Abdominal Aortic Aneurysm

A seventy-four-year-old man with long-standing high blood pressure and a fifty-year smoking history is admitted for back pain he attributes to gardening. He is comfortable at rest. His abdomen is soft, but when you palpate gently above the umbilicus you feel a wide, pulsating mass that seems to push your fingers apart rather than lift them. That distinction — expansile rather than merely transmitted pulsation — is the finding that separates a normal aorta from a dilated one, and it is a nursing assessment skill worth practising deliberately. An abdominal aortic aneurysm is a permanent, localized dilation of the abdominal aorta. It grows slowly, silently, and without symptoms for years, which is exactly what makes it dangerous: the first symptom is frequently the rupture. Once the wall tears, mortality is extremely high and is measured against how quickly the client reaches an operating theatre. The nurse's work sits in three places. Recognizing the client who has one and does not know it. Detecting the change that means the wall is failing. And, in the client already known to have one,...