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.
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
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
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
