Acute Pulmonary Edema
Under Supervision Of
Pro . Heba Abd Elazem
Dr. Asmaa Sayed Ahmed
Prepared by
Aya Said Mahmoud El.Rahmany
Medical surgical department
Frist term
Second year
2022-2023
Outline-:
• Introduction
• Definition
• Pathophysiology

Causes
• Risk factors
• Signs and symptoms
• Complications
• Prevention
• Diagnosis
• Treatment
• Nursing Care plan
• Summary
• Reference
Introduction
How Does Blood Flow Through Your Lungs ?
Once blood travels through the pulmonic valve, it enters your lungs.
This is called the pulmonary circulation. From your pulmonic valve,
blood travels to the pulmonary artery to tiny capillary vessels in the
.lungs
Here, oxygen travels from the tiny air sacs in the lungs, through the
walls of the capillaries, into the blood. At the same time, carbon
dioxide, a waste product of metabolism, passes from the blood into
the air sacs. Carbon dioxide leaves the body when you exhale. Once
the blood is purified and oxygenated, it travels back to the left atrium
through the pulmonary veins.
In a process called diffusion, oxygen moves from the alveoli to the
blood through the capillaries (tiny blood vessels) lining the alveolar
walls. Once in the bloodstream, oxygen gets picked up by the
hemoglobin in red blood cells.
Definition :Pulmonary Edema is a condition characterized by
fluid accumulation in the lungs caused by
extravasation of fluid from pulmonary vasculature in
to the interstitium and alveoli of the lungs .
Pathophysiology :Pulmonary edema is often caused by 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. This fluid
reduces normal oxygen movement through the lungs. These
two factors combine to cause shortness of breath.
Causes :Pulmonary edema is often caused by 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. This fluid
reduces normal oxygen movement through the lungs. These
two factors combine to cause shortness of breath.
Congestive heart failure that leads to pulmonary edema may
be caused by :-
Heart attack, or any disease of the heart that weakens or
)stiffens the heart muscle (cardiomyopathy
Leaking or narrowed heart valves (mitral or aortic valves)
Sudden, severe high blood pressure (hypertension)
Pulmonary edema may also be caused by :
- 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
Risk factors :Most pulmonary edema is caused by an underlying problem
with your heart (usually congestive heart failure). This
type of pulmonary edema is called cardiogenic pulmonary
edema. When pulmonary edema isn’t related to a heart
condition, it’s called non-cardiogenic pulmonary edema
In addition to heart-related causes, other common risk
factors for pulmonary edema include :
- Hypertension (high blood pressure)
- Kidney disease or kidney failure
- Obesity
- Diabetes
- Severe asthma
- Pneumonia
- Lung infection
- Sepsis (widespread infection) or blood infection
- Smoke or toxin inhalation
- Illicit drug use or overdose
- Alcohol abuse
- Exposure to high altitudes
- Near drowning
- Severe trauma or injury
Sign and symptoms :Sudden (acute) pulmonary edema symptoms :1 - Difficulty breathing (dyspnea) or extreme shortness of
breath that worsens with activity or when lying down
2 - A feeling of suffocating or drowning that worsens when
lying down
3- A cough that produces frothy sputum that may have blood
4- Anxiety, restlessness or a feeling that something bad is about
to happen
5 -Cold, clammy skin
6 - Wheezing or gasping for breath
Complications :Complications of pulmonary edema depend on the cause
In general, if pulmonary edema continues, the pressure in
the pulmonary artery can rise (pulmonary hypertension).
Eventually, the heart becomes weak and begins to fail, and
pressures in the heart and lungs go up .
Pulmonary edema complications may include :- Breathing difficulty
- Swelling of the legs, feet and belly area
- Buildup of fluid in the membranes that surround the lungs
) pleural effusion)
- Congestion and swelling of the liver
- Immediate treatment is necessary for acute pulmonary
edema to prevent death .
Prevention :You may be able to prevent pulmonary edema by managing
existing heart or lung conditions and following a healthy
lifestyle .
