Nursing Care and Pathophysiology for Pulmonary Edema

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!