Pulmonary Edema, Pulmonary Edema Nursing Diagnosis, Pulmonary Edema Nursing Interventions, and Pulmonary Edema Nursing Care Plans

Pulmonary Edema, Pulmonary Edema Nursing Diagnosis, Pulmonary Edema Nursing Interventions, and Pulmonary Edema Nursing Care Plans

This guide is about pulmonary edema nursing diagnosis, pulmonary edema nursing interventions, and pulmonary edema nursing care plans. It can be used to develop pulmonary edema nursing care plans for educational purposes.

Pulmonary Edema

What is pulmonary edema?

Pulmonary edema, also known as pulmonary congestion, is a lung condition that involves the accumulation of fluids in the lungs. Difficulty in breathing is one of the classic signs of pulmonary edema. Acute pulmonary edema is considered a medical emergency and can be fatal but can also respond to treatment quickly if it is diagnosed early.

Signs and Symptoms of Pulmonary Edema

What are the signs of pulmonary edema?

  • Acute or sudden pulmonary edema:
  • Hypoxia
  • Dyspnea (difficulty of breathing) – worsened when lying down or with activity
  • Cold, clammy skin
  • Wheeze
  • Gasping for breath
  • Feeling suffocated or drowning
  • Productive cough – frothy sputum (may be blood-tinged)
  • Tachycardia (fast heartbeat; may be irregular)
  • Cyanosis (e.g. blue tinged lips)
  • Anxiety
  • Chronic or long-term pulmonary edema:

(In addition to the signs and symptoms of above)

  • Rapid weight gain
  • Fatigue
  • Edema on the lower extremities
  • Difficulty of walking uphill

Pulmonary Edema
Pulmonary edema – respiratory lung disease infographic with flat cartoon man drawing showing his internal organs – healthy and unhealthy alveoli, medicine and health isolated vector illustration

Causes of Pulmonary Edema

Which is most likely to cause pulmonary edema?

There are two types of pulmonary edema in terms of causation: cardiogenic and non-cardiogenic.

  • Cardiogenic Pulmonary Edema: The most common cause of pulmonary edema is heart disease, such as acute myocardial infarction, congestive heart failure (CHF), coronary artery disease (CAD), cardiomyopathy, heart valve problems, and hypertension (which enlarges the heart). Cardiogenic pulmonary edema occurs when the heart is unable to pump out the normal blood volume from the lungs due to a dysfunction in the left ventricle. This puts more pressure to the left atrium of the heart. When there is an increased left atrial pressure, the hydrostatic pressure in the capillaries of the lungs are retrogradely elevated. The fluid is pushed into the pulmonary air sacs, which results to difficulty of breathing.
  • Non-Cardiogenic Pulmonary Edema: If there is no left ventricular dysfunction despite the fluid accumulation in the lungs, the pulmonary edema might be non-cardiogenic, or not caused by any problems in the heart. This may result from acute respiratory distress syndrome (ARDS), pneumonia, sepsis, viral infections (hantavirus and dengue virus), severe bleeding, brain injury (neurogenic), fluid overload, acute asthma, thromboembolism, lung surgery, trauma (e.g. post-intubation), or drug use (e.g. cytokines and heroin). Non-cardiogenic pulmonary edema may also be due to smoke inhalation, near drowning, high altitude or physical exertion, such as exercise, swimming and diving (swimming-induced or immersion pulmonary edema).

Complications of Pulmonary Edema

What are major complications of cardiogenic pulmonary edema CPE )?

  1. Edema of the abdominal cavity and lower extremities. If left untreated, pulmonary edema can further increase the pulmonary arterial pressure. This condition is called pulmonary hypertension. When this occurs, the right ventricle of the heart fails, causing the pressure in the right atrium to further elevate. This will eventually cause swelling in the abdomen and lower extremities.
  2. Pleural Effusion. The increased pressure in the pulmonary circulation may lead to the accumulation of fluid in the pleural cavity which surrounds the lungs.
  3. Liver congestion and swelling. There can be increased pressure in the hepatic portal system, causing the liver to be congested and swollen, thereby unable to detoxify the blood as normal.

Pulmonary Edema Nursing Diagnosis

What is the nursing diagnosis for Oedema?

Pulmonary Edema Nursing Diagnosis

Breathing problems require immediate diagnosis and treatment. Your doctor can make a preliminary diagnosis of pulmonary edema based on your signs and symptoms and the results of a physical exam, electrocardiogram and chest X-ray.

Once your condition is more stable, your doctor will ask questions about your medical history, especially whether you have ever had cardiovascular or lung disease.

Tests that may be done to diagnose pulmonary edema or to determine why you developed fluid in your lungs include:

  • Chest X-ray. A chest X-ray can confirm the diagnosis of pulmonary edema and exclude other possible causes of your shortness of breath. It’s usually the first test done when someone has signs or symptoms of pulmonary edema.
  • Chest CT. A computed tomography (CT) scan of the chest may not provide the cause for the pulmonary edema, but can give your doctor indirect clues to help make a diagnosis.
  • Pulse oximetry. A sensor is attached to your finger or ear and uses light to determine how much oxygen is in your blood.
  • Arterial blood gas test. Blood is taken, usually from an artery in your wrist, and checked for the amount of oxygen and carbon dioxide it contains (arterial blood gas concentrations).
  • B-type natriuretic peptide (BNP) blood test. Increased levels of BNP may signal a heart condition.
  • Other blood tests. Blood tests to diagnose pulmonary edema and its causes also usually include a complete blood count, metabolic panel to check kidney function and thyroid function test.
  • Electrocardiogram (ECG or EKG). This painless test detects and records the timing and strength of your heart’s signals using small sensors (electrodes) attached to the skin on your chest and legs. The signals are recorded in the form of waves on graph paper or a monitor. An ECG can show signs of heart wall thickening or previous heart attack. A portable ECG machine such as a Holter monitor may be used to continuously monitor your heartbeat at home.
  • Echocardiogram. An echocardiogram creates a moving picture of your heart using sound waves (ultrasound). It can identify areas of poor blood flow, abnormal heart valves and heart muscle that is not working normally. Your doctor can use this test to help diagnose fluid around the heart (pericardial effusion).
  • Cardiac catheterization and coronary angiogram. This test may be done if an ECG, echocardiogram or other tests don’t show the cause of pulmonary edema, or if you also have chest pain.

