Pulmonary Edema: Causes, Symptoms, and Treatment

Pulmonary Edema

• Pulmonary edema is a life-threatening condition
• It is characterized by serous fluid accumulation in lung tissue and alveoli, leading to water in the lungs
• Untreated pulmonary edema can lead to drowning

Causes

• Myocardial infarction or heart failure: Ineffective pumping leads to fluid buildup
• Increased pressure in the left ventricle: Occurs due to left ventricular failure
• Rapid IV fluid infusion: Overloads the circulatory system
• Pulmonary embolism (PE): Blood clot obstructs blood flow
• Opioid overdose: Suppresses respiration

Signs and Symptoms

• Severe respiratory distress: Includes dyspnea, labored breathing, and use of accessory muscles
• Brothy pink sputum: Frothy appearance due to air bubbles
• Productive cough: Often accompanied by brothy pink sputum
• Restlessness, agitation, and disorientation: Caused by hypoxia
• Tachycardia and tachypnea: Common responses to hypoxia
• High blood pressure: Due to anxiety and stress
• Retractions and nasal flaring: Signs of increased breathing effort
• Sudden weight gain: Due to fluid buildup
• Decreased urinary output: Inability to eliminate excess fluid
• Cyanosis: Bluish skin discoloration due to low oxygen
• Cold extremities and diaphoresis: Signs of poor circulation
• Audible wheezing and crackles: Sounds due to fluid buildup in lungs

Diagnosis

• Signs and symptoms
• Chest x-ray: Reveals infiltrates and enlarged heart
• Arterial blood gas (ABG) analysis: May show respiratory acidosis or alkalosis

Medical Management

• Oxygen therapy: Improves oxygen levels
• Diuretics: Eliminate excess fluid
• Inotropic agents and cardiotonics: Improve heart's pumping ability
• Nitroglycerin (Nitro): Reduces pulmonary congestion and improves heart function
• Morphine: Reduces pain, anxiety, and preload, but may cause respiratory depression

Nursing Interventions

• Strict intake and output (I&O) monitoring and daily weight monitoring: Tracks fluid balance
• Evaluation of medication effectiveness: Monitors respiratory status and weight loss
• Assess respiratory and cardiac status: Monitors vital signs, breath sounds, and oxygen saturation
• Administer medications and oxygen as ordered
• Position in high Fowler's or orthopnic position: Improves breathing
• Explain procedures: Reduces anxiety
• Close monitoring of breath sounds: Assesses fluid buildup
• Saline lock for IV access: Allows medication administration
• Monitor vital signs, ABGs, and pulse oximetry: Assesses patient condition
• Oxygen therapy with Venturi or non-rebreather mask
• Mechanical ventilation: May be needed in severe cases
• Monitoring of laboratory values: Assesses response to treatment

Pulmonary Embolism (PE)

• Pulmonary embolism (PE) is an acute emergency
• PE is caused by a clot or foreign substance that travels to the lungs, obstructing blood flow

Causes

• Deep vein thrombosis (DVT): Most common source of clots
• Fat emboli: Occur after trauma or surgery
• Air emboli: Occur after certain medical procedures
• Tumor emboli: Occur when tumor pieces break off
• Amniotic fluid emboli: Occur during childbirth

Signs and Symptoms

• Sudden onset of chest pain: May be pleuritic
• Tachypnea and dyspnea: Due to reduced oxygen
• Apprehension: Feeling of impending doom
• Rales (crackles): Sounds due to fluid buildup
• Hemoptysis: Coughing up blood
• Shock: Occurs if a large portion of the lungs is affected
• Diminished breath sounds: Due to reduced airflow
• Elevated white blood cell count: Sign of inflammation
• Pleural friction rub: Grating sound due to pleura inflammation
• Hypoxia: Due to reduced oxygen
• Low blood pressure: Sign of shock
• Diaphoresis: Due to stress and anxiety

Diagnosis

• Signs and symptoms
• Chest x-ray: May be clear initially, but abnormalities may appear later
• D-dimer test: Blood test to help rule out a PE
• Computed tomography (CT) scan: Visualizes clot in lungs
• Ventilation/perfusion (V/Q) scan: Assesses blood flow and ventilation

Medical Management

• Anticoagulation therapy: Prevents further clot formation
• Thrombolytic therapy: Dissolves existing clots
• Oxygen therapy: Improves oxygen levels
• Mechanical ventilation: May be needed in severe cases

