Pulmonary Edema

PULMONARY EDEMA (ACUTE HEART FAILURE)

Pulmonary edema is the abnormal accumulation of fluid in the lungs. The fluid may accumulate in the interstitial spaces or in the alveoli.

PULMONARY EDEMA

Pulmonary edema is usually caused by heart failure. As the heart fails, pressure in the vein going through the lungs starts to rise. As the pressure increases, fluid is pushed into the air spaces (alveoli). This fluid interrupts normal oxygen movement through the lungs, resulting in shortness of breath.

Clinical Manifestations             

restless and anxious breathlessness and a sense of suffocation hands become cold and moist cyanotic nail beds skin turns ashen (gray) weak and rapid pulse distended neck veins Incessant coughing mucoid sputum (blood-tinged, frothy fluid ) confused stuporous breathing is rapid, noisy, and moist sounding. oxygen levels (saturation) are significantly decreased

Assessment and Diagnostic Findings  Blood oxygen levels -- low in patients with pulmonary edema  Chest x-ray -- may reveal fluid in or around the lung space or an

enlarged heart  Ultrasound of the heart (echocardiogram) -- may show a weak

heart muscle, leaky or narrow heart valves, or fluid surrounding the heart

Prevention

 Like most complications, pulmonary edema is easier to prevent than to

treat. To recognize it in its early stages, the nurse:   

auscultates the lung fields and heart sounds, measures JVD, and assesses the degree of peripheral edema and the severity of breathlessness.

 Early indicators of developing pulmonary edema  dry, hacking cough;  fatigue  weight gain;  development or worsening of edema  decreased activity tolerance  In an early stage, the condition may be corrected by placing the patient in

an upright position with the feet and legs dependent, eliminating overexertion, and minimizing emotional stress to reduce the left ventricular load.

 Long-range approach to preventing pulmonary edema must be directed at

identifying its precipitating factors.

Medical Management  PHARMACOLOGIC THERAPY

Oxygen Therapy  Morphine  Diuretics  Dobutamine  Milrinone  Nesiritide 

Nursing Management POSITIONING THE PATIENT TO PROMOTE CIRCULATION

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The patient is positioned upright, preferably with the legs dangling over the side of the bed.

PROVIDING PSYCHOLOGICAL SUPPORT MONITORING MEDICATIONS NURSING ALERT Because of the resulting diuresis, the patient’s electrolyte levels, especially potassium and sodium, need to be monitored closely. Fluid balance in some patients is very brittle; they easily become hypovolemic or hypervolemic with small changes in the amount of circulating fluid. Falling blood pressure, increasing heart rate, and decreasing urine output indicate that the circulatory system is not tolerating diuresis and that measures must be taken to reverse the fluid imbalance that has occurred. Serum creatinine is monitored to assess renal function. Men with prostatic hyperplasia must be observed for signs of urinary retention.