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1. RATHEESH R.L
PULMONARY EDEMA

2. DEFINITION
Pulmonary Edema is a condition
characterized by fluid accumulation in the
lungs caused by extravasation of fluid
from pulmonary vasculature in to the
interstitium and alveoli of the lungs

3. ALTERNATIVE NAMES:
 Lung/pulmonary congestion
 Lung water

4. CAUSES AND RISK FACTORS
 CARDIOGENIC CAUSES
 Pulmonary edema is a complication of a
myocardial infarction (heart attack),
mitral or aortic valve disease,
cardiomyopathy, or other disorders
characterized by cardiac dysfunction.

5.  Severe arrhythmias(
tachycardia/bradycardia)
 Hypertensive crisis
 Valvular heart disease (especially aorta and
mitral disease)
 Fluid overload

6. NON-CARDIOGENIC
 Lung infections
 Exposure to toxins such as chlorine and
ammonium
 Kidney diseases (failure to remove waste)
 Smoke inhalation ( damage to capillaries)
 High altitudes

7. PATHOPHYSIOLOGY
 Fluid backs up into the veins of the lungs.
Increased pressure in these veins forces
fluid out of the vein and into the air
spaces (alveoli). This interferes with the
exchange of oxygen and carbon dioxide in
the alveoli.

8. SYMPTOMS:
 Extreme shortness of breath, severe difficulty
in breathing
 Feeling of "air hunger" or "drowning" (is a
respiratory distress marked by gasping, labored
breathing or dyspnea)
 "Grunting" sounds with breathing (abnormal
short, deep, hoarse sound)
 Inability to lie down
 Rales (abnormal rattling sound)

9. SYMPTOMS:
 Restlessness
 Wheezing
 Anxiety
 Cough
 Excessive sweating
 Pale skin
 Nasal flaring
 Coughing up blood
 Breathing, absent temporarily

10. SIGNS:
 Listening to the chest with a stethoscope
(auscultation) may show crackles in the lungs
or abnormal heart sounds.
 A chest x-ray may show fluid in the lung
space.
 An echocardiogram may be performed in
addition to (or instead of) a chest x-ray.

11. TESTS AND DIAGNOSIS
 History collection and physical examination
(Exertional Dyspnea, Orthopnea,
Aspiration of food or foreign body, Direct
Chest injuries, Walking High altitude,
Chest Pain(right or left), Leg pain or
swelling(Pulmonary Embolism).

12.  Echocardiogram may show Weak heart
muscle, Leaking or narrow heart valves and
Fluid surrounding the heart
 Cardiac catheterization shows the
visualization of heart and cardiomegally.

13.  Chest x-ray (Fluid in or around the lung
space and enlarged heart )
 Electrocardiography: There will be
changes in the rhythm of heart.

14.  ABG analysis: hypoxia and hypocapnia
initially and hypercapnea in later stage
with respiratory and metabolic acidosis

15. MANAGEMENT
 This is a medical emergency! Do not delay
treatment. Hospitalization and immediate
treatment are required.
 Oxygen is given, by a mask or through
endotracheal tube using mechanical
ventilation.

16.  Preload reducers: Medications include
diuretics such as furosemide to remove fluid
and nitroglycerin.
 Afterload reducers: such as Vasodilators
(sodium nitroprusside) to help the heart pump
better
 drugs to treat anxiety (alprax)

17.  Morphine: this is administering to reduce pain
and anxiety.
 Anti-hypertensive medications should be
administer to control blood pressure.
 other medications to treat the underlying
cardiac disorder.

18.  Treating high altitude pulmonary edema: if
patients are travelling to high altitude and
experience mild symptoms of HAPE,
descending a few feet (600-900) will
relieve symptoms.
 Oxygen administration is required.

19. NURSING MANAGEMENT
 Assess the general condition of the
patient
 Remove the etiological factors
 Advice to take low sodium diet
 Instruct the patient to take more fruits
and vegetables
 Instruct to do regular medical check-up
 Instruct to take medicines on proper time

20.  Instruct to take treatment for lung
infections and kidney diseases.
 While travelling to high altitude instruct
the patient to take proper rest in
between.