Pulmonary edema is an abnormal buildup of fluid in the lungs that causes shortness of breath. It occurs when fluid leaks into the tiny air sacs (alveoli) and spaces around the alveoli in the lungs. Pulmonary edema can be caused by issues with the heart like heart failure or heart attack that increase blood pressure in the lungs. Symptoms include cough, difficulty breathing, and wheezing. Treatment focuses on addressing the underlying cause, giving oxygen, diuretics to remove fluid, and in severe cases, use of a ventilator.

1. Pulmonary
Edema
PREPARED BY :
MR. OMPRAKASH VERMA
Msc LECTURER MEDICAL SURGICAL NURSING
RELIANCE INSTITUTE OF NURSING

2. Anatomy of lung

3. DEFINITION
Pulmonary edema is an abnormal buildup
of fluid in the lungs. This build up of fluid leads
to shortness of breath.
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.

4. Con………………………………………….
• Pulmonary edema is an accumulation of fluid
in the alveoli and interstitial spaces of the
lungs.
• Cardiogenic pulmonary edema (CPE) is
defined as pulmonary edema due to
increased capillary hydrostatic pressure
secondary to elevated pulmonary venous
pressure. ... Damage to the alveolar-capillary
barrier.

5. TYPES OF PULMONARY EDEMA
• 1. CARDIOGENIC PULMONARY EDEMA
• 2. NON CARDIOGENIC PULMONARY EDEMA

6. 1. CARDIOGENIC PULMONARY EDEMA
• Pulmonary edema is either due to direct
damage to cardiac tissue or a result of
inadequate function of the heart or circulatory
system
• Causes- 1. congestive heart failure
• Arrthythmias
• Fluid overload due to kidney failure

7. 2. NON CARDIOGENIC PULMONARY
EDEMA
• Define as the radiographic evidence of alveolar
fluid accumulation without hemodynamic . (flow
of blood within the organs and tissues of the
body)
• Causes-
• Inhalation of toxic gases
• Aspiration
• E.g.. Gastric fluid or incase drowing
• Multiple blood transfusion
• Several infection

8. 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
 kidneys do not remove excess fluid and waste products from the body,
and the excess fluid accumulates in the lungs.
 Narrowed arteries that bring blood to the kidneys
 Lung damage caused by poisonous gas or severe infection
 Major injury

9. HTN
• pulmonary edema, such as high blood
pressure due to narrowed kidney arteries
(renal artery stenosis) and fluid buildup due to
kidney disease or heart problems.

10. congestive heart failure
• congestive heart failure. When the heart is
not able to pump efficiently, blood can back
up into the veins that take blood through the
lungs. As the pressure in these blood vessels
increases, fluid is pushed into the air spaces
(alveoli) in the lungs.

11. Cardiomyopathy
• is a condition in which the heart becomes
enlarged and cannot ... Left or right
ventricular systolic pump function of the heart
is impaired, leading to progressive heart ... A
person suffering from
dilated Cardiomyopathy may have an
enlarged heart, with pulmonary edema

12. PATHOPHYSIOLOGY
• Due to etiological factors
• Increase hydrostatic pressure the pulmonary
vessels
• Result in increase of fluid filtration in to
interstitial spaces of the lung
• So lymph drains in to the alveolar space

13. • If the lymphatic flow becomes high fluid moves
from the pleura to the alveolar walls
• If the alveolar epithelium is damaged
• The fluid accumulates in the alveoli
• Hypoxemia
• Alveolar membrane is thickened by fluid

14. • So no exchange of O2 and carbandioxide
• Oxygen diffusion is impaired
• Then lead to pulmonary edema

15. Symptoms
 Coughing up blood or bloody froth
 Orthopnea: The inability to breathe easily except when sitting up
straight or standing
 paroxysmal nocturnal dyspnea refers to attacks of severe
shortness of breath and coughing that generally occur at night.
 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

16. 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 (sounds that are high-pitched)
 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)

17. 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

18. • Pulmonary Edema ... Multiple, thin, short,
white lines which are perpendicular to
the chest wall at the lung base are seen (white
oval) representing fluid which has
leaked ...around the lung space…

19. 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 .
•

20. 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.

21. 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

22. 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.

23. complication
Dysrrythmias Congestive heart failure which is due to
the heart's inability to pump the blood out of
the pulmonary circulation at a sufficient rate resulting
in elevation in wedge pressure and pulmonary edema -
this may be due to left ventricular failure, arrhythmias,
or fluid overload,
Respiratory failure Pulmonary edema is fluid
accumulation in the tissue and air spaces of the lungs.
It leads to impaired gas exchange and may
cause respiratory failure. ...