Clinical meaning
Aortic dissection occurs when a tear develops in the inner layer (intima) of the aorta, allowing blood to surge through the tear into the media (middle layer). This creates a false lumen that can propagate proximally or distally, compromising blood flow to branch vessels. Stanford Type A involves the ascending aorta (most lethal) and Type B involves the descending aorta distal to the left subclavian artery. The nurse must recognize the sudden onset of severe tearing chest or back pain, monitor vital signs closely, maintain a calm environment, and report all changes immediately.
Exam relevance
Risk factors: - Chronic hypertension (most common risk factor) - Sudden cessation of antihypertensive medications - Cocaine use (acute hypertensive crisis) - Marfan syndrome and other connective tissue disorders - Bicuspid aortic valve - Age >60 years, male sex - Prior aortic surgery or catheterization - Pregnancy (third trimester)
Diagnostics: - Monitor vital signs frequently and report hypertension or hypotension - Report sudden severe chest or back pain described as tearing or ripping - Compare bilateral upper extremity blood pressures as directed and report asymmetry - Monitor peripheral pulses (radial, femoral, pedal) and report changes - Report changes in level of consciousness or neurological status - Monitor urine output and report if <30 mL/hr