S. Esthar Rani, U. Thenmozhi, S. Jayabharathi, M. Mariyammal, M. Rajeshwari, Reena Ignatius*
Nursing Department, Kauvery Heartcity, Tamilnadu
Correspondence: Tel: 9789612707; email: reena.ignatius2011@gmail.com
Nursing Care of Patient with Thoracic Endo vascular Aortic Repair (TEVAR)
Background
The aorta is the largest artery in the body that carries blood away from your heart to the rest of your body. Although your aorta is a tough, durable workhorse, sometimes its walls can weaken and bulge in what is called an aortic aneurysm. Aneurysms often occur in the aorta which can dissect or rupture. Some aortic aneurysms burst, some don’t. Others force blood flow away from your organs and tissues, causing problems, such as heart attacks, kidney damage, stroke, and even death. There are two locations of aortic aneurysms. One, in the chest, is a thoracic aortic aneurysm. The other is in the abdomen and is called an abdominal aortic aneurysm.
Thoracic endovascular aortic repair (TEVAR) is a procedure to treat an aneurysm in the upper part of your aorta. TEVAR is a minimally invasive surgery done with a small incision through which a device called a stent graft that is used to reinforce the aneurysm. A stent graft is a metal tube covered in fabric. It helps to prevent the aneurysm from bursting.
Case Presentation
A 47-year-old male, a euglycemic and hypertensive patient, came with complaints of epigastric pain, back pain, palpitation, increased BP from the previous evening, and got admitted for further management.
On examination he was found conscious and oriented
Vitals: BP – 160/100mm Hg – Right
150/100 -Left (upper extremities)
Peripheral pulsations – Bounding at a rate of 111 bpm
Cardiac enzymes – Trop T was found to be negative.
ECG – within normal limits
ECHO – Grade I diastolic Dysfunction, Mild MR
Based on clinical suspicion, CT aortogram was done to rule out Aortic dissection.
CT Aortic Angiography – Cardiomegaly, Aneurysm of Ascending Aorta 3.6cm in AP diameter, Moderate left pleural effusion, Collapse of left Lung, Evidence of hyperdense lesion in anterior mediastinum – ? Haematoma, Organ malperfusion
Nursing Management
(a). BP was stabilized with Nitro Glycerin (NTG) infusion and anti-hypertensive medication. Nurses maintained an hourly BP chart.
(b). Routine blood investigations like CBC, LFT & RFT were sent.
(c). Nurses skilled in IV infusion and blood sampling techniques (Phlebotomy) obtained the samples with a sterile technique to prevent thrombophlebitis.
(d). Renal Function Test showed Blood Urea- 74 mg/dl, Sr.Creatinine -3 mg/dl. With evidence of decreased renal perfusion, Nephrologist opinion obtained, diagnosed with Acute Kidney Injury (AKI) & Azotemia. Rational antibiotics were started.
(e). Tagged the patient case note with NO CHEST PHYSIO mark.
(f). Fluid was restricted for the patient upto 2 litre of water/day.
(g). Nurses skilled in IV infusion and blood sampling techniques (Phlebotomy) obtained the samples with a sterile technique to prevent thrombophlebitis.
(h). In view of renal dysfunction and organ malperfusion, family was counselled on the need to undergo emergency TEVAR.
(i). After 1 cycle of Hemodialysis, Patient was taken up for TEVAR procedure.
(j). With keen observation and after applying splints for immobilization, procedure was done at the femoral site to prevent complications.
(k). Nurses gathered the opinions and advice from Anesthesiologist, Pulmonologist, Nephrologist and implemented for the patient.
(l). On 6/7/2020 he was electively intubated for breathlessness after nurses developed rapport and obtained consent after explaining the procedure.
(m). Nurses arranged & cross matched blood in advance to manage any emergency situation.
(n). Postoperatively, patient’s hemoglobin was found to be 6g/dl after 1.2L of blood loss and so patient was transfused with 2 units of whole blood & 2 units of Packed cells appropriately.
(o). ICD was inserted in view of possible haemothorax.
Post-operative nursing care specific to TEVAR
(a). Nurses monitored Femoral site for any active bleeding.
(b). Maintained pulse chart with doppler to prevent stasis and embolism formation. Vital parameters were keenly monitored during procedure and post operatively.
(c). Two cycles of Hemodialysis were done.
(d). Renal function was optimized after the procedure with effective fluid restriction and I/O chart maintenance.
(e). Nurses cared for the patient’s Activities of Daily Living (ADL), developed a good rapport with the attenders and patient, which aids in early prognosis.
Diversional therapy was provided to the patient by listening to music, watching television, reading newspaper. Nurses listened to the patient calmly whenever he open up about him and gave reassurance about his health and that made him to recover soon.
(f). Diversional therapy was provided to the patient by listening to music, watching television, reading newspaper. Nurses listened to the patient calmly whenever he open up about him and gave reassurance about his health and that made him to recover soon.
(g). Nurses used AIDET technique (Acknowledge, Introduce, Duration, Explanation and Thank you) while communicating with the patient and attenders to gain their confidence and to improve the satisfaction level.
Conclusion
Active listening to patient sufferings promotes the bonding and interpersonal relationship of nurses & patient thereby enhances good co-operation, quality of patient care. After a complicated surgery, under the keen supervision and assistance of the nurse, patient health status in the hospital become hemodynamically stable with efficient care of nurses. Patient was discharged stable, and went home happily, with good prognosis.
Ms. Reena Ignatius
Nurse Educator