3/10/2015
Pulmonary Edema
“Nursing care”
By: Karima mohamed
Italian hospital
Nozha international hospital
What’s pulmonary edema?
It’s the accumulation of
fluids in the alveoli and
interstitial spaces of the
lungs.
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Types
Points
Definition
Cardiogenic
Pulmonary edema is
either due to a direct
damage to the cardiac
tissue or a result of
inadequate functioning
of the heart or
circulatory system
Non- cardiogenic
The radiographic
evidence of alveolar
fluid accumulation
without hemodynamic
evidence to suggest
cardiogenic etiology
Cause
1- CHF (congestive heart
failure).
2- Severe arrhythmia.
3- HTN crisis.
4- fluid overload due to
kidney failure or
intravenous therapy.
1- Inhalation of toxic
gases.
2- Aspiration (gastric
fluid incase of
drowning).
3- multiple blood
transfusion.
4- severe infection.
Clinical manifestation
1- Cough and restlessness during sleep.
2- sudden onset of dyspnea.
3- severe anxiety, irritability.
4- cool, moist skin.
5- tachycardia.
6- orthopnea.
7- distended jugular veins.
8- noisy, wet respirations that do not clear with coughing.
9- cough with frothy, blood-tinged sputum.
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Diagnostic evaluation
1- Clinical findings on assessment.
2- Oxymetry or ABG values.
3- Chest X-rays. (for fluids in and around lung space or enlarged heart)
4- Echocardiogram (for valves).
5- Measurement for pulmonary artery wedge pressure by swan ganz
catheter.
6- Blood culture for suspected infection.
7- Cardiac markers for MI.
Management
1- oxygen therapy: high flow either by non-rebreather mask or
ETT intubation and mechanical ventilation
2- High fowlers position (HOB 90◦)
3- Morphine: decrease anxiety and resistance which the heart
must pump.
4- Diuretic therapy (lasix): reduces fluid overload and
pulmonary congestion.
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5- vasodilator therapy ( nitroglycerin): reduces amount of
blood returning to the heart and reduces the resistance that
the heart must pump.
6- contractility enhancement therapy (digoxin): improves
ability of the heart muscle to pump more effectively,
allowing for complete emptying of blood from the ventricle
and a subsequent decrease in fluid backing up in the lungs.
*Aminophylline: may prevent bronchospasm associated
with pulmonary congestion, Use with caution as it may
increase heart rate inducing tachydysrhythmia
Complications
1- Dysrrhythmias.
2- Respiratory failure.
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Nursing Alert and Diagnosis
1- Impaired gas exchange related to excess
fluid in the lungs.
2- anxiety related to sensation of suffocation
and fear.
Initial Nursing management
1- supplementary oxygen with face mask.
2- elevate the head side or keep it in sitting position.
3- monitor vital signs.
4- catheterization.
5- cardiac monitoring.
6- ECG.
7- pulse oxymetry.
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Nursing intervention
1- help the patient relax to promote oxygenation.
2- place the patient in high flower’s position to enhance lung
expansion.
3- administer oxygen as ordered.
4- carefully record the time morphine is given and the amount
administered.
5- assess the patient’s condition frequently.
6- be alert to development of a new non-productive cough.
7- osculate the lung fields for breath sounds and be alert for crackles
(rales)
8- monitor oxymetry and report the findings of < 92 %
9- monitor ABG results for presence of hypoxemia and hypercapnia.
10- monitor ECG for dysrrhythmia development that be related to
hypoxemia, acid-base imbalance, or ventricular irritability.
11- keep the emergency equipments ready (airway, ambu bag, intubation
tray)
12- closely monitor I/O chart.
13- record weight daily and report if steady gaining.
14- monitor vital signs every 15 – 30 mins.
15- provide frequent mouth care to reduce dryness of mucous membrane.
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16- keep environment calm and quiet.
17- be alert for signs of increasing respiratory distress
18- assess for edema especially in dependent areas such as
ankles and sacrum.
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