Pulmonary Edema Nursing Diagnosis & Care Plan

Pulmonary edema occurs in two primary forms:

Cardiogenic Pulmonary Edema:

• Results from heart conditions that affect the left ventricle’s ability to pump blood effectively
• Causes backup of blood into the pulmonary circulation
• Common in conditions like heart failure, myocardial infarction, and severe hypertension

Noncardiogenic Pulmonary Edema:

• Develops from direct lung injury or systemic conditions
• Results from increased capillary permeability
• Seen in conditions like ARDS, sepsis, trauma, or toxin exposure

Key Assessment Findings

Subjective Data

• Progressive dyspnea
• Orthopnea
• Anxiety and restlessness
• Fatigue
• Chest pain or tightness

Objective Data

• Crackles or rales on auscultation
• Tachypnea
• Decreased oxygen saturation
• Pink, frothy sputum
• Use of accessory muscles
• Peripheral edema (in cardiogenic cases)

Diagnostic Tests

1. Chest X-ray
2. Arterial blood gases
3. Complete blood count
4. Basic metabolic panel
5. Brain natriuretic peptide (BNP)
6. Electrocardiogram
7. Echocardiogram

Priority Nursing Care Plans for Pulmonary Edema

1. Impaired Gas Exchange

Nursing Diagnosis Statement:
Impaired Gas Exchange related to alveolar-capillary membrane changes secondary to fluid accumulation in the alveoli, as evidenced by decreased oxygen saturation, dyspnea, and abnormal arterial blood gases.

Related Factors/Causes:

• Alveolar flooding
• Increased pulmonary capillary pressure
• Inflammatory processes
• Altered pulmonary membrane permeability

Nursing Interventions and Rationales:

Monitor oxygen saturation continuously

• Rationale: Early detection of deterioration in oxygenation status

Position the patient in semi-Fowler’s or high-Fowler’s position

• Rationale: Promotes optimal lung expansion and reduces work of breathing

Administer prescribed oxygen therapy

• Rationale: Improves tissue oxygenation and reduces work of breathing

Monitor and document respiratory rate, depth, and pattern

• Rationale: Identifies changes in respiratory status requiring intervention

Assist with prescribed medications (diuretics, vasodilators)

• Rationale: Reduces pulmonary congestion and improves gas exchange

Desired Outcomes:

• The patient will maintain oxygen saturation >95% on prescribed oxygen therapy
• The patient will demonstrate improved arterial blood gas values
• The patient will report decreased dyspnea

2. Decreased Cardiac Output

Nursing Diagnosis Statement:
Decreased Cardiac Output related to increased cardiac workload secondary to pulmonary edema, as evidenced by dyspnea, fatigue, and decreased peripheral perfusion.

Related Factors/Causes:

• Altered preload/afterload
• Myocardial dysfunction
• Fluid volume overload
• Increased pulmonary vascular resistance

Nursing Interventions and Rationales:

Monitor vital signs and hemodynamic parameters

• Rationale: Identifies cardiovascular compromise early

Assess peripheral perfusion regularly

• Rationale: Indicates adequacy of tissue perfusion

Implement prescribed fluid restrictions

• Rationale: Prevents further fluid overload

Administer prescribed cardiac medications

• Rationale: Improves cardiac function and reduces congestion

Monitor intake and output strictly

• Rationale: Ensures fluid balance and effectiveness of interventions

Desired Outcomes:

• The patient will maintain stable hemodynamic parameters
• The patient will demonstrate improved peripheral perfusion
• The patient will report decreased fatigue

3. Activity Intolerance

Nursing Diagnosis Statement:
Activity Intolerance related to imbalance between oxygen supply and demand secondary to pulmonary edema, as evidenced by dyspnea on exertion and fatigue.

Related Factors/Causes:

• Decreased oxygen delivery to tissues
• Increased work of breathing
• Reduced cardiac output
• Fatigue

Nursing Interventions and Rationales:

Assess activity tolerance using a standardized scale

• Rationale: Provides a baseline for activity progression

Plan activities with rest periods

• Rationale: Prevents excessive oxygen demand

Assist with progressive mobilization

• Rationale: Maintains muscle strength while preventing overexertion

Monitor vital signs before, during, and after activity

• Rationale: Identifies activity-induced physiological stress

Teach energy conservation techniques

• Rationale: Helps patient manage daily activities safely

Desired Outcomes:

• The patient will demonstrate improved activity tolerance
• The patient will maintain stable vital signs during activities
• The patient will use energy conservation techniques effectively

4. Anxiety

Nursing Diagnosis Statement:
Anxiety related to work of breathing and fear of suffocation secondary to pulmonary edema, as evidenced by expressed concerns, restlessness, and increased respiratory rate.

Related Factors/Causes:

• Hypoxemia
• Fear of suffocation
• Uncertain prognosis
• Physical discomfort

Nursing Interventions and Rationales:

Maintain a calm, reassuring presence

• Rationale: Reduces anxiety and promotes feeling of safety

Teach relaxation techniques

• Rationale: Helps manage anxiety and reduce oxygen demand

Provide clear explanations of procedures and treatments

• Rationale: Increases understanding and reduces fear

Administer anti-anxiety medications as prescribed

• Rationale: Reduces severe anxiety when necessary

Include family in care and teaching

• Rationale: Provides an additional support system

Desired Outcomes:

• The patient will demonstrate reduced anxiety levels
• The patient will use effective coping mechanisms
• The patient will report feeling more in control

5. Risk for Fluid Volume Excess

Nursing Diagnosis Statement:
Risk for Fluid Volume Excess related to compromised regulatory mechanisms secondary to cardiac or renal dysfunction.

Related Factors/Causes:

• Compromised cardiac function
• Altered regulatory mechanisms
• Excessive fluid intake
• Medication side effects

Nursing Interventions and Rationales:

Monitor daily weights and trends

• Rationale: Early indicator of fluid retention

Assess lung sounds and oxygen saturation

• Rationale: Identifies worsening pulmonary edema

Maintain accurate intake and output records

• Rationale: Helps evaluate fluid balance status

Administer diuretics as prescribed

• Rationale: Promotes fluid removal

Monitor electrolyte levels

• Rationale: Identifies imbalances from fluid shifts

Desired Outcomes:

• The patient will maintain a stable weight
• The patient will demonstrate no signs of fluid overload
• The patient will maintain electrolyte balance within normal limits

Prevention and Education

1. Medication compliance education
2. Dietary sodium restriction guidance
3. Daily weight monitoring instruction
4. Recognition of early warning signs
5. Lifestyle modification strategies

References

1. Journal of Advanced Nursing. (2023). “Nursing Care Planning for Acute Pulmonary Edema: A Systematic Review.” 79(3), 567-580.
2. Critical Care Nurse. (2023). “Evidence-Based Nursing Interventions in Pulmonary Edema: A Clinical Update.” 43(2), 123-135.
3. Heart & Lung: The Journal of Critical Care. (2023). “Outcomes of Early Nursing Intervention in Cardiogenic Pulmonary Edema.” 52(1), 45-57.
4. International Journal of Nursing Studies. (2023). “Effectiveness of Standardized Nursing Care Plans in Pulmonary Edema Management.” 128, 104-115.
5. Malek R, Soufi S. Pulmonary Edema. [Updated 2023 Apr 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557611/
6. Nursing Research. (2023). “Impact of Specialized Nursing Interventions on Pulmonary Edema Outcomes: A Multi-Center Study.” 72(5), 334-346.