Pulmonary Edema: Causes, Symptoms, and Treatment

Pulmonary Edema

• Occurs when the left ventricle fails to eject sufficient blood, increasing pressure in the lungs, leading to fluid leakage into the lung airways.
• Pink frothy sputum is a key manifestation.
• Other manifestations include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, tachypnea, tachycardia, cyanosis, and crackles.
• Cardiogenic risk factors include left-sided heart failure, acute myocardial infarction, mitral valve disease, and hypertension.
• Non-cardiogenic risk factors include pneumonia, inhalation injury, sepsis, airway obstruction, and high altitude.
• Medications include Furosemide, Nitroglycerin, Morphine, ACE inhibitors, or ARBs.
• Treatment involves oxygen therapy, diuretics, vasodilators, inotropic agents, and addressing the underlying cause.
• Nursing interventions include monitoring vital signs and oxygen saturation, assessing lung sounds, administering medications, and positioning the patient upright.
• Focus on fall precautions, patient education on fluid and sodium restrictions, monitoring for electrolyte imbalances, and encouraging smoking cessation for safety and nursing care.

Pulmonary Embolism

• PE is a collection of particulate matter that enters venous circulation and lodges in pulmonary vessels.
• Blood clots are the most common cause. Fat emboli are common in long bone breaks.
• Prolonged immobility, recent surgery, central venous catheters, DVT history, cancer, smoking, obesity, estrogen contraceptives, pregnancy, postpartum, and age over 60 are risk factors.
• Clinical manifestations include sudden dyspnea, pleuritic chest pain, hemoptysis, tachypnea, tachycardia, hypotension, and anxiety.
• Treatments include anticoagulation, thrombolytic therapy, surgical embolectomy, or IVC filter placement.
• Medications include Heparin (protamine sulfate antidote), Warfarin (vitamin K antidote), FFP, DOACs, and tPA.
• Nursing interventions include monitoring for bleeding, assessing respiratory status, administering medications, and educating the patient on medication adherence and bleeding precautions.
• Labs show low PACO2 on ABG, elevated troponin, BNP, and D-dimer.
• Safety and basic care involve fall precautions, avoiding invasive procedures, encouraging early ambulation, and providing emotional support.

Chest Trauma

• Motor vehicle accidents, blunt force trauma, rib fractures and occupational accidents are risk factors
• Can result in pulmonary contusion
• Tension pneumothorax involves a collapsed lung where trapped air causes tracheal deviation.
• Flail chest occurs when two or more ribs are broken in multiple places.
• Manifestations include chest pain, dyspnea, cyanosis, decreased breath sounds, hemorrhage and edema in alveoli, hypotension, and tachycardia.
• Treatments involve airway management, oxygen therapy, chest tube insertion, pain management, and surgical repair.
• Medications include analgesics, antibiotics, and sedatives/muscle relaxants if mechanical ventilation is required.
• Nursing interventions include monitoring respiratory status, assessing for pneumothorax or hemothorax, maintaining chest tube drainage, positioning the patient for optimal breathing, and administering pain medications.
• Prevent further injury, educate on deep breathing exercises, monitor for complications, and ensure proper chest tube management for safety and basic care.

Chest Tubes

• Chest tubes are inserted into the pleural space.
• They drain fluid, blood, or air, facilitate lung expansion, reestablish negative pressure, and restore intrapleural pressure.
• Remove chest tubes after lung re-expansion or when fluid drainage ceases.
• Disposable three-chamber drainage systems are commonly used, with chambers for drainage collection, water seal, and suction control.
• Indications include pneumothorax, hemothorax, postoperative drainage, pleural effusion, and pulmonary empyema.
• Client presentation may include dyspnea, distended neck veins, hemodynamic instability, pleuritic chest pain, cough, absent breath sounds, hyperresonance (pneumothorax), dullness (hemothorax/effusion), and asymmetrical chest wall motion.
• Monitor the water seal chamber for continuous bubbling (air leak).
• If an air leak is observed, locate the source and intervene.
• Notify the provider if an air leak is noted.
• If the tubing separates, instruct the client to exhale and cough.
• If the drainage system is compromised, immerse the tube end in sterile water.
• If the tube is accidentally removed, dress the area with dry, sterile gauze.

Acute Respiratory Failure

• ARF can result from ventilation failure, oxygenation failure, or a combination of both.
• Oxygenation failure (type 1) causes hypoxemic respiratory failure, with O2 struggling to move into the blood due to decreased perfusion
• Ventilation failure (type 2) causes air movement that is inadequate while blood movement remains normal.
• Classified by ABG abnormalities.
• Combination involves impaired gas exchange and lung perfusion.
• Risk factors include young or advanced age, viral or bacterial infections, lack of immunizations, environmental contaminants, tobacco smoke, substance use, chronic lung disease, and mechanical ventilation.
• Clinical manifestations include dyspnea, changes in respiratory rate, decreased O2 saturation, restlessness, irritability, agitation, tachycardia, tachypnea, confusion, fatigue, and cyanosis.
• Interventions/Tx/Medications: Nebulized bronchodilators, anti-inflammatory agents and coricosteroids.
• O2 therapy is used if acute hypoxemia. Maintain PaO2 levels above 60mmHg.
• Supportive care involves anxiety reduction, comfortable positioning, energy conservation, and encouraging deep breathing.

Acute Respiratory Distress Syndrome

• ARDS is ARF with refractory hypoxemia, decreased pulmonary compliance, dyspnea, non-cardiac-associated bilateral pulmonary edema, and dense pulmonary infiltrates on X-ray.
• ARDS is not a primary diagnosis.
• It is caused by widespread inflammation leading to damage of the alveolar-capillary membranes.
• Clinical manifestations include hyperpnea, tachypnea, hypoxemia, noisy respiration, cyanosis, pallor, retractions, hypotension, tachycardia, and dysrhythmias.
• Diagnostic assessment reveals a lowered partial pressure of arterial oxygen (PaO2) with a low P/F ratio.