A.H. is a 70-year-old retired construction worker who has experienced lumbosacral pain, nausea, and upset stomach for the past 6 months. He has a history of heart failure, high cholesterol, hypertension (HTN), sleep apnea, and depression
His chronic medical problems have been managed over the years with oral medications: benazepril (Lotensin) 5 mg/day, fluoxetine (Prozac) 40 mg/day, furosemide (Lasix)
20 mg/day, Potassium chloride (KCl) 20 mEq bid, and lovastatin (Mevacor) 40 mg with the evening meal.
A.H. has just been admitted to the hospital for surgical repair of a 6.2-cm abdominal aortic aneurysm
(AAA) that is now causing him constant pain. On arrival on your floor, his vital signs (VS) are 109/81, 61, 16,
and 98.3 ° F (36.8 ° C). When you perform your assessment, you find that his apical heart rhythm is regular
and his peripheral pulses are strong. His lungs are clear, and he is awake, alert, and oriented. There are no
abnormal physical findings; however, he hasn't had a bowel movement for 3 days. His electrolytes, blood
chemistries, and clotting studies are within normal range, except his hematocrit is 30.1%, and hemoglobin
is 9 g/dL.
A.H. has several common risk factors for AAA that are evident from his health history. Identify and explain three factors.
Hyperlipidemia, leading to atherosclerosis: This is inferred because he is taking lovastatin, a drug used
to reduce serum lipid levels. Atherosclerosis injures vessel walls, causing weakness.
HTN: The elevated blood pressure (BP) puts a continuous strain on weakened arterial walls.
Advanced age: HTN and atherosclerosis are more common in the elderly.
Male gender: For unknown reasons, the incidence of AAA is higher in men.
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