Pulmonary Edema: Topic Outline

Pulmonary Edema
LOWER RESPIRATORY TRACT DISORDERS
TOPIC OUTLINE  Anxiety, restlessness, or a sense of apprehension

(1) Definition  Skin and mucous membrane may be pale to
(2) Pathophysiology cyanotic
(3) Clinical Manifestations  Tachycardia and JVD are common signs.
(4) Assessment & Diagnostic Findings
(5) Prevention ASSESSMENT AND DIAGNOTIC FINDINGS
(6) Medical Management  Assess pt’s airway and breathing to determine
(7) Nsg Management the severity of respiratory distress, along with
VS.
DEFINITION  Pt is placed on cardiac monitoring, and IV
→ the abnormal accumulation of fluid in the access is confirmed or established for
interstitial spaces and alveoli of the lungs. administration of drugs.
→ associated with acute decompensated HF that LABORATORY TESTS ARE OBTAINED:
can lead to acute respiratory failure and death.  ABG
 ELECTROLYTES
 BUN
 CREATININE
 CHEST X-ray – to confirm the extent of
pulmonary edema in the lung fields.
PREVENTION
To recognize pulmonary edema early the nurse
must:
 Assess the degree of dyspnea
 Auscultates the lung fields and heart sounds
 Assess the degree of peripheral edema.
Early indicators of developing pulmonary edema:
 Hacking cough
PATHOPHYSIOLOGY  Fatigue
 Weight gain
 Increase edema
 Decreased activity tolerance
In its early stage, pulmonary edema may be

alleviated by increasing dosages of diuretics and
by implementing other interventions to
decrease preload (place pt in an upright position
with the feet and legs dependent reduces left
ventricular workload).
MEDICAL MANAGEMENT
CLINICAL MANIFESTATIONS Clinical management of a patient with acute
 Difficulty breathing (dyspnea) or extreme pulmonary edema d/t left ventricular failure is
shortness of breath that worsens with activity or directed toward reducing volume overload,
when lying down improving ventricular function, and increasing
 A feeling of suffocating or drowning that oxygenation.
worsens when lying down
 A cough that produces frothy sputum that may Oxygen Therapy
be tinged with blood  To relieve hypoxemia and dyspnea.
 Wheezing or gasping for breath  Nonrebreathing mask is used.
 Cold, clammy skin
1
Pulmonary Edema
LOWER RESPIRATORY TRACT DISORDERS
 If respiratory failure is severe or persists,  Because the pt is in an unstable condition, nurse

noninvasive positive pressure ventilation is must remain with the pt.
the preferred mode of assisted ventilation.  Give the pt simple, concise information in
 For some pts, endotracheal intubation (ET) reassuring voice about what is being done to
and mechanical ventilation are required. treat the condition and the expected results.
 The ventilator can provide positive end-
expiratory pressure, which is effective in Monitoring Medications
reducing venous return, decreasing fluid  The pt receiving diuretic therapy may excrete
movement from the pulmonary capillaries to the large volume of urine within minutes after a
alveoli, and improving oxygenation. potent diuretic is given.
 Oxygenation is monitored by pulse oximetry  Bedside commode may be used.
and by measurements of ABG.  Indwelling catheter may be inserted, in order to
carefully monitor urine output.
Diuretics  Pt receiving continuous IV infusions of diuretics
Diuretics promote the excretion of sodium and and vasoactive medications requires continuous
water by the kidneys. ECG monitoring and frequent measurement
 Furosemide or another loop diuretic is given of VS.
by IV push or as a continuous infusion to  Pts who receive continuing therapy require
produce a rapid diuretic effect. management in an ICU.
 BP is closely monitored as the urine output
increases, because it is possible for the pt to
become hypotensive as intravascular volume
decreases.
 I&O, daily weights, serum electrolytes, and
creatinine are carefully monitored.
 As the clinical manifestations stabilize, the pt is
transitioned to oral diuretics.
Vasodilators
 IV nitroglycerin or nitroprusside may enhance
symptom relief in pulmonary edema.
 Their use is contraindicated in pts who are
hypotensive.
 BP is continually assessed in pts receiving IV
vasodilator infusions.
NSG MANAGEMENT
Positioning the Patient to Promote Circulation
 Pt positioned up right, preferably with the legs
dangling over the side of the bed.
 This has the immediate effect of decreasing
venous return, decreasing right ventricular SV,
and decreasing lung congestion.
Providing Psychological Support

 Reassuring the pt and providing skillful
anticipatory nursing care are integral parts of
the therapy.

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Pulmonary Edema

LOWER RESPIRATORY TRACT DISORDERS

TOPIC OUTLINE  Anxiety, restlessness, or a sense of apprehension

In its early stage, pulmonary edema may be

 If respiratory failure is severe or persists,  Because the pt is in an unstable condition, nurse

Providing Psychological Support

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