Nursing Interventions

• Monitor vital signs, breath sounds, and oxygen saturation
• Administer medications as ordered
• Position in high Fowler's position: Improves breathing
• Explain procedures: Reduces anxiety
• Monitor of laboratory values: Assesses response to treatment
• Blockage of one or more pulmonary arteries, usually by a blood clot from the legs or pelvis

Risk Factors

• History of DVT: Increased risk of PE
• Pregnancy and Postpartum: Increased blood coagulation
• Birth Control Pills: Increased risk of blood clots
• Immobilization: Prolonged bed rest or sitting increases risk

Diagnosis

• Arterial Blood Gases (ABGs): Determines oxygen levels
• Chest X-ray: Identifies lung abnormalities
• Spiral or Helical CT Scan: Detailed lung and blood vessel image
• VQ Scan: Evaluates air and blood circulation in lungs
• Pulmonary Angiography: Visualizes blood flow using dye
• D-dimer Blood Test: Detects protein fragment from clot breakdown

Nursing Interventions

• Bed Rest: Reduces further clot formation
• Head of Bed Elevated: Improves breathing
• Pain Management: Medications to manage pain
• Calm Environment: Reduces anxiety
• Lab Value Monitoring: Monitor blood clotting factors
• Bleeding Monitoring: Monitor for signs of bleeding
• Respiratory Status Monitoring: Monitor breathing rate, oxygen saturation, lung sounds
• TED Hose: Compression stockings to prevent clots
• Oxygen Therapy: Improves oxygen levels
• Turn, Cough, Deep Breathe: Clears airways
• Adequate Hydration: Thins blood and prevents dehydration
• Lower Extremity Elevation: Reduces swelling, improves blood flow
• Pedal Pulse Assessment: Ensures blood flow to feet
• Leg Circumference Measurement: Monitors for swelling
• Medication Education: Educate on medications, including anticoagulants
• Venous Pooling Prevention: Educate on preventing venous pooling
• Follow-up Lab Tests: Monitor anticoagulation therapy effectiveness
• Safety Precautions: Use soft toothbrush, electric razor, avoid going barefoot to reduce bleeding risk
• Medic Alert Bracelet: Informs emergency personnel about condition

Medications

• Heparin and Lovenox: Anticoagulants, typically in hospital
• Coumadin: Oral anticoagulant for long-term use
• Eliquis and Xarelto: Newer oral anticoagulants

Other Treatments

• Embolectomy: Surgical clot removal
• Filter Placement: Catches clots, prevents travel to lungs

Acute Respiratory Distress Syndrome (ARDS)

• ARDS is a severe lung injury causing alveolar fluid leakage

Causes

• Complications of Other Diseases: Pneumonia, sepsis, trauma
• Aspiration: Inhaling foreign material
• Renal Failure: Fluid overload
• COPD: Increases risk of ARDS

Pathophysiology

• Increased Alveolar Membrane Permeability: Allows fluid leakage
• Pulmonary Edema: Fluid buildup in the lungs
• Surfactant Alteration: Leads to alveolar collapse
• Hemorrhage: Damaged capillaries allow blood leakage

Diagnosis

• Pulmonary Function Tests: Assesses lung function
• Arterial Blood Gases (ABGs): Low oxygen, high carbon dioxide, low bicarbonate
• Chest X-ray: Shows infiltrates in the lungs

Clinical Manifestations

• Respiratory Distress: Shortness of breath (dyspnea)
• Tachypnea: Rapid breathing
• Hypotension: Low blood pressure
• Hypoxia: Low oxygen levels
• Nasal Flaring: Widened nostrils during breathing
• Intercostal Retractions: Indrawing of spaces between ribs
• Sternal Retractions: Indrawing of breastbone
• Cyanosis: Bluish skin due to low oxygen
• Crackles and Rhonchi: Abnormal lung sounds
• Tachycardia: Rapid heart rate
• Decreased Urinary Output: Reduced urine output

Treatment

• Treat the Underlying Cause: If possible
• Supportive Care: Primarily focuses on maintaining oxygenation
• Positive Pressure Oxygen: Mechanical ventilation
• PEEP (Positive End-Expiratory Pressure): Keeps alveoli open
• Paralysis and Sedation: Prevents fighting the ventilator
• Medications: Numerous medications to manage condition

Nursing Interventions

• Vital Sign Monitoring: Heart rate, blood pressure, respiratory rate, oxygen saturation

Learn about pulmonary edema, a life-threatening condition involving fluid accumulation in the lungs. This lesson covers its causes, including heart failure and opioid overdose, as well as key signs and symptoms like respiratory distress and pink sputum. Understand the urgent need for treatment to prevent drowning.