Pulmonary Edema - T. Pittman PDF

Preview

Summary

T. Pittman...

Description

Pulmonary Edema Pathophysiology Pulmonary edema is a severe life threating accumulation of fluid in the alveoli an interstitial space of the lung that can result from severe heart failure.

Risk Factors            

Acute MI. Fluid volume overload. Hypertension. Valvular heart disease. Postpneumonectomy. Postevacuation of pleural effusion. Acute respiratory failure. Left-sided heart failure. High altitude exposure or deep sea-diving. Trauma. Sepsis. Medication toxicity.

Expected Findings            

Anxiety. Inability to sleep. Persistent to cough pink, frothy sputum. Tachypnea, dyspnea, and orthopnea. Hypoxemia. Cyanosis (later stage). Crackles. Tachycardia. Reduced urine output. Confusion and stupor. S3 heart sound (gallop). Increased pulmonary artery occlusion pressure.

Nursing Care 

1

Position the client in high-fowler’s position with feet and legs dependent or sitting on the side of the bed to decrease preload.



      

Administer high-flow oxygen using a face mask or nonrebreather mask. Bilevel positive airway pressure or intubation/ventilation can become necessary. Be prepared to intervene quickly. Monitor vital signs every 15 minutes until stable. Monitor intake and output. Check ABGs, electrolytes, SaO2, and chest x-ray findings. Maintain a patent airway. Suction as needed. Ensure the restriction of fluid intake. Monitor hourly urine output. Watch for intake greater than output or hourly urine less than 30 mL/hr. Provide emotional support for the client and family.

Medications     

Rapid-acting diuretics such as furosemide and bumetanide promote fluid excretion. Morphine decreases sympathetic nervous system response and anxiety and promotes mild vasodilation. Vasodilators decrease preload and afterload. Inotropic agents such as digoxin and dobutamine improve cardiac output. Antihypertensives such as ACE inhibitors and beta-blockers decrease afterload.

Patient Education       

2

Use techniques to promote effective breathing techniques. Understand prescribed medications and how to administer them. Continue to take medications even if feeling better. Follow instructions for reasons to contact the provider. Remain on a low-sodium diet and restrict fluids as prescribed. Measure weight daily at the same time. Notify the provider of a gain of more than 2 lbs in 1 day or 5 lbs in 1 week. Report swelling of feet or ankles or any shortness of breath or angina....