If the physician has prescribed an antihypertensive drug to control hypertension, administer the drug, as ordered, and monitor your patient’s blood pressure. During the acute phase of an aortic aneurysm, monitor the patient for rupture, which would cause him to progress into shock quickly. Assess him for rapidly declining blood pressure, changes in level of consciousness, cool and clammy skin, and decreasing urine output. Monitor his respiratory rate; it may increase to compensate for decreased circulating oxygenated blood, weakened pulses, and tachycardia.

If your patient undergoes surgery for an aortic aneurysm, focus on maintaining cardiopulmonary and renal function and graft patency postoperatively. Also, monitor him for complications of surgery, such as CVA, renal failure, MI, respiratory insufficiency, and neurologic dysfunction.

To assess cardiopulmonary status, monitor his vital signs, ECG, serum electrolyte levels, and ABG measurements. Assess all peripheral pulses and compare the pulse, warmth, and color in his arms. Monitor his central venous pressure (CVP) readings and treat him for low blood volume as needed. Perform neurologic checks every 30 to 60 minutes, assessing his level of consciousness, pupillary reaction to light, arm and leg movement, and hand grasps.

A thrombus or plaque that breaks loose from the aorta may impair renal perfusion. Hypotension also can reduce renal perfusion. So monitor your patient’s blood pressure and CVP and administer fluids and volume expanders to ensure adequate renal perfusion. Monitor his urine output. Report an output of less than 30 ml/hour for 2 consecutive hours. Also, assess his serum BUN and creatinine levels for adequate renal function.

To assess graft patency, palpate the peripheral pulses distal to the graft. Immediately report to the surgeon a decreased or absent pulse accompanied by cool, mottled skin.

Protect graft patency by preventing hypotension and hypertension. Treat hypotension, which promotes thrombosis, with I.V. fluids, volume expanders, or blood products, as prescribed. Treat hypertension, which puts stress on the graft suture lines, with the prescribed diuretic or other antihypertensive drug.

To monitor your patient for graft infection, check his temperature and WBC count every 4 hours. Observe the operative site for signs of local infection, such as redness, warmth, edema, and purulent drainage. Administer a broad-spectrum antibiotic, as ordered, and encourage coughing and deep breathing.

After surgery, your patient is at risk for paralyticileus resulting from bowel manipulation, anesthesia, pain medication, and immobility. Auscultate his abdomen for the return of bowel sounds. Monitor him for flatus and record his gastric output. Reposition him every 2 hours and encourage earlyambulation.

More Medical Tips

Before your patient undergoes surgery, explain the procedure and outline what he can expect in the ICU, including cardiac, CVP, and pulmonary pressure monitoring and LV. fluid administration. Also, tell him that he may need an arterial line, indwelling urinary catheter, and endotracheal tube.

After his surgery, explain that frequent assessment of vital signs and peripheral pulses is necessary to determine graft patency. Explain the need for early ambulation to prevent complications. Instruct him on coughing, deep breathing, and splinting the incision. Have him perform return demonstrations.

Whether your hypertensive patient had surgery or was successfully treated with drug therapy, he may be prescribed one or more anti hypertensive drugs. Before he goes home, teach him the name of any prescribed drug and its dosage and therapeutic and adverse effects. Instruct him to take his blood pressure at home, and demonstrate how to take a pulse.

Discuss the signs and symptoms of a recurring aneurysm. Stress the need for him to promptly call his physician if signs or symptoms recur.

Loop Diuretics and Digitalis Toxicity

A hypertensive patient taking a loop diuretic has an increased risk of developing electrolyte imbalances, particularly hypokalemia. If your patient also has heart failure and is taking a digitalis glycoside, such as digoxin, and a loop diuretic, he has an increased risk of developing digitalis toxicity.

Be alert for the following signs and symptoms of digitalis toxicity:

• anorexia, nausea, vomiting, diarrhea, and abdominal pain
• headache, restlessness, irritability, depression, personality changes, lethargy, confusion, disorientation, insomnia, psychosis, and seizures
• atrial or ventricular arrhythmias, heart block, accelerated junctional rhythms, and atrial tachycardia with atrioventricular block
• blurred vision, flickering lights, white borders around dark objects, and colored dots.

Also, obtain your patient’s baseline serum potassium level and monitor his serum potassium and digitalis levels. To ensure the accuracy of his serum digitalis level, obtain the sample at least 8 hours after the last dose, preferably before administering a daily oral maintenance dose.