PULMONARY EDEMA

Presented By:
Ms. Rumela Chakraborty
M.sc. Nursing 2nd year
b. m. birla college of nursing
 INTRODUCTION

Pulmonary edema is an abnormal buildup of fluid in the

lungs. This build up of fluid leads to shortness of
breath.
 DEFINITION

Pulmonary Edema ; is a
condition characterized by
fluid accumulation in the
lungs caused by
extravasation of fluid from
pulmonary vasculature in to
the interstitium and alveoli
of the lungs.
 TYPES

❖Cardiogenic pulmonary edema

❖Noncardiogenic pulmonary edema

❖Neurogenic pulmonary edema

CAUSES OF CARDIOGENIC PULMONARY EDEMA

❖Hypertension
❖Left ventricular failure
❖Dysrhythmia
❖LV hypertrophy and cardiomyopathy
❖LV volume over load
❖Myocardia infarction
❖left ventricular outflow obstruction
CAUSES OF NON-CARDIOGENIC PULMONARY EDEMA

❖ Drugs Induced.
❖Fluid overload (IV fluids).
❖Hypalbuminaemia ( Nephrotic syndrome, Malnutrition)
❖Smoke inhalation toxic chemical ( CO, SO2 , CO2 )
❖Aspiration of gastric contents
❖Near drowing
❖ARDS
❖O2 toxicity
❖Malignancics blocking lymphatic outflow.
CAUSES OF NEUROGENIC PULMONARY EDEMA

❖ Neurogenic stimuli.

❖Head injury

❖Seizures
 STAGING OF PE
Three stages of PE can be distinguished based on the degree of fluid
accumulation:
➢Stage-1 : all excess fluid can still be cleared by lymphatic drainage.

➢Stage-2 : characterized by the presence of interstitial edema.

➢Stage-3 : characterized by alveolar edema due to altered alveolor-

capillary permeability
 STAGING OF PE
➢ Mild: Only engorgement of pulmonary vasculature is seen.

➢Moderate: There is extravasation of fluid into the interstitial

space due to changes in oncotic pressure.

➢Severe: Alveolar filling occurs.

CLINICAL MANIFESTATION

➢Symptom
0 Acute (sudden)
0 Chronic (long-term)
➢Sings
 SYMPTOM OF PULMONARY EDEMA
ACUTE
❑ Shortness of breath.
❑ A Feeling of suffocating.
❑ Anxiety
❑ restlessness
❑ Cough-frothy sputum that may be tinged with blood
❑ excessive sweating
❑pale skin
❑chest pain if PE is cause by cardiac abnormality
❑palpitation
 LONG TERM (CHRONIC)

❖ Long term(chronic)
❖ Peroxisomal nocturnal dyspnea
❖ Orthopnea
❖ Rapid weight gain
❖ Loss of appetite
❖ Fatigue
❖ Ankle and leg swelling
 SINGS
▪ Coughing up blood or bloody froth ▪Tachycardia
▪ Orthopnea ▪Tachypnea
▪paroxysmal nocturnal dyspnea ▪Confusion
▪Grunting, gurgling, or wheezing sounds ▪Agitation
with breathing
▪Anxious
▪Problems speaking in full sentences
because of shortness of breath ▪Diaphoric
▪ Anxiety or restlessness ▪Hypertension
▪Cool extremities
▪Decrease in level of consciousness
▪Rales
▪Leg or abdominal swelling
▪Wheezing
▪Pale skin
▪CVS findings ; S3 ,accentuation of
▪Excessive Sweating. pulmonic component of S2, jugular
venous distention.
 PHYSICAL EXAMINATIONS
1. The health care provider will listen to your lungs and heart with a stethoscope to check for:
▪Abnormal heart sound
▪Crackles in your lungs, called rales
▪ Increased heart rate (tachycardia)
▪Rapid breathing (tachypnea)