For example, controlling cholesterol and blood pressure can
help lower the risk of heart disease. Follow these tips to
keep your heart healthy
Eat a healthy diet rich in fresh fruits, vegetables, whole
grains, fat-free or low-fat dairy, and a variety of proteins
. Don't smoke
. Get regular exercise
. Limit salt and alcohol
. Manage stress
. Manage
weight
Diagnosis :Tests that can help diagnose pulmonary edema or
determine the reason for fluid in the lungs include
1 . chest X-ray can confirm the diagnosis of pulmonary edema and
exclude other possible causes of shortness of breath. It's usually the first
.test done when a health care provider suspects pulmonary edema
2. Chest computerized tomography (CT) scan. A chest CT scan
gives more details about the condition of the lungs. It can help a
.provider diagnose or rule out pulmonary edema
3. Pulse oximetry. A sensor is attached to a finger or ear. It uses light
.to determine how much oxygen is in the blood
4. Arterial blood gas test. This test measures the amount of oxygen
.and carbon dioxide in the blood
5. B-type natriuretic peptide (BNP) blood test. Increased levels of
.BNP may signal a heart condition
6. Other blood tests. Blood tests to diagnose pulmonary edema and
its causes also usually include a complete blood count, metabolic panel
.to check kidney function and thyroid function test
7. Electrocardiogram (ECG or EKG). This painless test detects and
records the timing and strength of the heart's signals. It uses small
sensors (electrodes) attached to the chest and sometimes to the arms or
legs. Wires attach the sensors to a machine, which displays or prints
results. An ECG can show signs of heart wall thickening or previous heart
attack. A portable ECG device such as a Holter monitor may be used to
.continuously monitor the heartbeat at home
8. Echocardiogram. An echocardiogram uses sound waves
(ultrasound) to create pictures of the beating heart. It can identify areas
of poor blood flow, heart valve issues and heart muscle that is not
working properly. An echocardiogram can help diagnose fluid around
the heart
9. Cardiac catheterization and coronary angiogram. This test
may be done if other tests don't show the cause of pulmonary edema,
or when there's also chest pain. It helps health care providers see
blockages in the heart arteries. A long, flexible tube (catheter) is inserted
in a blood vessel, usually in the groin or wrist. It's guided to the heart.
Dye flows through the catheter to arteries in the heart. The dye helps
.the arteries show up more clearly on X-ray images and video
10. Ultrasound of the lungs. This painless test uses sound waves to
measure blood flow through the lungs. It can quickly reveal signs of fluid
buildup and plural effusions
Treatment :-
The first treatment for acute pulmonary edema is oxygen.
Oxygen flows through a face mask or a flexible plastic tube with
two openings (nasal cannula) that deliver oxygen to each
nostril. This should ease some symptoms
A health care provider monitors the oxygen level. Sometimes it
may be necessary to assist breathing with a machine such as a
mechanical ventilator or one that provides positive airway
pressure.
Depending on the severity of the condition and the reason for
the pulmonary edema, treatment might include one or more of
the following medications :
Diuretics. Diuretics, such as furosemide (Lasix), decrease the
pressure caused by excess fluid in the heart and lungs .
Blood pressure drugs. These help manage high or low blood
pressure, which can occur with pulmonary edema. A provider
may also prescribe medications that lower the pressure going
into or out of the heart. Examples of such medicines are
nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside
(Nitropress)
Inotropes. This type of medication is given through an IV for
people in the hospital with severe heart failure. Inotropes
improve heart pumping function and maintain blood pressure.
Morphine (MS Contin, Infumorph, others). This narcotic may
be taken by mouth or given through an IV to relieve shortness
of breath and anxiety.
