Acute Pulmonary Edema

Pulmonary Edema: Definition

Abnormal accumulation of fluid in the interstitial spaces and alveoli of the lung

•Life-threatening condition

•Associated with acute decompensated HF

Pulmonary edema Results from

•left ventricular failure

•AMI or acute exacerbation of CHF

•Non- cardiac disorders (renal failure)

Left ventricle fails

-=> blood backs up into left atrium=>

-Rapid increase in atrial pressure=> increased pulmonary venous pressure=> interstitial edema

-"flash pulmonary edema"

left sided HF

-affects the lungs

-crackles

-SOB

-dyspnea

-orthopnea

-pink frothy sputum

-paroxysmal nocturnal dyspnea

-pulmonary edema

-hypoxia

-change LOC

-IMPAIRED gas exchange

-cough

for left sided HF

-pulmonary artery wedge pressure (4-12)

Right sided HF

-JVD

-ascites

-hypervolemia

-anorexia

-hepatomegaly

-weight gain

-peripheral edema

-hypertension

-nausea

-weakness

for r sided HF what do we look at

CVP

Right sided HF interventions

-I/O

-daily weight (same time each day)

-educate

-diuretics

-LOW NA/ fluid restriction diet

-restrictive clothing

L sided HF interventions

-elevate HOB

-OXYGEN

-diuretics

-pulse ox continuous

-ABG

can HF be acute

yes

Chronic congestive failure can have acute episode

they stop taking meds/ have a trigger

-have their sx coming out at that moment

fluid builds from the

bases

-important to listen for breath sounds, if their is fluid in the lungs patients cannot exchange gasses

how will pulmonary edema patients look

-dusky

-pale

-no gas exchange

-drowning from within

Clinical Manifestations of pulmonary edema

•Decreased cerebral oxygenation

•Confusion, anxious, restless→stuporous

•Sudden dyspnea

•Sense of suffocation

•Cold, moist, pale

•Weak, rapid pulse

•Cyanosis/ashen (Skin/nail beds)

•Neck vein distention

•Cough

•Breathing is rapid, noisy

•"Drowning in secretions"

•Decreased oxygen saturations

•Sputum→ pink, frothy sputum (Fluid within alveoli mixes with air)

physical assessment for pulmonary edema

•ABC evaluation

•Vital signs

•Cardiac monitor

•IV access

diagnostic tests for pulmonary edema

•Electrolytes

•BUN/Creatinine

•CBC

•CXR

•Right vs. Left

pulmonary edema on an xray

prevention of pulmonary edema

•Easier to prevent than treat

•Assess for early indicators

early stages of pulmonary edema you need to

•Upright position

•Legs dependent

•Eliminate overexertion

•Minimize stress

Patient education

pulmonary edema medical management

•Correct the underlying disorder

goals for medical management

•Reduce volume overload

•Improve ventricular function

•Increase respiratory exchange

what interventions do you do

-oxygen

-diuretics

-Vasodilators

-nursing actions

Oxygen Therapy

•Relieve hypoxemia and dyspnea

•NRB

•NIPPV

•Endotracheal intubation

•Mechanical ventilation

Diuretics

•Loop diuretic (IV)

•BP monitoring

•U/O monitoring

•I/O

•Daily weights

•Electrolytes

Vasodilators

•IV nitroglycerin

•IV nitroprusside

•Monitor BP

Nursing Management

•Upright

•Legs dangling

•Psychological support

•Monitoring medications

nursing management pt 2

•Assisting with intubation

•Administer oxygen/monitor hypoxia

•Administer and monitor response to medication

•I/O

•VS

•N/V

•EKG monitoring

•Electrolytes

•Position to promote optimal circulation

•Provide psychological support