-threatening complications if left

untreated. Modifiable risk factors for AAA include smoking, hypertension, atherosclerosis,

obesity, and high cholesterol, while non-modifiable risk factors include age, gender, and family
history. The disease progresses through several stages, from damage to the aortic wall to aortic

dilation and eventually rupture. It is important to seek medical attention if you experience any

symptoms of AAA to prevent complications and improve outcomes.

VIII. MANAGEMENT

This section presents the ideal and actual medical and surgical interventions that provides

direction for the care of the patient to adequately address needs, the nursing care plans, and the

promotive and preventive management of the overall health and well-being of the patient.

A. Medical and Surgical

Small aneurysm

If you have a small abdominal Aortic aneurysm — about 1.6 inches, or 4 centimeters (cm), in

diameter or smaller — and you have no symptoms, your doctor may suggest a watch-and-

wait (observation) approach, rather than surgery. In general, surgery isn't needed for small

Aneurysms because the risk of surgery likely outweighs the risk of rupture.

If you choose this approach, your doctor will monitor your aneurysm with periodic

ultrasounds, usually every six to 12 months and encourage you to report immediately if you

start having abdominal tenderness or Back pain — potential signs of a dissection.

Medium aneurysm

A medium aneurysm measures between 1.6 and 2.1 inches (4 and 5.3 cm). It's less clear how

the risks of surgery versus waiting stack up in the case of a medium-size abdominal Aortic

aneurysm. You'll need to discuss the benefits and risks of waiting versus surgery and make a
decision with your doctor. If you choose watchful waiting, you'll need to have an ultrasound

every six to 12 months to monitor your aneurysm.

Large, fast-growing or leaking aneurysm

If you have an aneurysm that is large (larger than 2.2 inches, or 5.6 cm) or growing rapidly

(grows more than 0.5 cm in six months), you'll probably need surgery. In addition, a leaking,

tender or painful aneurysm requires treatment. There are two types of surgery for abdominal

Aortic aneurysms.

Open-abdominal surgery to repair an abdominal Aortic aneurysm involves removing the

damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into

place, through an open-abdominal approach. With this type of surgery, it will likely take you

a month or more to fully recover.

Endovascular surgery is a less invasive procedure sometimes used to repair an aneurysm.

Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an

artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a

metal mesh support — is placed at the site of the aneurysm and fastened in place with small

hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the

aneurysm.

Recovery time for people who have endovascular surgery is shorter than for people who have

open-abdominal surgery. However, follow-up appointments are more frequent because

 endovascular grafts can leak. Follow-up ultrasounds are generally done every six months for

the first year, and then once a year after that. Long-term survival rates are similar for both

endovascular surgery and open surgery.

The options for treatment of your aneurysm will depend on a variety of factors, including

location of the aneurysm, your age, kidney function and other conditions that may increase

your risk of surgery or endovascular repair.

