Unit 1: Pulmonary Edema

Question 1

Pulmonary edema occurs from diseases that result in…

Answer 1

FVO!

Question 2

Causes of Pulmonary Edema (7)

Answer 2

1. HF
2. RF
3. ARDs
4. High altitudes (vasoconstriction leading to capillary leakage)
5. Brain trauma
6. Rapidly expanding lung
7. Laboring AFAB (due to FVO)

Question 3

We said pulmonary edema could result from a “rapidly expanding lung,” but when might we see this?

Answer 3

Pt with a pneumothorax that gets a chest tube, which rapidly expands the lungs

Removal of fluid from the pleural space quickly

Question 4

What patient population is most at risk for developing Pulmonary edema? Why?

Answer 4

Older adults; Higher incidence of HF

As the amount of blood ejected from the left ventricle diminishes, the hydrostatic pressure builds in the pulmonary venous system and results in fluid-filled alveoli and pulmonary congestion..

Question 5

What mental status changes would we see with pulmonary edema? Why? (4)

Answer 5

1. Confusion (disorientation)
2. Restlessness
3. Anxiety
4. Lethargy

Decreased O2 to the brain

Question 6

What early S/S in older adults might we suspect for pulmonary edema?

Answer 6

Confusion!
Gramps be talkin’ none sense again

Question 7

Objective S/S of pulmonary edema (7)

Answer 7

1. Crackles in lung bases
2. Dyspnea (at rest)
3. Cough (irritating + persistent)
4. Pink, frothy sputum
5. Tachycardia leading to dysrhythmias
6. Altered BP
7. Reduced U/O

Late S/S: diaphoresis + cyanosis

Question 8

In what situations would hypotension be present along with pulmonary edema? What else might we see?

Answer 8

Decreased cardiac output (Ex. caused by an acute MI or left-sided HF)
Decreased Urine output

Question 9

What’s suuuper important to document about the lung sounds heard r/t pulmonary edema?

Answer 9

The precise location of the crackles!
B/c the level of fluid progresses from the bases to high levels in the lungs as the condition worsens

Question 10

What’s the simplest nursing intervention we should perform if we suspect pulmonary edema?

Answer 10

Reassurance!
“Chill tf out brother”

Question 11

Nursing Interventions r/t to Pulmonary edema:

Answer 11

1. Raise HOB
2. Oxygen
3. SpO2 + VS
4. Meds (or IV access to admin them)

Question 12

Medical Mx of pulmonary edema aims to reduce ______ and _______ on the heart.

Answer 12

Reduce preload (pulmonary venous return) and afterload (systemic vascular resistance) on the heart

Question 13

What medications do we use for pulmonary edema? (3)
Indicate whether the med reduces preload, afterload, or both.

Answer 13

1. Diuretics (preload)
2. Nitroglycerin (preload + afterload)
3. Morphine (afterload + maybe preload)

Question 14

What medication would we use if we had pulmonary edema aaand hypotension?

Answer 14

Ionotropic support (increase the squeeze/contractility of the heart) = positive inotropes
Ex. dobutamine

Question 15

If a renal failure patient develops pulmonary edema, what do?

Answer 15

Ultrafiltration

*she said HF pt’s in her lecture…. ?

Question 16

What’s the priority assessment r/t Acute pulmonary edema?

Answer 16

ABC’s!

Question 17

What type of oxygen delivery devices should we use r/t Acute Pulmonary edema? (3)

Answer 17

1. O2 by facemask (High-flow O2)
2. Noninvasive Positive Pressure Ventilation (BIPAP)
3. Intubation/Mechanical Ventilation

Question 18

D/C Teaching for HF patient admitted w/ pulmonary edema should include teaching from who and what? (testing, meds, pt teaching)

Answer 18

Case Management, Social Worker, blah blah blah

1. Left Ventricular Systolic Function Test (EF test)
2. ACE or ARB
3. Smoking cessation
4. Activity as tolerated = work up to routine exercise