Introduction
Abdominal aortic aneurysm (AAA) represents a critical health concern, particularly among older adults, and poses significant challenges within the field of adult nursing. Defined as a localised dilation of the abdominal aorta exceeding 3 cm in diameter, AAA can lead to life-threatening complications such as rupture if not identified and managed promptly (NICE, 2020). This essay aims to explore the pathophysiology, risk factors, and clinical management of AAA, with a specific focus on the role of adult nurses in screening, patient education, and post-operative care. By drawing on current evidence and guidelines, the discussion will highlight the importance of timely intervention and the nurse’s contribution to improving patient outcomes. The essay is structured into three main sections: an overview of AAA and its impact, the nurse’s role in prevention and early detection, and the complexities of post-operative care and long-term management.
Understanding Abdominal Aortic Aneurysm: Pathophysiology and Impact
An abdominal aortic aneurysm occurs when the wall of the abdominal aorta weakens, leading to progressive dilation. This weakening is often associated with atherosclerosis, a process involving plaque buildup that compromises the structural integrity of the vessel (Sakalihasan et al., 2018). Other contributing factors include genetic predisposition, hypertension, and lifestyle choices such as smoking, which exacerbate vascular damage (Norman and Curci, 2013). While many AAAs remain asymptomatic and are detected incidentally through imaging, a ruptured aneurysm presents with severe abdominal pain, hypotension, and shock, carrying a mortality rate of up to 80% (Reimerink et al., 2013).
The impact of AAA on public health is considerable, particularly as the condition disproportionately affects men over the age of 65. In the UK, the NHS AAA Screening Programme targets this demographic, reflecting the need for early identification to prevent catastrophic outcomes (NHS, 2021). However, the condition’s often asymptomatic nature means that many cases go undiagnosed until an emergency arises. This raises questions about the adequacy of screening accessibility and public awareness, areas where adult nurses can play a pivotal role. Furthermore, the psychological burden on patients diagnosed with AAA should not be underestimated, as the fear of rupture can lead to significant anxiety, necessitating holistic nursing support.
The Role of Adult Nurses in Prevention and Early Detection
Adult nurses are uniquely positioned to contribute to the prevention and early detection of AAA through health promotion, patient education, and participation in screening initiatives. Indeed, nurses often act as the first point of contact for patients in primary care settings, making their role in identifying at-risk individuals critical. For instance, during routine assessments, nurses can evaluate risk factors such as smoking history, family history of aneurysms, and hypertension, subsequently advising patients on lifestyle modifications (NICE, 2020). Encouraging smoking cessation, for example, is a key intervention, as tobacco use is strongly linked to aneurysm progression (Sakalihasan et al., 2018).
Moreover, nurses support the NHS AAA Screening Programme by educating patients about the importance of ultrasound screening, which is offered to men aged 65 and over in the UK (NHS, 2021). Although the programme has reduced AAA-related mortality by enabling early detection, uptake remains suboptimal in some regions due to lack of awareness or access barriers (Jacomelli et al., 2017). Here, nurses can address these gaps by providing clear, accessible information and reassuring patients about the non-invasive nature of the screening process. However, it must be acknowledged that screening is not without limitations; false positives can lead to unnecessary anxiety, and not all aneurysms are detectable at early stages. Nurses must therefore balance their advocacy for screening with realistic communication about its scope and potential emotional impacts.
Post-Operative Care and Long-Term Management in Adult Nursing
For patients diagnosed with AAA, surgical intervention—either through open repair or endovascular aneurysm repair (EVAR)—is often necessary when the aneurysm reaches a critical size, typically 5.5 cm in men (NICE, 2020). The post-operative phase presents significant challenges, and adult nurses play an essential role in ensuring recovery and preventing complications. Immediate post-operative care involves monitoring for signs of infection, bleeding, or vascular complications such as endoleaks in EVAR procedures (Walker et al., 2015). Nurses must also manage pain effectively, as inadequate control can hinder mobility and delay recovery, increasing the risk of thromboembolism.
In the long term, nurses contribute to patient education on lifestyle adjustments and adherence to follow-up imaging, which is crucial for detecting late complications (Norman and Curci, 2013). This involves fostering a therapeutic relationship to support patient compliance, particularly in managing comorbidities like hypertension, which can exacerbate aneurysm risk even post-repair. Additionally, the psychological aftermath of surgery, including fear of recurrence, requires nurses to provide reassurance and, if necessary, facilitate access to mental health support. While nurses are well-equipped to deliver such care, resource constraints within the NHS can sometimes limit the extent of personalised follow-up, highlighting a broader systemic challenge in AAA management.
Conclusion
In summary, abdominal aortic aneurysm poses a significant health challenge that demands a multifaceted approach from adult nurses. This essay has demonstrated that nurses are instrumental across the spectrum of AAA care, from prevention and early detection through screening advocacy to comprehensive post-operative and long-term management. Their role in patient education, risk factor modification, and holistic support is vital in reducing the morbidity and mortality associated with AAA. However, limitations such as screening uptake disparities and resource constraints within healthcare systems underscore the need for ongoing improvements in service delivery. Ultimately, the contribution of adult nurses not only enhances clinical outcomes but also addresses the emotional and psychological needs of patients, reflecting the essence of person-centred care. As the prevalence of AAA continues to rise with an ageing population, the importance of nursing expertise in this area cannot be overstated, with implications for both policy and practice in ensuring equitable and effective care.
References
- Jacomelli, J., Summers, L., Stevenson, A., Lees, T., and Earnshaw, J.J. (2017) Impact of the first 5 years of a national abdominal aortic aneurysm screening programme. British Journal of Surgery, 104(9), pp. 1125-1131.
- NHS (2021) AAA Screening Programme. National Health Service.
- NICE (2020) Abdominal aortic aneurysm: diagnosis and management. National Institute for Health and Care Excellence.
- Norman, P.E. and Curci, J.A. (2013) Understanding the effects of tobacco smoke on the pathogenesis of aortic aneurysm. Arteriosclerosis, Thrombosis, and Vascular Biology, 33(7), pp. 1473-1477.
- Reimerink, J.J., van der Laan, M.J., Koelemay, M.J., Balm, R., and Legemate, D.A. (2013) Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm. British Journal of Surgery, 100(11), pp. 1405-1413.
- Sakalihasan, N., Michel, J.B., Katsargyris, A., Kuivaniemi, H., Defraigne, J.O., Nchimi, A., Powell, J.T., Yoshimura, K., and Hultgren, R. (2018) Abdominal aortic aneurysms. Nature Reviews Disease Primers, 4, p. 34.
- Walker, T.G., Kalva, S.P., Yeddula, K., Wicky, S., Kundu, S., Drescher, P., d’Othee, B.J., Rose, S.C., and Cardella, J.F. (2015) Clinical practice guidelines for endovascular abdominal aortic aneurysm repair. Journal of Vascular and Interventional Radiology, 26(11), pp. 1632-1646.