 NURSING CARE PLAN

ASSESSME NURSIN PLANNING INTERVENTI RATIONAL EVALUATI

NT G ON E ON
DIAGNO
SIS
SUBJECTIV Anxiety INDEPENDE  Provide a  A quiet INDEPENDE
E CUES: related to NT quiet, environm NT
“nasakit iti fear of After 8 hours private ent can After 8 hours
barukong ko” death of nursing place for reduce of nursing
as verbalized evidence intervention, significant anxiety intervention,
by the patient by request the patient others to  Anxiety the patient
with a scale to have will be able wait. may was able to
of 6-10 family at to:  Reduce escalate  Verbalize
OBJECTIVE the bedside  Verbalize unnecessar with an the
CUES: all the time strategist y external excessive strategies
 Pains to reduce stimuli conversat to reduce
 Headache his  Explain all ion, his
V/S: anxiety procedures noise, and anxiety
 BP: level as equipmen level
130/80  Will appropriate, t around  the client
(pre- demonstra using the client will
hypertensi te a simple,  The demonstr
on) positive concrete informati ate a
coping words. on helps positive
method allay coping
anxiety. method.
 Client
who are
anxious
may not
be able to
comprehe
nd
anything
more than
simple,
clear,
brief
instructio
ns
ASSESSME NURSIN PLANNING INTERVENTI RATIONAL EVALUATI
NT G ON E ON
DIAGNO
SIS
SUBJECTIV Risk for DEPENDEN  If decreased  Rapid, DEPENDEN
E CUES: decreased T cardiac efficient T
“nasakit iti cardiac After 8 hours output is interventi After 8 hours
barukong ko” output of nursing related to on is of nursing
as verbalized related to intervention, further critical to intervention,
by the patient rupture of the patient dissection preserve the patient
with a scale the aorta will be able (severe circulatio was able to
of 6-10 no to: aortic n and life  The client
OBJECTIVE evidenced,  The client insufficienc maintains
CUES: a risk maintains y) or adequate
 Pains diagnosis adequate ruptured cardiac
 Headache is not cardiac aorta, output, as
V/S: evidenced output, as anticipate evidenced
 BP: by sing evidenced emergency by HR of
130/80 and by HR of angiograph 83 beats
(pre- symptoms, 60-100 y and per
hypertensi as the beats per surgery. minute,
on) problem minute,  Administer  These 120/80BP
has not normotens medications maintain palpable
occurred ive BP, , adequate pulse,
and palpable intravenous cardiac clear lung
nursing pulse, fluids, and output sounds,
interventio clear lung blood as before urine
n are sounds, ordered. surgical output pf
directed at urine interventi more than
prevention. output pf on. 30ml/hr
more than and
40ml/hr  Stay with
and the client.  The
normal presence
level of of
conscious competen
ness t, calm
staff may
provide
emotional
support
and
reduce
 Prepare the fear.
client for
surgical  The
repair. informati
on helps
to allay
anxiety.
Clients
who are
anxious
may not
be able to
comprehe
nd
anything
more than
simple,
brief
instructio
ns and
 If decreased explanati
cardiac ons.
output is
drug  Beta-
induced, blockers
anticipate have a
the negative
following: inotropic
- For beta- effect,
blocker: which
May stop can
the drug or potentiate
reduce the heart
dose. failure.
- For The
vasodilators
 : Stop the presence
drug and of
administer crackles
isotonic and S3
solution indicates
(0.9% heart
normal failure.
saline
solution) or  Fluids are
plasma usually
expanders. required
to
maintain
increased
intravasc
ular
volume.

IX. DRUG STUDY

Generic, Dose, Mechani Indication Contraind Adverse Nursing
Brand Frequenc sm of ication Effects Responsib
and y, Route, Action ility
Classific Duration
ation of
Administ
ration
Generic: 80mg PO Telmisart Telmisartan is - dehydr - Changes  Monito
Telmisar OD an blocks used alone or ation in vision. r BP
tan the in combination - high - dizziness carefull
Brand: vasoconst with other levels , y after
Micardis rictor and medications to of lighthead initial
Classific aldostero treat high potassi edness, dose;
ation: ne- blood pressure. um in or and
angioten secreting Telmisartan is the fainting. periodi
sin II effects of also used to blood - fast cally
receptor angiotens decrease the - renal heartbeat thereaft
blockers in II by chance of heart artery . er.
(ARBs). selectivel attack, stroke, stenosis - large Monito
Used in y or death in - low hives. r more
the blocking people 55 blood - painful frequen
treatmen the years of age or pressur urination tly with
t of binding older who are e or preexis
cardiova of at high risk for - liver changes ting
scular angiotens cardiovascular proble in biliary
disease. in II to disease. ms urinary obstruc
the AT1 - blockag frequenc tive
receptor e of a y. disorde
in many bile - swelling rs or
tissues, duct in the hepatic
such as - decreas hands, insuffic
vascular ed lower iency.
smooth kidney legs, and  Monito
muscle functio feet r
and the n dialysis
adrenal - pregna patients
gland. ncy closely
- decreas for
ed orthost
blood atic
volume hypote
nsion.
 Lab
tests:
Periodi
c Hgb,
creatini
ne
clearan
ce,
liver
enzyme
s.
 Monito
r
conco
mitant
digoxin
levels
through
out
therapy
.
Generic: 50mg PO Metoprol Metoprolol is Metoprolol  Headach 1. Ensure
Metoprol BID ol is a indicated for is es. Make that the
ol cardio the treatment contraindic sure you patient is
Brand: selective of angina, ated in rest and taking the
Lopresso beta-1- heart failure, patients drink medication
r adrenergi myocardial with severe plenty of as
Classific c receptor infarction, bradycardi fluids. ... prescribed,
ation: inhibitor atrial a, sick  Feeling at the
beta that fibrillation, sinus tired, correct
blockers, competiti atrial flutter syndrome, dizzy or dose and
it works vely and second- or weak. If frequency,
by blocks hypertension. third- metoprol and report
relaxing beta1- Some off-label degree AV ol makes any
blood receptors uses of block, you feel discrepanci
vessels with metoprolol cardiogenic dizzy or es to the
to minimal include shock, weak, healthcare
slowing or no supraventricula decompens stop provider.
heart effects on r tachycardia ated heart what Before
rate to beta-2 and thyroid failure, and you're administeri
improve receptors storm. All the sick sinus doing, ng
blood at oral indications of syndrome and sit or intravenou
flow and doses of metoprolol are unless a lie down sly, have a
decrease less than part of functioning until you second
blood 100 mg cardiovascular pacemaker feel practitioner
pressure in adults. diseases. is present. better. ... independen
It  Cold tly check
decreases hands or the original
cardiac feet. ... order and
output by  Feeling dose
negative sick calculation
inotropic (nausea) s.
and ...
chronotro  Stomach 2. Check
pic pain. the label of
effects. the
medication
.
Do not
confuse
Toprol-XL
(metoprolo
l) with
Topamax
(topiramate
). Do not
confuse
Lopressor
with
Lyrica. Do
not
 confuse
metoprolol
tartrate
with
metoprolol
succinate.

