Nursing Care and Pathophysiology for Pulmonary Edema
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Outline
Overview
- Pulmonary edema
- Fluid build-up in lungs
- Caused by blood backflow in lung vessels
- Presents as dyspnea and crackles
- Managed with medications and oxygen
Nursing Points
General
- Pathophysiology
- Increased pressure in lung vessels
- Fluid shifts from capillaries into alveoli and interstitial space
- Gas exchange impaired
- Hypoxemia
- Causes
- Altered/decreased cardiac output
- Causing backflow of blood
- Increased pressure in lung vessels
Assessment
- Presentation
- Dyspnea and tachypnea
- Tachycardia
- Diaphoresis
- Lung crackles
- Cough up pink foamy sputum
- Nurse assessment
- Vital signs
- Continuous pulse oximetry
- Listen to lungs
- Doctor orders
- Assess lung status
- Chest X Ray
- ABGs
- Determine cause
- ProBNP lab draw -> indicates stretching of heart (heart failure)
- CT scan
- Echocardiography
- Assess lung status
Therapeutic Management
- Supplement oxygen
- Nasal cannula
- Mask
- BIPAP
- Intubation if indicated
- Medication
- Diuretics -> remove excess fluid from body
- Nitroglycerin -> decrease preload in heart
- ACE inhibitors -> decrease afterload, improve output
Nursing Concepts
- Gas exchange -> decreased due to the fluid build-up in the lungs
- Oxygenation ->affected by decreased gas exchange
- Perfusion -> organ perfusion is altered due to decreased gas exchange and oxygenation
Patient Education
- Follow fluid restrictions as ordered
- Take medications as ordered
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Transcript
Hey guys! In this lesson we will talk about nursing are and the pathophysiology for pulmonary edema.
In this lesson, we will cover the pathophysiology and causes of pulmonary edema, patient assessment and presentation, and management. Let’s begin with the patho.
So what happens is that something is causing increased pressure in the pulmonary vessels. That increased pressure causes fluid to shift from the vessels out into the lungs. Fluid in the lungs impairs gas exchange and results in hypoxemia. Let’s talk about what might cause this to happen.
So, pulmonary edema begins with the increased pressure in the lung vessels, so what causes the increased pulmonary pressure? Any disease that alters the output of the heart can cause the backflow of blood which increases the pressure in those lung vessels. An example is congestive heart failure, or left sided heart failure. When this side of the heart is failing to pump blood effectively to the rest of the body, it backflows to the lung vessels, increasing pressure and resulting in pulmonary edema. Next, let’s talk about what this patient will present with.
This patient has fluid in the lungs, so they are going to have a hard time breathing. They will feel short of breath and breath fast to try to get oxygen. Their heart rate will go up in attempt to compensate for the decreased oxygenation. The patient will appear diaphoretic as they struggle to get air. When you listen to their lungs, you will hear crackles from the fluid. If the patient coughs sputum up, it may appear to be pink and foamy because of red blood cells that shifted into the lung space from that increased vessel pressure. Now let’s talk about what you as the nurse will assess.
First and foremost, check those vital signs. Hook them up to the continuous pulse oximetry so that you can see their oxygen levels at all times. Listen to their lungs for those crackles we mentioned.
You will tell the doctor about the changes in your patient, and they will probably order a chest X Ray to get a picture of the lungs. They might order arterial blood gases to see the true oxygen and carbon dioxide level in the arterial blood. A proBNP lab test can indicate if a patient is in heart failure as it results from the stretching of the heart. The doctor might order other tests to determine the cause of the pulmonary edema such as a CT scan and an echo.
So when your patient has pulmonary edema, their body is not getting the oxygen that it needs so it must be supplemented to perfuse those organs. You may start with a nasal cannula or mask. If the pulse ox doesn’t go up, or the patient is completely exhausted, you may have to put the patient on a BIPAP to assist with breathing. If the patient stops breathing on their own, they will need to be intubated. Now let’s move on to medications that the doctor will order.
The doctor will order diuretics to help to immediately relieve the lungs of the excess fluid. Nitroglycerin may be given to decrease the preload in the heart. ACE inhibitors may be ordered to decrease afterload and improve cardiac output. The doctor will probably order a fluid restriction for this patient to help avoid the fluid overload effects on the lungs.
