Nursing Care and Pathophysiology for Pulmonary Edema
Included In This Lesson
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
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Nursing Care and Pathophysiology for Pulmonary Edema
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!
NCLEX
Concepts Covered:
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Circulatory System
- Nervous System
- Skeletal System
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System