3. DEFINITION
Pulmonary edema is an abnormal
buildup of fluid in the lungs. This build
up of fluid leads to shortness of breath.
4. CAUSES
Congestive cardiac failure
Heart attack,
Cardiomyopathy
Leaking or narrowed heart valves (mitral or aortic valves)
Sudden, severe high blood pressure.
Certain medicines
High altitude exposure
Kidney failure
Narrowed arteries that bring blood to the kidneys
Lung damage caused by poisonous gas or severe infection
Major injury
5. Symptoms
Coughing up blood or bloody froth
Orthopnea
paroxysmal nocturnal dyspnea
Grunting, gurgling, or wheezing sounds with breathing
Problems speaking in full sentences because of shortness of
breath
Anxiety or restlessness
Decrease in level of consciousness
Leg or abdominal swelling
Pale skin
Excessive Sweating
6. 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)
7. Diagnostic test
o Blood chemistries
o Blood oxygen levels(oximetry or arterial blood
gases)
o Chest x-ray
o Complete blood count (CBC)
o Echocardiogram (ultrasound of the heart) to see
if there are problems with the heart muscle
o Electrocardiogram (ECG) to look for signs of a
heart attack or problems with the heart rhythm
8. 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 .
•
9. pharmacological management
• Morphine :
reduce anxiety
• Diuretic therapy :
reduce fluid overload and pulmonary congestion
• Vasodialator 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.
10. Initial nursing care
Supplimental oxygen with face mask
Elevate the head side and keep sitting posture
Monitor vital signs
Iv line
Catheterization
Cardiac monitoring
Ecg
Pulse oxymetry
11. 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.