Guys, it’s really important to emphasize the need for your patient to follow the fluid restriction and take the medications that are ordered. It is a challenge for some people to limit fluids. I can’t tell you how many times I have had my patients tell me that they skip their diuretics because they don’t want to pee all the time. This puts me straight into lecture mode to explain what will happen to them if they don’t take them.
Alright guys, let’s review the key points on pulmonary edema. Pulmonary edema is caused by any disease that causes increased lung vessel pressure, causing fluid to shift into the lungs. The patient will present with difficulty breathing, fast breathing, and diaphoresis from struggling for oxygen. You will hear crackles in their lungs from the fluid. Your assessment will consist of a full set of vital signs, and listening to the lung sounds. The doctor may order a chest X Ray to view the lungs and a proBNP to check for heart failure causing the pulmonary edema. Pulmonary edema is managed with oxygen supplementation, fluid restrictions, and medications to decrease the fluid overload in the lungs.
Our priority nursing concepts for a patient with pulmonary edema are gas exchange, oxygenation, and perfusion.
We love you guys! Go out and be your best self today! And as always, Happy Nursing!
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Study Plan Lessons
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
EKG (ECG) Course Introduction
ABGs Nursing Normal Lab Values
Care of the Pediatric Patient
Coronary Artery Disease Concept Map
Electrical A&P of the Heart
Respiratory A&P Module Intro
ABG (Arterial Blood Gas) Interpretation-The Basics
Computed Tomography (CT)
COPD Concept Map
Electrolytes Involved in Cardiac (Heart) Conduction
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI)
Nursing Care and Pathophysiology for Sickle Cell Anemia
Adult Vital Signs (VS)
CT & MR Angiography
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nasal Disorders
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Pediatric Vital Signs (VS)
Respiratory Acidosis (interpretation and nursing interventions)
Thrombocytopenia
Cardiovascular Angiography
Preload and Afterload
Respiratory Alkalosis
Congestive Heart Failure Concept Map
Echocardiogram (Cardiac Echo)
Performing Cardiac (Heart) Monitoring
Hypertension (HTN) Concept Map
Pulmonary Function Test
Electroencephalography (EEG)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology for Asthma
02.02 Cardiomyopathy for CCRN Review
Leukemia
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Lymphoma
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Respiratory Terminology
Oncology Important Points
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Lung Cancer
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Heart (Cardiac) and Great Vessels Assessment
Intracranial Pressure ICP
Nursing Care and Pathophysiology for Pulmonary Edema
Cerebral Perfusion Pressure CPP
Cerebral Perfusion Pressure CPP
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
Grief and Loss
Dementia and Alzheimers
Acute Coronary Syndrome (ACS)
Immunology Module Intro
Respiratory Infections Module Intro
Sickle Cell Anemia
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Aneurysm & Dissection
Nursing Care and Pathophysiology for Heart Failure (CHF)
Hemoglobin (Hbg) Lab Values
Iron Deficiency Anemia
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Sinus Bradycardia
Nursing Care and Pathophysiology for Anaphylaxis
Cardiopulmonary Arrest
Hematocrit (Hct) Lab Values
Nursing Care and Pathophysiology for Anaphylaxis
Sinus Tachycardia
Meds for Alzheimers
Pacemakers
White Blood Cell (WBC) Lab Values
Heart (Heart) Failure Exacerbation
Platelets (PLT) Lab Values
Coagulation Studies (PT, PTT, INR)
Hypertensive Emergency
Supraventricular Tachycardia (SVT)
Fibromyalgia
Migraines
Tension and Cluster Headaches
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Cholesterol (Chol) Lab Values
Nursing Care and Pathophysiology of Hypertension (HTN)
Leukemia
Pulmonary Embolism
Acute Respiratory Distress
Cardiac (Heart) Disease in Pregnancy
Nursing Care and Pathophysiology for Cardiomyopathy
Respiratory Structure & Function
ACLS (Advanced cardiac life support) Drugs
Fever
Respiratory Trauma Module Intro
Seizure Causes (Epilepsy, Generalized)
Increased Intracranial Pressure
Nursing Care and Pathophysiology for Pulmonary Embolism
Anti-Platelet Aggregate
Respiratory Procedures Module Intro
Electrical Activity in the Heart
Nursing Care and Pathophysiology for Meningitis
Respiratory Terminology
Thrombin Inhibitors
Thrombolytics
Blood Plasma
Patient Positioning
Acute Otitis Media (AOM)
07.06 Increased Intracranial Pressure (ICP) for CCRN Review
Dystocia
Acute Bronchitis
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Asthma
Asthma
Cystic Fibrosis (CF)
Congenital Heart Defects (CHD)
Congenital Heart Defects (CHD)
Respiratory Structure & Function
Defects of Increased Pulmonary Blood Flow
Defects of Decreased Pulmonary Blood Flow
Obstructive Heart (Cardiac) Defects
Obstructive Heart (Cardiac) Defects
Respiratory Functions of Blood
Mixed (Cardiac) Heart Defects
10.01 Arterial Blood Gas (ABG) Interpretation for CCRN Review
Hierarchy of O2 Delivery
Histamine 1 Receptor Blockers
10.03 Acute Respiratory Failure for CCRN Review
Airway Suctioning
