تم تحميل هذا الملف من منتديات تمريض مستشفى غزة الاوروبي http://egh-nsg.forumpalestine.com/ لتحميل اجمل واروع المحاضرات فقط قم بزيارتنا وسوف تكون من الاوائل مع تحيات المدير العام علاء شعت

2. Pulmonary Edema

3. Pulmonary edema
 It’s life threatening condition is defined as
abnormal accumulation of fluid in the lung
tissue and/or alveolar space.

4. Pathophysiology/ Etiology
The present of fluid in the alveolio impedes
gas exchange especially oxygen movement
into pulmonary capilary.

5. Pathophysiology/ Etiology
 Pulmonary edema most commonly occurs as a result of
increase micro vascular pressure from abnormal cardiac
function.
 If cause is : Heart disease “ cardiovascular disease”
e.g. Acute left ventricular failure, MI, aortic stenosis,
sever mitral valve disease, hypertension, CHF.
Inadequate left ventricular Function
Fluid begins to leak to interstitial space
and the alveoli
 Hypervolemia “circulatory overload” lead to increase
intravascular pressure in the lung.

6.  If cause is lung injuries.
A) Flash pulmonary edema
e.g. Pt who has undergone pneumoectomy
Remove of one lung or partial of lung
Cardiac output goes to remaining lung.
If pt fluid is not montoring closly.
Pulmonary edema

7. Note
 This pulmonary edema still until pt’s
pulmonary vasculature attempt to
adapt.

8. Pathophysiology/ Etiology
B) Re-expansion pulmonary edema.
this caused by rapid reinflation of the lung after removal of
the air from pneumothorax or evacuation of fluid from a large
pleural effusion.

9.  Other causes:
- Hypervolemia “circulatory overload”
- Infections pneumonia.
- Organophesphorous poisoning.

10. Clinical manifestation:
 Dyspnea, orthopnea.
Note: pt usually uses accessory muscle of respiration with
retraction of intracostal space and supera-clavicular areas.
 Cough with varying amount white-or-pink tinged frothy sputum.
 Air hunger and central cyanosis.
 Noisy breathing “inspiration and expiratory wheezing and
bubbling sounds.
 Distended neck veins.
 Respiratory distress: 1- anxiety, ayitated
2- confusion or stuporous
 Tachycardia, hypotension , shock

11. Diagnostic Evaluation
 Auscultation reveals crackles.
 Chest x-ray show interstitial marking “edema”
 Pulse oximetry, ABG reveals hypoxemia.
 measuring of pulmonary artery wedge pressure by
Swan-Gam catheter.

12. Management
1.The immediate objectives are:
a- improve oxygenation.
b- reduce pulmonary congestion.
2. Identify and correct of precipitation factors to prevent recurrence.
3. Increase oxygen tension
a- Reduce fluid volume by diuretics and vasodilators”
b- Improving heart ability to pump “glycoside, beta agonists”
c- Decease anxiety
4. Oxygen therapy
a- Use high oxygen flow.
b- Intubations and Mechanical ventilation

13. Cont..
5- Morphine sulfate to:
a- Reduce anxiety.
b- Venous pooling of blood in the periphery.
c- Reduce resistance against which the heart must pump.
6- Vasodilator therapy “Nitroglycerin”
- to reduce amount of blood returning to the heart.
- to reduce resistance against which the heart most pump.
7- Diuretic therapy “lasix”
- to reduce blood volume and pulmonary congestion.

14. Cont..
8- Contractility enhancement “Digoxin, dopamin, aminophyllin
to improve heart muscle to pump
complete emptying of blood from the ventricle.
Decrease fluid backing up into the lungs.
 Aminophylline to prevent bronchospasm.

15. Complication
 Dysrhythmias.
 Respiratory failure.

16. Nursing Intervention
 Improve oxygenation
 Decrease anxiety.