Page 1725 - Saunders Comprehensive Review For NCLEX-RN

auscultate breath sounds to identify
respiratory complications.
i. Encourage turning, coughing and deep
breathing, and splinting the incision.
j. Ambulate as prescribed.
k. Prepare the client for discharge by
providing instructions regarding pain
management, wound care, and activity
restrictions.
l. Instruct the client not to lift objects
heavier than 15 to 20 lb for 6 to 12
weeks.
m. Advise the client to avoid activities
requiring pushing, pulling, or
straining.
n. Instruct the client not to drive a vehicle
until approved by the PHCP.
o. Endovascular aneurysm grafting
involves insertion of a graft using a
vascular catheter; it does not require
an abdominal incision. The
preoperative and postoperative care is
similar to that of a surgical abdominal
aneurysm repair.
F. Thoracic aneurysm repair
1. Description
a. A thoracotomy or median sternotomy
approach is used to enter the thoracic
cavity.
b. The aneurysm is exposed and excised,
and a graft or prosthesis is sewn onto
the aorta.
c. Total cardiopulmonary bypass is
necessary for excision of aneurysms in
the ascending aorta.
d. Partial cardiopulmonary bypass is used
for clients with an aneurysm in the
descending aorta.
2. Postoperative interventions
a. Monitor vital signs and neurological
and renal status.
b. Monitor for signs of hemorrhage, such
as a drop in BP and increased pulse
rate and respirations, and report them
to the PHCP immediately.
c. Monitor chest tubes for an increase in
chest drainage, which may indicate
bleeding or separation at the graft site.

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