Pulmonaryedema 160624071007

om verma
msc lecturer medical surgical nursing

1. Pulmonary Edema PREPARED BY : MR. OMPRAKASH VERMA Msc LECTURER MEDICAL SURGICAL NURSING RELIANCE INSTITUTE OF NURSING

2. Anatomy of lung

3. DEFINITION Pulmonary edema is an abnormal buildup of fluid in the lungs. This build up of fluid leads to shortness of breath. Pulmonary edema is the abnormal accumulation of fluid in the interstitial spaces surrounding the alveoli with the advancement of fluid accumulation in the alveolar spaces.

4. Con…………………………………………. Pulmonary edema is an accumulation of fluid in the alveoli and interstitial spaces of the lungs. Cardiogenic pulmonary edema  (CPE) is defined as pulmonary edema  due to increased capillary hydrostatic pressure secondary to elevated  pulmonary  venous pressure. ... Damage to the alveolar-capillary barrier.

5. TYPES OF PULMONARY EDEMA 1. CARDIOGENIC PULMONARY EDEMA 2. NON CARDIOGENIC PULMONARY EDEMA

6. 1. CARDIOGENIC PULMONARY EDEMA Pulmonary edema is either due to direct damage to cardiac tissue or a result of inadequate function of the heart or circulatory system Causes- 1. congestive heart failure Arrthythmias Fluid overload due to kidney failure

7. 2. NON CARDIOGENIC PULMONARY EDEMA Define as the radiographic evidence of alveolar fluid accumulation without hemodynamic . (flow of blood within the organs and tissues of the body) Causes- Inhalation of toxic gases Aspiration E.g.. Gastric fluid or incase drowing Multiple blood transfusion Several infection

8. CAUSES Congestive cardiac failure Heart attack, Cardiomyopathy Leaking or narrowed heart valves (mitral or aortic valves) Sudden, severe high blood pressure. Certain medicines High altitude exposure Kidney failure kidneys  do not remove excess fluid and waste products from the body, and the excess fluid accumulates in the lungs. Narrowed arteries that bring blood to the kidneys Lung damage caused by poisonous gas or severe infection Major injury

9. HTN   pulmonary edema , such as  high blood pressure due  to narrowed kidney arteries (renal artery stenosis ) and fluid buildup  due  to kidney disease or heart problems.

10. congestive  heart failure  congestive  heart failure . When the  heart  is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.

11. Cardiomyopathy is a condition in which the heart becomes enlarged and cannot ... Left or right ventricular systolic pump function of the heart is impaired,  leading  to progressive heart ... A person suffering from dilated  Cardiomyopathy  may have an enlarged heart, with  pulmonary edema  

12. PATHOPHYSIOLOGY Due to etiological factors Increase hydrostatic pressure the pulmonary vessels Result in increase of fluid filtration in to interstitial spaces of the lung So lymph drains in to the alveolar space

13. If the lymphatic flow becomes high fluid moves from the pleura to the alveolar walls If the alveolar epithelium is damaged The fluid accumulates in the alveoli Hypoxemia Alveolar membrane is thickened by fluid

14. So no exchange of O2 and carbandioxide Oxygen diffusion is impaired Then lead to pulmonary edema

15. Symptoms Coughing up blood or bloody froth Orthopnea : The inability to breathe easily except when sitting up straight or standing  paroxysmal nocturnal dyspnea  refers to attacks of severe shortness of breath and coughing that generally occur at night. Grunting , gurgling, or wheezing sounds with breathing Problems speaking in full sentences because of shortness of breath Anxiety or restlessness Decrease in level of consciousness Leg or abdominal swelling Pale skin Excessive Sweating

16. Examinations The health care provider will listen to your lungs and heart with a stethoscope to check for: Abnormal heart sound Crackles  in your lungs, called rales ( sounds that are high-pitched) Increased heart rate (tachycardia) Rapid breathing (tachypnea) The health care provider will perform a thorough physical exam. Leg or abdominal swelling Abnormalities of your neck veins (which can show that there is too much fluid in your body) Pale or blue skin color (pallor or cyanosis )

17. Diagnostic test Blood chemistries Blood oxygen levels( oximetry or arterial blood gases) Chest x-ray Complete blood count (CBC) Echocardiogram (ultrasound of the heart) to see if there are problems with the heart muscle Electrocardiogram ( ECG ) to look for signs of a heart attack or problems with the heart rhythm

18. Pulmonary Edema  ... Multiple, thin, short, white lines which are perpendicular to the  chest  wall at the lung base are seen (white oval) representing fluid which has leaked ...around the lung space…

19. Treatment Pulmonary edema is almost always treated in the emergency room or hospital. You may need to be in an intensive care unit (ICU). Oxygen is given through a face mask or tiny plastic tubes are placed in the nose. A breathing tube may be placed into the windpipe (trachea) so you can be connected to a breathing machine (ventilator) if you cannot breathe well on your own. The cause of edema should be identified and treated quickly. For example, if a heart attack has caused the condition, it must be treated right away. Medicines that may be used include: Diuretics that remove excess fluid from the body Medicines that strengthen the heart muscle, control the heartbeat, or relieve pressure on the heart .

20. pharmacological management Morphine : reduce anxiety Diuretic therapy : reduce fluid overload and pulmonary congestion Vasodialator therapy ( nitroglycerine) : reduce the amount of blood returning to the heart and reduces resistance heart must pump. Contractility enhancement therapy: ( Digoxin,dopamine , dobutamine ) Improves the , ability of the heart muscle to pump more effectively, allowing for complete emptying of blood from left ventricle and a subsequent decrease in fluid backing up in to the lungs. Aminophylline : Prevent bronchospasm associated with pulmonary congestion .

21. Initial nursing care Supplimental oxygen with face mask Elevate the head side and keep sitting posture Monitor vital signs Iv line Catheterization Cardiac monitoring Ecg Pulse oxymetry

22. Nursing care Help the patient relax to promote oxygenation. Place the patient in high Fowler’s position to enhance lung expansion. Administer oxygen as ordered. Carefully record the time morphine is given and the amount administered. Assess the patient’s condition frequently. Watch for complications of treatment such as electrolyte depletion. Monitor vital signs every 15 to 30 minutes or more often as indicated. Urge the patient to comply with the prescribed medication regimen to avoid future episodes of pulmonary edema. Explain all procedure to the patient and his family. Emphasize reporting early signs of fluid overload. Review all prescribed medications with the patient. Discuss ways to observe physical energy.

23. complication Dysrrythmias Congestive heart failure which is due to the heart's inability to pump the blood out of the  pulmonary  circulation at a sufficient rate resulting in elevation in wedge pressure and  pulmonary edema  - this may be due to left ventricular failure,  arrhythmias , or fluid overload,  Respiratory failure Pulmonary edema  is fluid accumulation in the tissue and air spaces of the lungs. It  leads  to impaired gas exchange and may cause  respiratory failure . ...