3. DEFINITION
Pulmonary edema is a condition
characterized by fluid accumulation in the
lungs caused by extravasations of fluid
from pulmonary vasculature into the
alveoli and interstitial spaces of the lungs
6. Respiratory Bronchioles, Alveolar (Cont.)
Ducts, and Alveoli
• Lungs contain small saccular outpocketings
called alveoli.
• They have a thin wall specialized to promote
diffusion of gases between the alveolus and the
blood in the pulmonary capillaries.
• Gas exchange can take place in the
respiratory bronchioles and alveolar ducts
as well as in the alveoli
• The spongy nature of the lung is due to the
packing of millions of alveoli together.
11. Cells in Alveolus
Type I cells :
simple squamous cells
forming lining
Type II cells :
or septal cells secrete
surfactant
Alveolar macrophages
13. EPIDEMIOLOGY
• Pulmonary edema occurs in about 1% to 2% of
the general population.
• Between the ages of 40 and 75 years, males are
affected more than females.
• After the age of 75 years, males and females are
affected equally.
• The incidence of pulmonary edema increases
with age and may affect about 10% of the
population over the age of 75 years.
15. A. BASED ON INCITING MECHANISM
1. IMBALANCE OF STARLING FORCE
A. Increased pulmonary capillary pressure
-left ventricular failure
-Volume overload
B. Decreased plasma oncotic pressure
- Hypoalbuminemia due to different cause
C. Increased negativity of interstitial pressure
-Rapid removal of pneumothorax with
large applied negative pressures (unilateral)
16. Abst
ract
• Study:
Pulmonary edema related to changes in colloid osmotic
and pulmonary artery wedge pressure in patients after
acute myocardial infarction
• Samples:
26 patients with acute myocardial infarction of whom 14
developed pulmonary edema
• Findings:
Both increases in pulmonary capillary pressure and
decreases in colloid osmotic pressure leads to pulmonary
edema
(P L Luz da; H Shubin; M H Weil; E Jacobson)
17. BASED ON INCITING AGENT…..
2. ALTERED ALVEOLAR-CAPILLARY
MEMBRANE PERMEABILITY
o
o
o
o
o
o
o
o
Infectious pneumonia
Inhaled toxins, Aspiration
Circulating foreign substances
Endogenous vasoactive substances
Disseminated intravascular coagulation
Immunologic—hypersensitivity pneumonitis, drugs
Shock lung in association with non-thoracic trauma
Acute hemorrhagic pancreatitis
18. BASED ON INCITING AGENT…..
(Cont.)
3. LYMPHATIC INSUFFICIENCY
After lung transplant
Lymphangitic carcinomatosis
Fibrosing lymphangitis
19. BASED ON INCITING AGENT…..
(Cont.)
4. UNKNOWN OR INCOMPLETELY UNDERSTOOD
High-altitude pulmonary edema
Neurogenic pulmonary edema
Narcotic overdose
Pulmonary embolism
Eclampsia
After anesthesia
After cardiopulmonary bypass
20. B. BASED ON UNDERLINING CAUSE
Cardiogenic pulmonary edema
Due to increased pressure in the pulmonary
capillaries because of cardiac abnormalities
Increase in pulmonary venous pressure
Non- cardiogenic pulmonary edema
Evidence of alveolar fluid accumulation without
hemodynamic evidence
Hydrostatic pressure is normal
Leakage of protein and other molecule into the
tissue
21. PATHOGENESIS OF CPE
Congestion &
accumulation of
blood in the
pulmonary area
Decrease
pumping ability
to the systemic
circulation
Left sided
heart failure
Fluid leaks out of the
intravascular space to
the interstitium
Accumulation of
fluid
Pulmonary
edema
22. STAGING OF PE
Based on the degree of fluid accumulation:
Stage-1
All excess fluid can still be cleared by lymphatic
drainage.
Stage-2
Presence of interstitial edema
Stage-3
Alveolar edema due to altered alveolar- capillary
permeability
23. (Cont.)