3. Promote
physical
activity.
Encourage
the patient
to engage
in
moderate
physical
activity, as
tolerated,
to maintain
or improve
physical
function.

4. Take
apical
pulse
before
administeri
ng.
If <50 bpm
or if
arrhythmia
occurs,
withhold
medication
and notify
healthcare
professiona
l.
Generic: 40mg PO Atorvasta Atorvastatin is Atorvastati  Feeling  Assess
Atorvast OD tin indicated for n sick for
atin competiti the treatment contraindic (nausea) allergie
Brand: vely of several ations or s to
Lipitor inhibits types of include indigesti HMG-
Classific 3- dyslipidemias, patients on. Stick CoA
ation: hydroxy- including with to simple reducta
HMG- 3- primary hypersensit
CoA methylgl hyperlipidemia ivity to any meals se
reductas utaryl- and mixed of its and do inhibito
e coenzym dyslipidemia component not eat rs
inhibitor eA in adults, s. Female rich or  Obtain
s (HMG- hypertriglyceri patients spicy baselin
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X. DISCHARGE PLAN

Activity

 Gradually increase your activity. Start by walking short distances 2-3 times per day,

increasing the length of time as tolerated. Avoid exercising in extreme temperatures.

 No twisting, bending, straining or strenuous activity for 6 weeks after your surgery. Do

NOT lift anything over 5 pounds (a half gallon of milk) Examples of activities to avoid:

swinging a golf club, vacuuming, and gardening).

 Do not drive for 2 weeks after surgery or while taking prescription pain medications. You

may

ride in a car.

 Avoid sitting or standing for long periods. Get up and move around every 2 hours. When

sitting

in a chair pump your calves, or make circles with your toes. When sitting in a chair elevate your

legs above the level of your heart.

 You will take home an incentive spirometry device from the hospital. Keep it near you at

home

and use it 5-6 times per day for the first 2 weeks after surgery.
 If you smoke, please quit. Smoking increases your risk of developing heart disease, carotid

artery

disease, lung cancer, and worsens peripheral artery disease. It can also delay wound healing.

Diet/Eating

 Resume the diet you were on prior to surgery unless otherwise instructed by your physician.

 You may want to eat 5-6 small meals a day instead of 3 larger ones. Do not be surprised if

you have a decreased appetite or food has no taste for a few weeks after surgery. Your ability

to taste will return and your appetite will generally increase as your activity increases. If your

appetite is reduced and you are not getting enough calories a day, you can try some Ensure

which can be bought at most grocery stores. (If you are diabetic, Glucerna instead of Ensure

should be used).

 You will likely experience gas pains after your surgery. Walking and increasing your activity

is the most effective way you can help relieve this discomfort. If constipation occurs refer to

the medication section for instructions.

 For most people a low saturated fat and cholesterol diet which is high in fruits, vegetables,

and whole grains are a good healthy diet unless you are otherwise directed by your physician.

Incision

 Shower daily. Do NOT take a tub bath, use a whirlpool or swim until the incision is

completely healed. For most people this will be at least 4 weeks after the surgery.

