Pulmonary Edema

Pathophysiology

Findings

Medications

What is pulmonary edema?
Accumulation of fluid in the extravascular spaces of the lung. A common complication of cardiovascular disorders
May be chronic or acute.
Possibly becoming fatal rapidly

Pulmonary edema results from increased pulmonary capillary hydrostatic pressure or decreased colloid osmotic pressure. Normally, the two pressures are in balance.

If pulmonary capillary hydrostatic pressure increases, the compromised left ventricle needs higher filling pressures to maintain adequate output; these pressures are transmitted to the left atrium, pulmonary veins, and pulmonary capillary bed.

Fluids and solutes are then forced from the intravascular compartment into the lung interstitium. With fluid overloading the interstitium, some fluid floods peripheral alveoli and impairs gas exchange.

If colloid osmotic pressure decreases, the pulling force that contains intravascular fluids is lost, and nothing opposes the hydrostatic force. Fluid flows freely into the interstitium and alveoli, causing pulmonary edema. (See How pulmonary edema develops.)

What are the types of causes?

  • Heart disease or injury
  • Smoke or harmful fume inhalation
  • Shock
  • Multiple Trauma
  • Drug overdose
  • Pancreatitis
    -Hematologic or immunologic disorders
  • High altitude (HAPE, pulmonary edema)
  • Lung disease or injury
    -Lung disease or injury such as acute respiratory distress syndrome (ARDS)

What are the Risk Factors?

  • Arrythmias
  • Acute myocardial ischemia and infarction
  • Diastolic dysfunction
  • Fluid Overload
  • Impaired pulmonary lymphatic drainage
  • inhalation of irritating gases
  • left atrial myxoma
  • Left-sided heart failure
  • Pneumonia
  • Pulmonary venous-occlusive disease
  • Valvular heart disease

Antibiotics: For management of infection. If the cause is infection.
Meds: Penicillin. Cephalosporins

Diuretics: To reduce fluid accumulation. Especially in cardiogenic cause.


Furosemide . Spironolactone

Vasodilators: Dilate blood vessels and take the pressure load off the heart's left ventricle.


Nitroprusside . Morphine

Calcium channel blockers: Usually recommended for high altitude pulmonary edema.


Nifedipine

Procedures:


Tracheal intubation: To facilitate ventilation


Suction Catherization: To remove the fluids.

Interventions

Therapy:
Oxygen therapy: To maintain oxygen levels in the blood.


Hyperbaric therapy: Also known as hyperbaric oxygen therapy, is usually recommended for high altitude pulmonary edema.

Patient Teachings

Foods to eat: Eat a healthy diet of fruits, whole grains and vegetables.


Foods to avoid:


Foods high in salt content

Symptoms:

  • Chest pain
  • Coughing up frothy sputum
    -Difficulty breathing (dyspnea)
    -Hemoptysis
    • coughing blood
      -Wheezing
  • Increased heart rate
  • Anxiety
    -Excessive sweating
    -Dizziness
    -Increased breathing rate

-Restlessness and anxiety
-Rapid, labored breathing
-Diaphoresis
-Nasal flaring
-Intense, productive cough
-Frothy, bloody sputum
-Intercostal retractions
-Mental status changes
-Jugular vein distention
-Pulsus alternans
-Sweaty, cold, clammy skin
-Wheezing
-Crackles
-S3
-Tachycardia
-Pleural effusion
-Hypotension
-Thready pulse
-Peripheral edema
-Hepatomegaly

Diagonsis:

Arterial blood gas (ABG) analysis shows hypoxemia, hypocarbia, or respiratory alkalosis.

White blood cell count may reveal leukocytosis.

Plasma brain natriuretic peptide (BNP) is greater than 100 pg/mL.

Serum creatinine and blood urea nitrogen levels may be decreased secondary to decreased renal perfusion.

Chest X-rays show diffuse haziness of the lung fields, cardiomegaly, and pleural effusion.
Echocardiography reveals cardiac dysfunction.

DX:
Anxiety
Excess fluid volume
Fear
Impaired gas exchange
Ineffective coping
Risk for decreased cardiac perfusion

Give prescribed drugs; if the patient is experiencing acute cardiogenic pulmonary edema

give nitroglycerin sublingually every 5 minutes for 3 doses to ensure rapid preload reduction

Administer supplemental oxygen based on oxygen saturation levels and arterial blood gas

Place the patient in high Fowler's position to maximize chest expansion.

Provide a well-balanced, low sodium diet; restrict fluids if ordered.

Allow the patient to verbalize his feelings and concerns; provide emotional support and explanations in terms that the patient can understand.

Monitor vitals signs and obtain weight and height.