Mild:
Only engorgement of pulmonary vasculature
Moderate:
Extravasations of fluid into the interstitial
space due to changes in oncotic pressure
Severe:
Alveolar filling occurs
24. Causes of Pulmonary Edema
o Congestive Cardiac Failure
o Over hydration with intravenous Fluids
o Hypoalbuminemia:
Nephrotic Syndrome
Hepatic disease
Nutritional Disorders
oMalignancies of lymph system
25. Causes of Pulmonary Edema (Cont.)
o Altered Capillary Permeability of Lungs
Inhaled Toxins
Inflammation
Severe Hypoxia
o Respiratory Distress Syndrome
o Unknown Causes
Neurogenic Conditions
Narcotic Overdose
High altitude
26. Abst
ract
• Study:
Transfusion-related acute lung injury and pulmonary
edema in critically ill patients: a retrospective study
• Samples:
Consecutive patients at four intensive care units (ICUs)
• Findings:
94 required new respiratory support within 6 hours of
transfusion
Among 49 patients with confirmed acute pulmonary
edema, experts identified 7 cases with suspected TRALI
• Conclusion:
In the ICU, pulmonary edema frequently occurs after blood
transfusion
(Rana R, Fernández-Pérez ER, Khan SA, Rana S)
27. Clinical Manifestations
• Sudden onset of Dyspnea -
Orthopnea, Paroxysmal Nocturnal Dyspnea
• Agitated, Pale and possibly Cyanotic
• Restlessness and Irritability
• Skin- Clammy and Cold
28. Clinical Manifestations (Cont.)
•
•
•
•
Wheezing and Coughing
Distended Jugular Veins
Noisy wet respiration
On Auscultation- Bubbling Crackles, Wheezes
and Rhonchi
• HR is rapid
• BP- Elevated or Decreased
30. DIAGNOSTIC STUDY
History and Physical Examination
Blood studies
Routine; CBC
Liver function tests
Renal Function Tests
Arterial blood gas analysis
Serum cardiac biomarkers
35. NURSING DIAGNOSIS
1. Ineffective breathing pattern
related to: fatigue and breathing aids
installation
2. Impaired gas exchange
related to: distention of pulmonary capillaries
36. NURSING DIAGNOSIS
3. Risk for infection
related to: the invasion of microorganisms area
secondary to endotracheal tube installation
4. Ineffective tissue perfusion
related to: decreased cardiac muscle
contractility
37. NURSING DIAGNOSIS (CONT.)
5. Risk for Injury / trauma
related to: anxiety secondary to the installation of
breathing aids
6. Anxiety
related to: the threat of biological integrity
secondary to the actual installation of breathing
aids
39. COMMON INTERVENTIONS
• Oxygen
• High Fowlers position
• Legs in dependent position
• Activity restrictions
• Emotional rest
• Allay the anxiety
• Monitor ECG,
S. electrolytes
40. COMMON INTERVENTIONS (CONT.)
• Small meals than larger ones
• Monitor weight daily
• Maintain intake & output chart
• Restrict sodium & fluid intake
• Self care needs
• Increase activity gradually & as tolerated
• Medications
• Watch for complications of treatment such as
electrolyte depletion
42. • Emphasize reporting early signs of fluid overload
• Review all prescribed medications with the
patient and Family
• Discuss ways to observe physical energy
• Teach the patient- How to take slow and deep
breath
• Na restricted dietary pattern
• Need to monitor weight gain
43. EXPECTED OUTCOMES:
O2 Sat - >95%
RR 12 to 20 breaths/min
Airway Patency
- open, clear tracheobronchial passages
ABG
• PH 7.35-7.45
• Pa02 80 to 100 mm of Hg
• PaCo2 35 to 45 mm of Hg
Knowledge: Medications
44.
45.
46. BIBLIOGRAPHY
Lewis, Heitkemper, Dirksen (2004), MedicalSurgical Nursing, 6th Edition, Mosby,840-853
Manual of Medical & Surgical Nursing Care,
Nursing Intervention and Collaborative
management , 5th Edition, Mosby, 191-195
Lippincott, Manual of Nursing Practice, 8th
Edition, 416-417
47. (Cont.)
Givertz MM, Colucci WS, Braunwald
E(2005),
Textbook
of
Cardiovascular
Medicine,
7th
ed,
Elsevier
Saunders, Philadelphia,539
