Pulmonary edema is the abnormal accumulation of fluid in the lungs, which can be caused by conditions that increase hydrostatic pressure (cardiogenic) or abnormalities that damage the lung tissue and cause fluid leakage (noncardiogenic). Common symptoms include dyspnea, cough, and crackles heard on auscultation. Diagnosis involves chest imaging, blood gases, and echocardiogram. Treatment focuses on correcting hypoxemia with oxygen supplementation and reducing pulmonary hydrostatic pressure through diuretics, afterload reducers, and positioning the patient upright.

1. PULMONARY EDEMA

2. DEFINITION
Pulmonary edema is the abnormal
accumulation of fluid in the interstitial spaces
surrounding the alveoli with the advancement
of fluid accumulation in the alveolar spaces.
0r is a condition characterized by fluid
accumulation in the lungs caused by
extravasations of fluid from pulmonary
vasculature into the interstitium and alveoli of
the lungs.

3. EPIDEMIOLOGY
 Pulmonary edema occurs in about 1% to 2% of the
general population.
 Between the ages of 40 and 75 years, males are
affected more than females.
 After the age of 75 years, males and females are
affected equally.
 The incidence of pulmonary edema increases with
age and may affect about 10% of the population over
the age of 75 years.

4. TYPES
 Cardiogenic pulmonary edema
 Noncardiogenic pulmonary edema

5. Cardiogenic pulmonary edema
Is Pulmonary edema due to increased pressure in
the pulmonary capillaries because of cardiac
abnormalities that lead to an increase in pulmonary
venous pressure.
o Hydrostatic pressure is increased and fluid exit
capillary at increased rate .
o A rise in pulmonary venous and pulmonary
capillary pressures pushes fluid into the
pulmonary alveoli and interstitium.

6. Non cardiogenic pulmonary
edema
It is defined as the evidence of alveolar fluid
accumulation with out hemodynamic evidence that
suggest a cardiogenic etiology.
Hydrostatic pressure is normal
Leakage of protein and other molecule in to the
tissue

7. CAUSES
• Hypertension
• Left ventricular failure
• cardiomyopathy
CARDIOGENIC
PULMONARY
EDEMA
• Aspiration of gastric contents
• Drugs eg. Narcotics
• Sepsis
• Pneumonia
• Smoke inhalation
• Malignancies
• Pancreatitis
NONCARDIOGENIC
PULMONARY
EDEMA
• Head injury
NEUROGENIC
PULMONARY
EDEMA

8. PATHOPHYSIOLOGY
Accumulation of fluid in the alveoli
Damage of alveolar epithelium
Movement of the fluid from the interstitial in to
the alveolar walls
Increase in the fluid filtration into the interstitial
spaces of the lung

9. SIGNS AND SYPTOMS
 Dyspnea
 Tachycardia
 Orthopnea
 Hypertension
 Thin and frothy sputum
 On auscultation,
 Rhonchi
 Crackle sound
 Right ventricular failure with the
manifestation of hepatomegaly, jugular vein
distension and peripheral edema

10. DIAGNOSTIC FINDINGS
 Pulse oximetry <85%
 ABG: PaO2 = 30-50mm of Hg
 Routine CBC
 Liver and renal function test
Imaging
 chest radiography
Echocardiography
Ultrasound

11. DIFFERENTIAL DIAGNOSIS
 Pneumothorax
 Bronchitis
 Cardiac tamponed
 COPD
 Pericarditis
 Pneumonia (bacterial ,viral , PCP)
 Pulmonary embolism
 Shocks (cardiogenic ,septic ,anaphylactic)
 Venous air embolism

12. MEDICAL MANAGEMENT
 Correction of hypoxemia
 O2 therapy
 Mechanical ventilation
 Reducing preload
 Upright position
 Diuretics e.g furusemide
 Vasodilators
 Reducing after load
 Antihypertensive agents
 Supporting perfusion
 Ionotropic medications
e.gDigoxin.Amiodarone

13.  Endotracheal intubation and mechanical
ventilation, if respiratory failure occurs
 Positive end-expiratory pressure (PEEP)
 Monitoring of pulse oximetry and ABGS
 Morphine given intravenously in small doses to
reduce anxiety and dyspnea

14. NURSING MANAGEMENT
 Assist with administration of oxygen and
intubation and mechanical ventilation.
 Position patient upright (in bed if necessary) or
with legs and feet down to promote circulation.
Preferably position patient with legs dangling over
the side of bed.
 Provide psychological support by reassuring the
patient

15.  The patient receiving continuous IV infusions of
vasoactive medications requires ECG monitoring
and frequent measurement of vital signs

16. Nursing diagnosis
 Impaired Gas exchange related to excess fluid in
the lungs
 Anxiety related to sensation of suffocation and
fear

17. Initial nursing management
 Supplementary oxygen with face mask
 Elevate the head side or keep in sitting posture
 Monitor vital signs
 I/V Line
 Catheterization
 Cardiac monitoring
 ECG
 Pulse oxymetry

18. NURSING INTERVENTION
 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 admistered
 Assess the patient’s condition frequently

19. Patient education and health
maintenance
 Teach the patient about early symptoms before
onset of acute pulmonary edema
 If coughing develops (a wet cough), sit with legs
dangling over side of bed
 Teach the patient to slow and deep breath to
increase oxygenation
 Teach the patient to take sodium restricted diet
 Watch for weight gain

20. COMPLICATIONS
 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.

21. References
 Manual of medical and surgical nursing
care/Nursing intervention and collaborative
management/Mosby/5th Edition /page 191-195
 Lippincott/manual of Nursing practice/ 8th edition
/page no:416-417