But some care providers believe that the risks of morphine may
outweigh the benefits. They're more likely to use other drugs
It is important to diagnosis and treat, if possible, any nervous
..system problems or causes of heart failure
Nursing Diagnosis for Pulmonary Edema
1. Nursing Diagnosis : Impaired Gas Exchange related to pulmonary
edema as evidenced by shortness of breath, SpO2 level of 85%,
productive cough, and frothy phlegm
2. Nursing Diagnosis : Ineffective Breathing Pattern related to
pulmonary edema as evidenced by shortness of breath .
3. Nursing Diagnosis : Excess Fluid Volume related to impaired
regulatory mechanism secondary to pulmonary edema and heart failure
as evidenced by orthopnea, presence of S3 heart sound, presence of
adventitious breath sounds, oliguria, edema, jugular venous distension,
positive hepatojugular reflux, alterations in blood pressure, weight gain
over a short period of time, and pulmonary congestion
4. Nursing Diagnosis : Anxiety related to breathlessness from
inadequate oxygenation secondary to pulmonary edema
5. Nursing Diagnosis : Fatigue related to an imbalance between oxygen
supply and demand secondary to pulmonary edema as possibly
.evidenced by limited range of motion and weakness
nursing care plan
Nursing diagnosis
Impaired Gas
Exchange related to
pulmonary edema
as evidenced by
shortness of breath,
SpO2 level of 85%,
productive cough,
and frothy phlegm
Expected
outcomes
1) The patient
will maintain
optimal gas
exchange
Implementation
Rationale
- Administer
supplemental
oxygen, as
prescribed.
Discontinue if
SpO2 level is
above the target
range, or as
ordered by the
physician.
To increase the
oxygen level and
achieve an SpO2
value within the
target range
-Assess the
patient's vital
signs, especially
the oxygen
saturation and
characteristics
of respirations
at least every 4
hours. Also,
monitor the
results of ABG
.analysis
Allow the
1) The patient
patient to
Anxiety related to
will cope with
express anxious
breathlessness from anxiety through sensations and,
inadequate
establishing
if possible,
oxygenation
.coping patterns evaluate
secondary to
anxietypulmonary edema
2)The patient
provoking
will
situations
To assist in
creating an
accurate
diagnosis and
monitor
effectiveness of
medical
treatment. ABG
Analysis: To
check if there is
an increase in
PaCO2 and a
decrease in
PaO2, which are
the signs of
hypoxemia and
respiratory
.acidosis
Talking about
anxiety-inducing
situations and
thoughts can
help the patient
see things more
clearly and
recognize
anxiety-related
Evaluation
----------------
-----------------
demonstrate
enhanced
concentration
.
3) The patient
will distinguish
strategies
Assist the
patient in
learning new
techniques for
lowering anxiety
(e.g., relaxation
and deep
breathing
exercises,
positive
visualization,
and reassuring
self
..)statements
elements.
The patient can
control anxiety
in a variety of
ways by learning
new coping
.methods
Summary
Pulmonary edema—defined as excessive extravascular water in
the lungs—is a common and serious clinical problem.
Pulmonary edema can be life-threatening, but effective therapy
is available to rescue patients from the deleterious
consequences of disturbed lung fluid balance, which usually can
be identified and, in many instances, corrected. Because
rational and effective therapy depends on understanding basic
principles of normal and abnormal liquid, solute, and protein
transport in the lungs, this chapter begins with a brief overview
of the major factors that govern fluid and protein filtration in
healthy lungs before focusing on the pathophysiology of
pulmonary edema. Next, the chapter discusses diagnosis,
treatment, and resolution of pulmonary edema. Chapters 6 and
9 also provide additional information about the regulation of
fluid balance in the lungs, and Chapter 100 includes details
about the onset and management of acute lung injury and
acute respiratory distress syndrome, as currently defined and
.subsequently discussed
Reference
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ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli
GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A
Textbook of Cardiovascular Medicine. 12th ed. Philadelphia,
.PA: Elsevier; 2022:chap 50
Meyer NJ, Matthay MA. Pulmonary edema. In: Broaddus VC,
Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of
Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier;
.2022:chap 133
Rogers JG, O'Connor CM. Heart failure: pathophysiology and
diagnosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil
Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 52