acute pulmonary edema

acute pulmonary episode
– acute, rapid
– caused by decrease of ability of left ventricle to pump
– pathophys is same as congestive heart failure (altho a lot of people don’t have congestion)
– easier to prevent than treat

patho of acute pulmonary episode
1. something happens early to knock out that pump in the left ventricle – QUICKLY
– acute MI
– longstanding HTN – un-dx’ed
– valvular disease, esp. aortic stenosis – left ventricle has to pump blood thru here and you’re making it work RILLY hard because it’s harder and harder to get blood thru smaller and smaller hole…
– rapid arrhythmias – drop CO
– anything cardiotoxic

anatomy behind acute pulmonary edema
1. left ventricle is failed for some reason, and this creates stasis in left atrium
2. now pulmonary veins start to increase pressure, and there is stasis here too
3. due to increasing hydrostatic pressure in pulmonary veins/capillaries and stasis of blood d/t backup… fluid begins to leak into alveoli (bcaus alveoli are surrounded by capillaries)
4. as fluid mixes with air and takes up alveoli, you have less gas exchange – hypoxia!

tell-tale pink froth of APE and CHF
– fluid in alveoli begin to mix with air – becomes frothy, foamy
– can be mixed with blood = pink frothy sputum

pulmonary edema nursing assessment
1. restlessness, anxiousness… changes in LOC = d/t hypoxia
2. sudden shortness of breath, paroxysmal nocturnal dyspnea (fine all day, but to do bed and lay flat, get increased venous return from legs, and it can be more fluid than left ventricle can handle)
3. crackles
4. pale > cyanosis
5. gurgling respirations – secretions
6. pink frothy sputum
7. ABG – lower o2, increased co2
8. tachycardia – may lead to arrhythmias

pulmonary edema nursing goals
improve pumping of left ventricle
improve respiratory exchange – improving ventricles will help with this, but support/improve @ same time

pulmonary edema nursing interventions
1. oxygen
2. positive inotropics
3. morphine
4. diuretics
5. other meds
6. swan ganz, arterial line – monitoring
7. assess for shock – because it’s an acute emergency! pt may go into cardiogenic shock!

oxygen for pulmonary edema
– sometimes nasal canula, sometimes intubated and on respirator
– PEEP – decreases venous return by increasing intrathoracic pressure, will also improve o2
– ABGs
– pulse oximeter

+ inotropics for pulmonary edema
1. digoxin – slow HR, improve contractility
2. dopamine – increase HR, improve contraction
3. primacor, inocor – also improve contraction

morphine for pulmonary edema
– helps anxiety
– increases peripheral vasodilatation – decreases venous return
– be careful of reduction in RR

diuretics for pulmonary edema
you want them to work quickly!
– loop diuretic! furosimide! (takes 5 min)
– watch potassium, too then… esp if also on digoxin
– may need foley – accurate i+o
– daily weights – is fluid coming off?
– make sure they don’t have deficit of fluid
also: thiazides (hctz), ksparing (aldactone)

other general monitoring with pulmonary edema
it can happen suddenly!
watch for heart rate, resp changes, loc changes, lethargy
– sit them upright – help breathing, decrease venous return so heart doesn’t work so hard
– put oxygen on them
– have resp therapist come look

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