Pulmonary Edema

Nursing Diagnosis for Pulmonary Edema | Pathophysiology | Nursing Care Plan for Nursing Students

Pulmonary Edema | Pathophysiology | Care Plan for Nursing Students

Pulmonary edema, also known as pulmonary congestion, is a lung condition that involves the accumulation of fluids in the lungs. Difficulty of breathing is one of the classic signs of pulmonary edema. Acute pulmonary edema is considered a medical emergency and can be fatal but can also respond to treatment quickly if it is diagnosed early.

Signs and Symptoms of Pulmonary Edema

  • Acute or sudden pulmonary edema:
  • Hypoxia
  • Dyspnea (difficulty of breathing) – worsened when lying down or with activity
  • Cold, clammy skin
  • Wheeze
  • Gasping for breath
  • Feeling suffocated or drowning
  • Productive cough – frothy sputum (may be blood-tinged)
  • Tachycardia (fast heartbeat; may be irregular)
  • Cyanosis (e.g. blue tinged lips)
  • Anxiety
  • Chronic or long-term pulmonary edema:

(In addition to the signs and symptoms of above)

  • Rapid weight gain
  • Fatigue
  • Edema on the lower extremities
  • Difficulty of walking uphill
Pulmonary edema – respiratory lung disease infographic with flat cartoon man drawing showing his internal organs – healthy and unhealthy alveoli, medicine and health isolated vector illustration

Causes of Pulmonary Edema

There are two types of pulmonary edema in terms of causation: cardiogenic and non-cardiogenic.

  • Cardiogenic Pulmonary Edema: The most common cause of pulmonary edema is heart disease, such as acute myocardial infarction, congestive heart failure (CHF), coronary artery disease (CAD), cardiomyopathy, heart valve problems, and hypertension (which enlarges the heart). Cardiogenic pulmonary edema occurs when the heart is unable to pump out the normal blood volume from the lungs due to a dysfunction in the left ventricle. This puts more pressure to the left atrium of the heart. When there is an increased left atrial pressure, the hydrostatic pressure in the capillaries of the lungs are retrogradely elevated. The fluid is pushed into the pulmonary air sacs, which results to difficulty of breathing.
  • Non-Cardiogenic Pulmonary Edema: If there is no left ventricular dysfunction despite the fluid accumulation in the lungs, the pulmonary edema might be non-cardiogenic, or not caused by any problems in the heart. This may result from acute respiratory distress syndrome (ARDS), pneumonia, sepsis, viral infections (hantavirus and dengue virus), severe bleeding, brain injury (neurogenic), fluid overload, acute asthma, thromboembolism, lung surgery, trauma (e.g. post-intubation), or drug use (e.g. cytokines and heroin). Non-cardiogenic pulmonary edema may also be due to smoke inhalation, near drowning, high altitude or physical exertion, such as exercise, swimming and diving (swimming-induced or immersion pulmonary edema).

Complications of Pulmonary Edema

  1. Edema of the abdominal cavity and lower extremities. If left untreated, pulmonary edema can further increase the pulmonary arterial pressure. This condition is called pulmonary hypertension. When this occurs, the right ventricle of the heart fails, causing the pressure in the right atrium to further elevate. This will eventually cause swelling in the abdomen and lower extremities.
  2. Pleural Effusion. The increased pressure in the pulmonary circulation may lead to the accumulation of fluid in the pleural cavity which surrounds the lungs.
  3. Liver congestion and swelling. There can be increased pressure in the hepatic portal system, causing the liver to be congested and swollen, thereby unable to detoxify the blood as normal.

Diagnostic Tests for Pulmonary Edema

  • Pulse oximetry – to measure the oxygen level in the blood
  • Chest X-ray
  • Blood tests – including arterial blood gas analysis, full blood count, biochemistry, and thyroid function.
  • Electrocardiogram (ECG) – to determine if it is cardiogenic
  • Cardiac catheterization and coronary angiogram – insertion of a very thin and long catheter usually through the arm or neck, which the doctor can use to get a better visualization of the heart (a dye is usually injected), as well as to measure the pressure in the different chambers of the heart, and to possibly open a blocked artery.

