Pulmonary Edema

presented by : ASMAA ABDELHAMEED AHMED

OUTLINES:
Definition of pulmonary edema. Causes of Pulmonary edema. Clinical manifestation of pulmonary edema. Dyspnea scale Diagnostic measures. Management of Pulmonary edema. Nursing care plan of Pulmonary edema Complication of Pulmonary edema.

Pulmonary edema

Its life threatening condition is defined as abnormal accumulation of fluid in the lung tissue and/or alveolar sacs. Pulmonary edema is an abnormal build up of fluid in the air sacs of the lungs, which leads to shortness of breath

Causes of Pulmonary edema

Pulmonary edema is often classified as cardiogenic or non-cardiogenic. Cardiogenic Pulmonary Edema

Aortic valve disease (disorder of the valve that controls the flow of blood from the heart to the aorta, the artery that leads from the heart to the abdomen) Cardiomyopathy (weakened or abnormal heart muscle and function) Coronary heart disease Hypertension (high blood pressure) Mitral valve disease (disease of the valve that controls blood flow between the upper and lower chambers of the left side of the heart)

Causes of Pulmonary edema

Non-cardiogenic Pulmonary Edema Non-cardiogenic pulmonary edema is less common and occurs because of damage to the lung tissue and subsequent inflammation of lung tissue. This can cause the tissue that lines the structures of the lung to swell and leak fluid into the alveoli and the surrounding lung tissue, this increases the distance necessary for oxygen to travel to reach the bloodstream. The following are some examples of causes of noncardiogenic pulmonary edema. Kidney failure Inhaled toxins Medication side effects. Illicit drug use Adult respiratory distress syndrome (ARDS) Pneumonia

LAP 18 ~ 25mmHg

A rapid increase in hydrostatic pressure in the pulmonary capillaries leading to increased transvascular fluid filtration is the hallmark of acute cardiogenic or volume-overload edema. Increased hydrostatic pressure in the pulmonary capillaries is usually due to elevated pulmonary venous pressure from increased left ventricular end-diastolic pressure and left atrial pressure.

LAP > 25mmHg

Noncardiogenic pulmonary edema has a high protein content because the vascular membrane is more permeable to the outward movement of plasma proteins. The net quantity of accumulated pulmonary edema is determined by the balance between the rate at which fluid is filtered into the lung and the rate at which fluid is removed from the air spaces and lung interstitium.

IMPAIRED

Clinical manifestation:

Dyspnea , orthopnea . Anxiety Cough Excessive sweating Pale skin Restlessness Coughing up blood or bloody froth Decrease in level of alertness (consciousness) Distended neck veins. Respiratory distress Tachycardia, hypotension , shock

Dyspnea , the sensation of breathlessness or inadequate breathing, is the most common complaint of patients with cardiopulmonary. Dyspnea - common complaint/symptom
shortness of breath or breathlessness

Dyspnea

-Orthopnea describes shortness of breath while lying flat. -paroxysmal nocturnal dyspnea are generally described by the patient as wakening in the middle of the night, short of breath, with a need to walk Multiple etiologies 2/3 of cases - cardiac or pulmonary .

Differential Diagnosis

Composed of four general categories

Cardiac Pulmonary Mixed cardiac or pulmonary non-cardiac or non-pulmonary

Exams and Tests

The health care provider will perform a physical exam and use a stethoscope to listen to the lungs and heart. The following may be detected:
Crackles in the lungs, Abnormal heart sounds Increased heart rate (tachycardia) Pale or blue skin color (pallor or cyanosis) Rapid breathing (tachypnea)

Possible tests include:

Complete blood count (CBC) to check for anemia and reduced red cell count Other blood tests to measure blood chemistries and kidney function Blood oxygen levels (oximetry or arterial blood gases) -- low in patients with pulmonary edema Chest x-ray may reveal fluid in or around the lung space or an enlarged heart Electrocardiogram (ECG) to detect abnormal heart rhythm or evidence of a heart attack Ultrasound of the heart (echocardiogram) to see if there is a weak heart muscle, leaky or narrow heart valves, or fluid surrounding the heart

Management
1.The immediate objectives are: a- improve oxygenation. b- reduce pulmonary congestion. 2. Identify and correct of precipitation factors to prevent recurrence. 3. Increase oxygen tension a- Reduce fluid volume by diuretics and vasodilators b- Improving heart ability to pump glycoside, beta agonists c- Decease anxiety 4. Oxygen therapy a- Use high oxygen flow. b- Intubations and Mechanical ventilation

Cont..
5- Morphine sulfate to:

A-Reduce anxiety.
B- Reduce resistance against which the heart must pump. 6Vasodilator therapy Nitroglycerin

- to reduce amount of blood returning to the heart.

- to reduce resistance against which the heart most pump. 7Diuretic therapy lasix - to reduce blood volume and pulmonary congestion. 8Contractility enhancement Digoxin, dopamin, aminophyllin to improve heart muscle to pump complete emptying of blood from the ventricle. Decrease fluid backing up into the lungs. Aminophylline to prevent bronchospasm.

Nursing Care Plan

Nursing Diagnosis: Impaired gas exchange related to fluid overload as manifested by requirements of oxygen supplementation and shortness of breath with activity Expected Outcomes: Patient will be able to breathe on room air without shortness of breath by discharge. Nursing Interventions/Rationale: Encourage deep breathing techniques to open up lung bases increase oxygen exchange in blood. Auscultate breath sounds, listening for sounds of crackles or wheezes. Position in semi-fowlers position Administer a prophylaxis form of antibiotics to reduce chances of developing pneumonia

Cont..
Auscultate breath sounds. Note Adventitious breath sounds like wheezes, crackles. Elevate head ofthe bed, have patient lean on over bed table or sit on edge of the bed. Keep environmental pollution to aminimum like dust, smoke . Encourage or assist with abdominal or pursed lip breathing exercises. Assist with measures to improve effectiveness of cough efforts

Complication
Complications of pulmonary edema include: cerebral edema Stroke Myocardial infarction Respiratory failure Cardiogenic shock arrhythmias electrolyte disturbances,