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).

CLINICAL MANIFESTATIONS
 Difficulty breathing (dyspnea) or extreme
shortness of breath that worsens with activity or
when lying down
 A feeling of suffocating or drowning that
worsens when lying down
 A cough that produces frothy sputum that may
be tinged with blood
 Wheezing or gasping for breath
 Cold, clammy skin
MEDICAL MANAGEMENT
Clinical management of a patient with acute
pulmonary edema d/t left ventricular failure is
directed toward reducing volume overload,
improving ventricular function, and increasing
oxygenation.
Oxygen Therapy
 To relieve hypoxemia and dyspnea.
 Nonrebreathing mask is used.

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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
the preferred mode of assisted ventilation.
 For some pts, endotracheal intubation (ET)
and mechanical ventilation are required.
 The ventilator can provide positive end-
expiratory pressure, which is effective in
reducing venous return, decreasing fluid
movement from the pulmonary capillaries to the
alveoli, and improving oxygenation.
 Oxygenation is monitored by pulse oximetry
and by measurements of ABG.
Diuretics
Diuretics promote the excretion of sodium and
water by the kidneys.
 Furosemide or another loop diuretic is given
by IV push or as a continuous infusion to
produce a rapid diuretic effect.
 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.
must remain with the pt.
 Give the pt simple, concise information in
reassuring voice about what is being done to
treat the condition and the expected results.
Monitoring Medications
 The pt receiving diuretic therapy may excrete
large volume of urine within minutes after a
potent diuretic is given.
 Bedside commode may be used.
 Indwelling catheter may be inserted, in order to
carefully monitor urine output.
 Pt receiving continuous IV infusions of diuretics
and vasoactive medications requires continuous
ECG monitoring and frequent measurement
of VS.
 Pts who receive continuing therapy require
management in an ICU.

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.