This document discusses pulmonary edema, which is an abnormal accumulation of fluid in the lung tissue or alveolar space that can become life-threatening if severe. Pulmonary edema can be caused by cardiac issues like left ventricle failure that back blood up into the lungs, or non-cardiac issues like renal failure. Symptoms include dyspnea, coughing up foamy secretions, and hypoxemia. Diagnosis involves chest x-ray, pulse oximetry, and blood gas analysis. Treatment focuses on reducing overload and improving cardiac function using MONL protocol: morphine for anxiety relief, oxygen therapy, nitroglycerine to relieve symptoms, and diuretics like Lasix to excrete fluid. Nursing

1. PULMONARY EDEMA
NURSING Critical Care
respiration - lecture 2
Prepared & Designed BY :
dr.hind alassaf

2. Pulmonary edema definition :
Abnormal accumulation of fluid in the lung tissue or in the alveolar space or both
If become severe will become life threatening.
Causes of pulmonary edema :
1.Cardiac cause : left ventricle cause.
2.None cardiac cause : renal failure.

3. Pathophysiology :
• Pulmonary edema also called “flash pulmonary edema” if patient with one lung.
• The main causes due to pressure from abnormal cardiac function especially left
ventricle failure.
• The acute phase of pulmonary edema related to left ventricle failure.
• The blood backup of blood into the pulmonary vascular.

4. Clinical manifestation :
• Dyspnea and the breath noisy and moist called crackles sound.
• Pulse weak and Tachycardia.
• Neck vein distended.
• Air hunger and sense of suffocation.
•
• Patient hand become cold and moist.
• Central cyanosis and nails bed become cyanotic color.
•
• Skin color become turns ashen (gray).
• Patient become very anxious and confused.

5. ▪ Patient coughs out (or with suction out) :
‣ foamy secretion
‣ frothy secretion
‣ frothy pink blood sputum

6. Assessment and diagnostic findings :
Inspection :
‣ Observe signs and symptoms.
‣ Chest x-ray : increased interstitial marking.
‣ Pulse oximetry : the level of oxygen begin fall.
‣ ABGS analysis : observed sever hypoxemia.
Percussion :
‣ Normal percussion sound is resonance sound on the lung
‣ Abnormal sound when percuss on the chest wall dullness sound which
indicate filled with fluid (water, blood, serosa fluid).
Auscultation :
‣ the sound crackles in the lung base.
‣ This sound produced by movement of air into the fluid .

7. Medical management :
• The main purpose of treatment to reduce volume overload and improve
ventricle function
• Management depend on a term called (MONL)
• MONL (morphine, oxygen, nitroglycerine and Lasix)
1.Morphine :
• Intravenous with small dose 2-5 mg
• morphine reduce peripheral resistance, and venous return and reduce anxiety.

8. 2.Oxygen therapy :
• Oxygen should given to relieve hypoxemia and Dyspnea.
• Monitored oxygen by pulse oximetry.
• The face mask initially used.
• Used PEEP in ventilators (positive end expiratory pressure).
• If patient become more worsening should used insert ETT
and put patient on mechanical ventilators.
PEEP benefit in pulmonary edema :
‣ Reduce venous return to the heart.
‣ Decrease fluid movement in capillaries to the alveoli.

9. 3.Nitroglycerine Intravenous infusion :
• Vasodilator drugs include : nitroglycerine, Nitropursside or Nipride.
• Relief symptoms appear in pulmonary edema such oxygen hunger and suffocation
4. Diuretics (especially Lasix) :
• Diuretics excrete water and sodium by the kidney.
• Furosemide given push IV (40-100 mg) or contentious infusion to produce rapid
diuretic effect.
• Furosemide also cause vasodilation and pooling of blood in blood vessels so
reduce blood returned to the heart so decrease venous return.
• Metolazone may be administered as a second line therapy (used for congestive
heart failure and hypertension).

10. Nursing management :
1.To enhance oxygenation and decrease oxygen consumption :
• Position the patient to promote circulation : upright position with the leg
dangling over the side of the bed (if possible).
• Dangling leg decrease venous return and lead to decrease lung congestion.
• Use indwelling urinary catheter and bedside commode to reduce movement
and reduce consumption of oxygen.
2.Providing psychological support :
Talk to patient , the surrounded person around the take in reassure sound.

11. 3.Monitoring medication
A. Morphine administration :
• Need monitor patient respiratory depression, hypotension and vomiting.
• Not given if respiratory rate less than 12 breathminute.
• If respiratory depression occurs use the morphine antagonist (naloxone, Narcan)
B. Patient receiving diuretics :
• Monitor blood pressure to check hypotension.
• Monitor intake and output.
• Monitor electrolyte especially sodium and potassium.
• Electrocardiogram.
• Vital signs .
c. Patient receiving nitroglycerine :
• hypotension.
• bradycardia.
• headache, dizziness - may be diminished by laying down.

12. Summary of the lecture in video :
1. https://youtu.be/oRDOUv6dEpE

13. ThanksThanks:)FOR LISTENING ..