    During cardiac catheterization, a doctor inserts a long, thin tube (catheter) in an artery or vein in your groin, neck or arm. X-rays help guide the catheter through the blood vessel to your heart. During a coronary angiogram, dye flows through the catheter, allowing blood vessels to show up more clearly on the X-rays. A coronary angiogram can reveal any blockages and measure the pressure in your heart chambers.

  • Ultrasound of the lungs. This painless test uses sound waves to measure blood flow through the lungs. It can quickly reveal signs of fluid buildup and plural effusions. Lung ultrasound has become an accurate tool for diagnosing pulmonary edema.

Diagnostic Tests for Pulmonary Edema

  • Pulse oximetry – to measure the oxygen level in the blood
  • Chest X-ray
  • Blood tests – including arterial blood gas analysis, full blood count, biochemistry, and thyroid function.
  • Electrocardiogram (ECG) – to determine if it is cardiogenic
  • Cardiac catheterization and coronary angiogram – insertion of a very thin and long catheter usually through the arm or neck, which the doctor can use to get a better visualization of the heart (a dye is usually injected), as well as to measure the pressure in the different chambers of the heart, and to possibly open a blocked artery.

Pulmonary Edema Nursing Interventions

What are nursing interventions for edema?

Pulmonary Edema Nursing Interventions
  1. Oxygen therapy: The priority is to give oxygen to reverse the hypoxia or the deprivation of oxygen supply in the body. Severe hypoxia may require the use of mechanical ventilation to provide positive airway pressure.
  2. diuretics: To decrease the fluid that has accumulated in the heart and lungs, diuretics such as furosemide (Lasix) are usually administered.
  3. Anti-hypertensives: Hypertension may eventually lead to pulmonary edema. Blood pressure medications include beta blockers (e.g. bisoprolol) and ACE inhibitors (e.g. ramipril).
  4. Preload reducers and afterload reducers: Medications such as nitroglycerin may be used to decrease the pressure going into the heart.
  5. Anti-cholesterol drugs: For cardiogenic pulmonary edema, anti-cholesterol drugs might be prescribed to reduce the LDL or bad cholesterol that clog up the cardiac arteries.
  6. Antivirals or antibiotics: Bacteria and viruses are common underlying causes of the non-cardiogenic pulmonary edema.

Pulmonary Edema Nursing Care Plan Examples

Example 1

  1. Nursing Diagnosis: Impaired Gas Exchange related to pulmonary edema as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and frothy phlegm

Desired Outcome: The patient will maintain optimal gas exchange as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96% on room air (88-92% if patient has COPD) and verbalize ease of breathing.

Interventions Rationales
Assess the patient’s vital signs, especially the oxygen saturation and characteristics of respirations at least every 4 hours. Also, monitor the results of ABG analysis. To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
ABG Analysis: To check if there is an increase in PaCO2 and a decrease in PaO2, which are the signs of hypoxemia and respiratory acidosis.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed medications: diuretics antihypertensives, pressure reducers, and/or antibiotic/ antiviral medications. Administer the prescribed medications: diuretics antihypertensives, pressure reducers, and/or antibiotic/ antiviral medications. diuretics: To decrease the fluid that has accumulated in the heart and lungs, diuretics such as furosemide (Lasix) are usually administered.
Anti-hypertensives: Hypertension may eventually lead to pulmonary edema.
Preload reducers and afterload reducers: Medications such as nitroglycerin may be used to decrease the pressure going into the heart.
Anti-cholesterol drugs: For cardiogenic pulmonary edema, anti-cholesterol drugs might be prescribed to reduce the LDL or bad cholesterol that clog up the cardiac arteries.
Antivirals or antibiotics: Bacteria and viruses are common underlying causes of the non-cardiogenic pulmonary edema.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position. Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Turn the patient at least every 2 hours. Encourage to mobilize as tolerated. To prevent the complications of immobility such as thromboembolism that may worsen the pulmonary edema.

Example 2

  • Nursing Diagnosis: Ineffective Breathing Pattern related to pulmonary edema as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and blood-tinged frothy phlegm

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation above 96% on room air (88-92% if patient has COPD), and verbalize ease of breathing.

Interventions Rationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. To increase the oxygen level and achieve an SpO2 value within the target range of 88 to 92%.
Administer the prescribed medications (e.g. bronchodilators or combination inhalers / nebulizers) and antibiotic/antiviral medications. Bronchodilators: To dilate or relax the muscles on the airways.
Antibiotics or antivirals: To treat the underlying infection.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Perform chest physiotherapy such as percussion and vibration, if not contraindicated. Nebulization using sodium chloride (NaCl) may also be done, as ordered by the physician. Steam inhalation may also be performed. Suction as required. To facilitate clearance of thick airway secretions.

Pulmonary Edema, Pulmonary Edema Nursing Diagnosis, Pulmonary Edema Nursing Interventions, and Pulmonary Edema Nursing Care Plans

 

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