 Keep the incision clean and dry. It can be gently washed with soap and water. Do NOT scrub

the incision. Pat dry with a clean towel. Dry the incision first then the rest of your body. Use

a clean towel daily.

 Your incision will take several months to heal completely. It will feel raised and thickened

along the incision line which will slowly decrease over time. It will take several weeks for

this to resolve. Do not apply lotions, ointments, creams or bandages on the incision.

 During the first week you may notice some slight bloody drainage from the incision line. If

this happens apply dry gauze to that area using a small amount of tape if needed to secure it.

 If you have incisions in the groin area, make sure these are kept clean and dry. Use dry gauze

in skin folds if needed. Change as often as needed to keep the incisions dry.

 Coughing or sneezing is difficult after an abdominal surgery. Keep a pillow close at hand to

help splint the abdomen when needed. Coughing is good and helps clear the lungs of

mucous.

 Your incision will likely have staples. These are generally removed at the first post-operative

visit.

Medications

You have been prescribed

Aspirin 81 mg daily

Plavix 75 mg daily

Coumadin

It is VERY important that you take these medications as directed.

 You will be given a prescription for pain medication. Take it as directed. Do not use alcohol

with prescription pain medications. If you are having mild pain you can use over the counter

Acetaminophen (Tylenol). Take it as directed on the package. Use the prescription

 medication for moderate pain. Do not take Tylenol at the same time as prescription pain

medication.

 One of the side effects of narcotic pain medications is constipation and nausea. Most people

will have nausea if it is taken on an empty stomach. Eat a small snack with pain medication

to avoid this side effect. Drinking plenty of fluid and eating high fiber foods (fruits,

vegetables and whole grains) can help prevent constipation. If needed you can take Docusate

Sodium (Colace) 100 mg, a stool softener, once or twice a day. This can be purchased at

most drug stores. A laxative may be needed if the constipation continues. Generally, an over

the counter laxative, like Dulcolax tablets, will be recommended (take it as directed on the

packaging). If you take one dose of this laxative and your constipation is not relieved, call

your nurse practitioner or physician assistant for further instructions.

 An updated medication list will be given to you before you leave the hospital. New

prescriptions will be provided to you and education regarding new medications provided.

Please take the time to read this information. It is important for you to have a good

understanding of what medications you are taking. Call Your Surgeon for Any of These

Symptoms

 Leg swelling does not improve with frequent elevation above the level of the heart.

(Reminder: Lower leg and foot swelling is common after this procedure. If this happens

elevate your legs when you are reclining above the level of your heart. The swelling may last

for several weeks.

 Your leg becomes cold, painful or numb.

 There is bleeding at the incision that does not stop when pressure is applied.

 The incision has increasing pain, redness, swelling or draining pus.

 Leaking of fluid from the incision.

 Increasing abdominal (belly) pain, unable to pass gas, nausea or vomiting.

 You have chest pain or shortness of breath.

 You have chills or a fever over 101 degrees F.

Reducing your risk

 All patients with vascular disease should take important steps to prevent worsening of their

condition or development of new disease. It is very important that if you smoke, you quit.

Adequate management of high cholesterol, high blood pressure, and diabetes, along with

maintaining a normal weight is encouraged to all of our patients. This is one of the reasons

why routine follow-up with your primary care physician is very important to your continued

health and well-being.

Follow-up Appointment

 A follow-up appointment will be made for you prior to leaving the hospital. It will be 2-3

weeks after your surgery. It is extremely important that you make it to this appointment for

evaluation and recommendations for follow-up. Additionally, you need to make an

appointment to see your primary care physician within 1-2 weeks of being discharged from

the hospital.

Returning to Work

 Returning to work is generally discussed at the follow-up visit. If you have a desk job you

may be able to return to work in 4-6 weeks, as long as you can move around frequently. If

you have a job that requires physical labor you may be off work for about 12 weeks.
References

https://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/diagnosis-treatment/drc-

20350693#:~:text=Abdominal%20ultrasound.,belly%20area%2C%20including%20the%20aorta.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions/

https://www.thoughtco.com/spleen-anatomy-373248

https://nurseslabs.com/aortic-aneurysm-nursing-care-plan/3/

https://navicenthealth.org/js/tinymce/plugins/filemanager/files/macon-cardiovascular-institute/pdfs/

MCVI-DI-Open-AAA.pdf