Treatments for Pulmonary Edema

  1. Oxygen therapy: The priority is to give oxygen to reverse the hypoxia or the deprivation of oxygen supply in the body. Severe hypoxia may require the use of mechanical ventilation to provide positive airway pressure.
  2. Diuretics: To decrease the fluid that has accumulated in the heart and lungs, diuretics such as furosemide (Lasix) are usually administered.
  3. Anti-hypertensives: Hypertension may eventually lead to pulmonary edema. Blood pressure medications include beta blockers (e.g. bisoprolol) and ACE inhibitors (e.g. ramipril).
  4. Preload reducers and afterload reducers: Medications such as nitroglycerin may be used to decrease the pressure going into the heart.
  5. Anti-cholesterol drugs: For cardiogenic pulmonary edema, anti-cholesterol drugs might be prescribed to reduce the LDL or bad cholesterol that clog up the cardiac arteries.
  6. Antivirals or antibiotics: Bacteria and viruses are common underlying causes of the non-cardiogenic pulmonary edema.

Nursing Care Plans for Pulmonary Edema

  1. Nursing Diagnosis: Impaired Gas Exchange related to pulmonary edema as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and frothy phlegm

Desired Outcome: The patient will maintain optimal gas exchange as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96% on room air (88-92% if patient has COPD) and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs, especially the oxygen saturation and characteristics of respirations at least every 4 hours. Also, monitor the results of ABG analysis.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
ABG Analysis: To check if there is an increase in PaCO2 and a decrease in PaO2, which are the signs of hypoxemia and respiratory acidosis.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed medications: diuretics antihypertensives, pressure reducers, and/or antibiotic/ antiviral medications.Administer the prescribed medications: diuretics antihypertensives, pressure reducers, and/or antibiotic/ antiviral medications. Diuretics: To decrease the fluid that has accumulated in the heart and lungs, diuretics such as furosemide (Lasix) are usually administered.
Anti-hypertensives: Hypertension may eventually lead to pulmonary edema.
Preload reducers and afterload reducers: Medications such as nitroglycerin may be used to decrease the pressure going into the heart.
Anti-cholesterol drugs: For cardiogenic pulmonary edema, anti-cholesterol drugs might be prescribed to reduce the LDL or bad cholesterol that clog up the cardiac arteries.
Antivirals or antibiotics: Bacteria and viruses are common underlying causes of the non-cardiogenic pulmonary edema.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Turn the patient at least every 2 hours. Encourage to mobilize as tolerated.To prevent the complications of immobility such as thromboembolism that may worsen the pulmonary edema.
  • Nursing Diagnosis: Ineffective Breathing Pattern related to pulmonary edema as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and blood-tinged frothy phlegm

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96% on room air (88-92% if patient has COPD), and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hoursTo assist in creating an accurate diagnosis and monitor effectiveness of medical treatment
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range of 88 to 92%.
Administer the prescribed medications (e.g. bronchodilators or combination inhalers / nebulizers) and antibiotic/antiviral medications.Bronchodilators: To dilate or relax the muscles on the airways.
Antibiotics or antivirals: To treat the underlying infection.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s positionHead elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Perform chest physiotherapy such as percussion and vibration, if not contraindicated. Nebulization using sodium chloride (NaCl) may also be done, as ordered by the physician. Steam inhalation may also be performed. Suction as required.To facilitate clearance of thick airway secretions.

Other possible nursing diagnoses:

  • Activity Intolerance
  • Anxiety related to Acute Pulmonary Edema
Facebooktwitterredditpinterestmail

Check Also

Pneumothorax and Hemothorax

Pneumothorax and Hemothorax Nursing Diagnosis Interventions and Care Plans

Pneumothorax and Hemothorax Nursing Diagnosis NCLEX Review Care Plans Pneumothorax and Hemothorax Pneumothorax is a …

One comment

  1. Nursing Care Conference 2020 is delighted to welcomes participants from all around the world to attend the “28th World Congress on Nursing Care” which is to be held at Prague, Czech Republic on October 19-20, 2020. Nursing Care Conference 2020 Conference is an international platform to discuss and to share the knowledge regarding the current research, innovations and recent developments in the area of Nursing
    After the successful completion of 27 editions of Nursing Care Conferences, Conference Series LLC., Group with great honor announcing its “28th World Congress on Nursing Care” (Nursing Care Congress 2020) to be held on October 19-20, 2020 in Prague, Czech Republic
    Nursing Care Congress 2020 has become the premier platform for nurses all around the world not only for the presentations of new research, but also for unique networking opportunities. The theme of the Conference is “Exceptional Innovations of Nursing in Healthcare” will enhance the quality of Nursing and Health care with the latest interventions and revolutions.
    Conference link : https://nursingcare.nursingconference.com/asia-pacific/

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.