NURS6560-WK2 I-Human
Primary Diagnosis: Thoracic Aortic Dissection
Status/Condition: Guarded/Critical
Code Status: Full Code
Allergies: No Known Allergies
Admit to Unit: Cardiovascular ICU or Coronary ICU
Activity
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NURS6560-WK2 I-Human
Primary Diagnosis: Thoracic Aortic Dissection
Status/Condition: Guarded/Critical
Code Status: Full Code
Allergies: No Known Allergies
Admit to Unit: Cardiovascular ICU or Coronary ICU
Activity Level: Bedrest
Diet: NPO
IVF: 0.9% Saline at 75 ml/hr with close monitoring
Critical Drips: Start Osmolol 2 g/100 mL IV to keep SBP between 110-120 mm Hg and HR between 60-
70 bpm
Respiratory: Apply oxygen via nasal cannula to keep O2Sats >92%
Medications: Morphine Sulphate 2-4 mg IV q30min PRN chest pain
Discontinue Lisinopril
Hold ASA and Lopressor
Nursing Orders: Start 2 large bore peripheral IV’s
Insert foley catheter for strict I&O’s
Continuous HR, BP, and SPO2 monitoring
Record vital signs per unit protocol
Stat EKG with chest pain
Strict bedrest
Strict I&O’s
Follow Up Lab tests: Troponin q3h X3, CBC, CMP, PT/PTT, type and cross, lactate
Post-Admission Diagnostic testing: Chest CT or chest MRI, Echocardiogram, bedside cardiac
ultrasound
Consults: Stat cardiovascular consult for possible emergent surgery
Patient Education and Health:
Pamphlet explaining disease progression, pre- and post- surgery education and expectations
Smoking cessation
Cardiac rehabilitation
Discharge planning and required follow-up care:
Care management consult for discharge planning
Discharge to home vs rehabilitation facilityReferences
Black, J., Manning, W.J. (2019). Management of acute aortic dissection. Up-To-Date. Retrieved from
https://www.uptodate.com/contents/management-of-acute-aortic-dissection
Borloz, M. (2016). Thoracic aortic dissection. Clerkship Directors in Emergency Medicine. Retrieved from
https://saem.org/cdem/education/online-education/m4-curriculum/group-m4-
cardiovascular/thoracic-aortic-dissection
Shono, Y., Akahoshi, T., Mezuki, S., Momii, K., Kaku, N., Maki, J., Tokuda, K., Ago, T., Kitazono, T., &
Maehara, Y. (2017). Clinical characteristics of type A acute aortic dissection with CNS symptom.
American Journal of Emergency Medicine, 35, 1836-1838. DOI: 10.1016/j.ajem.2017.06.011
Strayer, R.J., Shearer, P.L., & Hermann, L.K. (2012). Screening, evaluation, and early
management of acute aortic dissection. US National Library of Medicine, National
Institutes of Health, 8(2), 152-157. DOI: 10.2174/157340312801784970
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