2. The health care provider will perform a thorough physical exam.

▪ Leg or abdominal swelling
▪Abnormalities of your neck veins (which can show that there is too much fluid in your body)
▪Pale or blue skin color (pallor or cyanosis)
 DIAGNOSTIC TEST
❖ CXR-PA view: unilateral or bilateral involvement, cardiogenic pattern or non cardiognic
pattern(air bronchogram signs, fluffy opacities, asymmetrical inhomogenous
involvement),lobar involvement in post infectious PE.
❖ ABG analysis: hypoxia and hypocapnia initially with respi. alkalois hypercapnea in later
stage with respi and metabolic acidosis
❖ Hemodynamic measurement with Swan-Ganz catheter
❖ Blood work up and septic screeno Blood chemistries o Blood oxygen levels(oximetry or
arterial blood gases)
❖Complete blood count (CBC)
❖Echocardiogram (ultrasound of the heart) to see if there are problems with the heart
muscle
❖Electrocardiogram (ECG) to look for signs of a heart attack or problems with the heart
rhythm
 TREATMENT
▪ Pulmonary edema is almost always treated in the emergency room or hospital. You
may need to be in an intensive care unit (ICU).
▪ Oxygen is given through a face mask or tiny plastic tubes are placed in the nose.
▪ A breathing tube may be placed into the windpipe (trachea) so you can be connected
to a breathing machine (ventilator) if you cannot breathe well on your own.
▪ The cause of edema should be identified and treated quickly. For example, if a heart
attack has caused the condition, it must be treated right away.
▪ Medicines that may be used include:
▪ Diuretics that remove excess fluid from the body
▪ Medicines that strengthen the heart muscle, control the heartbeat, or relieve pressure
on the heart .
 PHARMACOLOGICAL MANAGEMENT
• Morphine : reduce anxiety
• Diuretic therapy : reduce fluid overload and pulmonary congestion
• Vasodilator therapy ( nitroglycerine) : reduce the amount of blood
returning to the heart and reduces resistance heart must pump.
• Contractility enhancement therapy: (Digoxin, dopamine ,dobutamine )
Improves the , ability of the heart muscle to pump more effectively,
allowing for complete emptying of blood from left ventricle and a
subsequent decrease in fluid backing up in to the lungs.
• Aminophylline: Prevent bronchospasm associated with pulmonary
congestion.
INITIAL NURSING CARE
➢ Oxygenation with supplemental oxygen with face mask
➢ Elevate the head side and keep proper posture
➢ Monitor vital signs
➢ Iv line insertion
➢ Catheterization
➢ Cardiac monitoring along with hemodynamic monitoring
➢ ECG other investigation
 NURSING CARE
❖ Help the patient relax to promote oxygenation.
❖Place the patient in high Fowler’s position to enhance lung expansion.
❖Administer oxygen as ordered. Carefully record the time morphine is given and the amount
administered.
❖Assess the patient’s condition frequently.
❖Watch for complications of treatment such as electrolyte depletion. Monitor vital signs every
15 to 30 minutes or more often as indicated.
❖Urge the patient to comply with the prescribed medication regimen to avoid future episodes of
pulmonary edema.
❖Explain all procedure to the patient and his family. Emphasize reporting early signs of fluid
overload.
❖Review all prescribed medications with the patient.
❖Discuss ways to observe physical energy.
 COMPLICATION
❖Leg swelling(edema),
❖Abdominal swelling(ascites),
❖Pleural effusion,
❖Congestion & swelling of liver,
❖Acute heart attack (myocardial infarction [MI]),
❖Cardiogenic shock,
❖Arrhythmias,
❖Electrolyte disturbances,
❖Mesenteric insufficiency,
❖Protein enteropathy,
❖Respiratory arrest, and death.
DISTINGUISHING CARDIOGENIC FROM
NONCARDIOGENIC PULMONARY EDE
•Finding suggesting cardiogenic edema -S3 gallop -
elevated JVP -Peripheral edema

•Findings suggesting non-cardiogenic edema -

Pulmonary findings may be relatively normal in the
early stages
DISTINGUISHING CARDIOGENIC FROM
NONCARDIOGENIC PULMONARY EDE
Chest radiography
• Cardiogenic cause:
0 Cardiomegaly
0 Kerley B lines and loss of distinct vascular margins
0 Cephalization: engorgement of vasculature to the apices
0 Perihilar alveolar infiltrate
0 Pleural effusion
• Non cardiogenic cause:
-Heart size is normal
-Uniform alveolar infiltrate
-pleural effusion is uncommon
-lack of cephalization
DISTINGUISHING CARDIOGENIC FROM
NONCARDIOGENIC PULMONARY EDE
Hypoxemia
0 Cardiogenic
- due to ventilation perfusion miss match
-respond to administration of oxygen
0 Non cardiogenic
-due to intrapulmonary shunting
-persist despite oxygen supplimentation