Pulmonary Edema

Pulmonary edema It’s life threatening condition is defined

as abnormal accumulation of fluid in the lung tissue and/or alveolar space.

Pathophysiology/ Etiology

The present of fluid in the alveolio impedes gas exchange especially oxygen movement into pulmonary capilary.

Pathophysiology/ Etiology Pulmonary edema most commonly occurs as a result of

increase micro vascular pressure from abnormal cardiac function.

If cause is : Heart disease “ cardiovascular disease” e.g. Acute left ventricular failure, MI, aortic stenosis,

sever mitral valve disease, hypertension, CHF. Inadequate left ventricular Function Fluid begins to leak to interstitial space and the alveoli

Hypervolemia “circulatory overload” lead to increase intravascular pressure in the lung.

If cause is lung injuries.

A) Flash pulmonary edema

e.g. Pt who has undergone pneumoectomy Remove of one lung or partial of lung

Cardiac output goes to remaining lung.

If pt fluid is not montoring closly.

Pulmonary edema

Note

This pulmonary edema still until pt’s pulmonary vasculature attempt to adapt.

Pathophysiology/ Etiology

B) Re-expansion pulmonary edema.

this caused by rapid reinflation of the lung after removal of the air from pneumothorax or evacuation of fluid from a large pleural effusion.

Other causes:

- Hypervolemia “circulatory overload”

- Infections pneumonia.

- Organophesphorous poisoning.

Clinical manifestation:

Dyspnea, orthopnea. Note: pt usually uses accessory muscle of respiration with

retraction of intracostal space and supera-clavicular areas. Cough with varying amount white-or-pink tinged frothy

sputum. Air hunger and central cyanosis. Noisy breathing “inspiration and expiratory wheezing and

bubbling sounds. Distended neck veins. Respiratory distress: 1- anxiety, ayitated 2- confusion or stuporous Tachycardia, hypotension , shock

Diagnostic Evaluation Auscultation reveals crackles. Chest x-ray show interstitial marking “edema” Pulse oximetry, ABG reveals hypoxemia. measuring of pulmonary artery wedge

pressure by Swan-Gam catheter.

Management 1.The immediate objectives are: a- improve oxygenation. b- reduce pulmonary congestion.2. Identify and correct of precipitation factors to prevent

recurrence.3. Increase oxygen tension a- Reduce fluid volume by diuretics and vasodilators” b- Improving heart ability to pump “glycoside, beta

agonists” c- Decease anxiety 4. Oxygen therapy a- Use high oxygen flow. b- Intubations and Mechanical ventilation

Cont.. 5- Morphine sulfate to: a- Reduce anxiety. b- Venous pooling of blood in the periphery. c- Reduce resistance against which the heart must

pump.6- Vasodilator therapy “Nitroglycerin” - to reduce amount of blood returning to the heart. - to reduce resistance against which the heart most

pump.7- Diuretic therapy “lasix” - to reduce blood volume and pulmonary

congestion.

Cont..8- Contractility enhancement “Digoxin, dopamin,

aminophyllin to improve heart muscle to pump

complete emptying of blood from the ventricle.

Decrease fluid backing up into the lungs.

Aminophylline to prevent bronchospasm.

Complication Dysrhythmias. Respiratory failure.

Nursing Intervention Improve oxygenation Decrease anxiety.