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ABG (Arterial Blood Gas) Interpretation-The Basics
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ABG Course (Arterial Blood Gas) Introduction
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
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Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
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AIDS Case Study (45 min)
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Anaphylaxis Nursing Interventions for Certified Perioperative Nurse (CNOR)
Anemia for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology for Anemia
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Aneurysm and Dissection for Certified Emergency Nursing (CEN)
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Aortic Aneurysm – Thoracic signs Nursing Mnemonic (PEE BADS)
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Asthma Concept Map
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Bicarbonate (HCO3) Lab Values
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Cardiac (Heart) Enzymes
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Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
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Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
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Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Cardiovascular Trauma for Certified Emergency Nursing (CEN)
Cerebral Palsy (CP)
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Congestive Heart Failure (CHF) Labs
Congestive Heart Failure Concept Map
COPD (Chronic Obstructive Pulmonary Disease) Labs
COPD Concept Map
COPD Exacerbation for Progressive Care Certified Nurse (PCCN)
COPD management Nursing Mnemonic (COPD)
Coronary Artery Disease Concept Map
Cystic Fibrosis (CF)
Dementia Nursing Mnemonic (DEMENTIA)
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
EKG Basics – Live Tutoring Archive
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Heart (Cardiac) Failure Module Intro
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Heart Failure for Certified Emergency Nursing (CEN)
Heart Failure 2 – Live Tutoring Archive
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure Case Study (45 min)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Hematocrit (Hct) Lab Values
Hematologic Disorders for Certified Emergency Nursing (CEN)
Hemoglobin (Hbg) Lab Values
Hypertension for Certified Emergency Nursing (CEN)
Hypertension (HTN) Concept Map
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypertensive Crisis Case Study (45 min)
Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)
Intracranial Pressure ICP
Leukemia
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Leukemia Case Study (60 min)
Lymphoma
Management of Lyme Disease Nursing Mnemonic (BAR)
MI Surgical Intervention
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction (MI) Case Study (45 min)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Lyme Disease
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cellulitis
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dementia
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Guillain-Barre
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hypertension (HTN)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lung Cancer
Nursing Care Plan (NCP) for Lyme Disease
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Migraines
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Restrictive Lung Diseases
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan for Fibromyalgia
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan for Myocarditis
Nursing Care Plan for Nasal Disorders
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan for Pulmonary Edema
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Case Study for Head Injury
Nursing Case Study for Pediatric Asthma
Obstruction for Certified Emergency Nursing (CEN)
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Pacemakers
Pain Management and Procedural Sedation for Certified Emergency Nursing (CEN)
Pain Management for the Older Adult – Live Tutoring Archive
Pain Management Meds – Live Tutoring Archive
Pain (Acute, Chronic) for Progressive Care Certified Nurse (PCCN)
Palliative Care for Progressive Care Certified Nurse (PCCN)
Parasympathomimetics (Cholinergics) Nursing Considerations
Asthma
Pediatric Bronchiolitis Labs
Platelets (PLT) Lab Values
Pleural Effusion for Certified Emergency Nursing (CEN)
Preload and Afterload
Pulmonary Embolism for Progressive Care Certified Nurse (PCCN)
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Pulmonary Hypertension for Progressive Care Certified Nurse (PCCN)
Pulmonary Hypertension for Certified Emergency Nursing (CEN)
Red Blood Cell (RBC) Lab Values
Red Cell Distribution Width (RDW) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Spinal Cord Injury
Spinal Cord Injury Case Study (60 min)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Systemic Lupus Erythematosus (SLE)
Thrombocytopenia
Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Troponin I (cTNL) Lab Values
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vascular Disease for Progressive Care Certified Nurse (PCCN)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Warfarin (Coumadin) Nursing Considerations