Pulmonary Embolism / Pulmonary Edema Flashcards
(46 cards)
Excess fluid in the lungs (not the pleural space) =
pulmonary edema
causes of pulmonary edema
• Happens a lot in older folks –> decreased heart/kidney function
◦ HF
◦ Renal failure
◦ ARDS
◦ High altitudes
◦ Brain trauma
◦ Rapidly expanding lungs
— pneunothorax –> Pulling fluid off lungs too quickly when re-expanding the lung
◦ Most common: When giving too much fluid too quickly
what happens when fluid accumulates in the alveoli
cant exchange O2/Co2
on a patho level what is causing pulmonary edema (not diseases)
• Increased pulmonary pressure increases, fluid leaks across pulmonary capillaries into airway and tissue
which is bigger deal- acute pulmonary edema or pulmonary edema
Acute Pulmonary Edema (formerly known as flash pulmonary edema)
=Life threatening emergency
who is highest risk of acute pulmonary edema
• HF, renal, older folks
• Laboring parents on a lot of fluid can happen
◦ Results from severe fluid overload
acute pulmonary edema assessment findings
• Coarse Crackles (especially in bases)
• Cough
• SOB
• Pink, frothy sputum**
• Dyspnea
• Confusion
• Tachy/Dysrythmias
• Altered BP (low , high, or normal)
• Reduced urinary output (low cardiac output)
• Restlessness/anxiety
• Lethargy
interventions for pulmonary edema
• Reassurance
• HOB raised
• O2 increase
• Monitor SpO2, Vital signs
- Meds
• FIX UNDERLYING CAUSES
• Ultrafiltration
• Use ABC’s
• O2
◦ Face mask
◦ Noninvasive positive pressure ventilation (Bipap cpap)
◦ Intubation/Mechanical ventilation
meds we might give for pulmonary edema
nitroglycerin, morphine, diuretics, antihypertensives, dobutamine
which drug reduces preload (pulmonary venous return) :
diuretic, antihypertensive, or dobutamine
diuretic
which drug provide ionotropic support (heart contraction):
diuretic, antihypertensive, or dobutamine
dobutamine
which drug reduces the afterload (systemic vascular resistance):
diuretic, antihypertensive, or dobutamine
antihypertensive
goals for managing pulmonary edema long term? who do you want on the team for helping to manage them?
-manage underlying diseases that cause pulmonary edema
-HF core measures
◦ Discharge instructions
◦ Left ventricular systolic function
◦ ACE or ARB
◦ Smoking cessation
-• Activity as tolerated / Work up to routine exercise
-case management/social worker
HF core measures re: managing pulmonary edema
◦ Discharge instructions
◦ Left ventricular systolic function
◦ ACE or ARB
◦ Smoking cessation
A PE is caused by a blockage- what kind of things can block your vessels?
air, liquid, solid
Take me through the patho of what happens when you have a PE
• Reduced gas exchange
• Reduced oxygenation
• Pulmonary tissue hypoxia
• Decreased perfusion –> increases resistance in pulmonary vasculature –> increase work of R side of heart to push blood out into the lungs –> R sided HF –> poor perfusion to rest of body
• Possible death
Most common cause of a PE =
DVT! VTE (venous thromboembolism)
Path of DVT to PE
DVT → dislodges → vena cava → right atrium → right ventricle → pulmonary vessels → platelets aggregate → triggers other substances that cause vessel constriction
→ Impaired gas –> impaired tissue perfusion –> hypoxemia
When the DVT dislodge and goes into your pulmonary vasculature what happens to the right side of the heart?
becomes hard to the right ventricle to push blood into the lungs
What puts someone at increase risk of DVT/PE
• Increased age
• Hypercoagulable states
• Obesity
• hypercoagulable state
• Prolonged immobility
• Central venous catheter
• IV drug use
• Sepsis
virchow’s triad =
= increase risk of developing a blood clot from
1.) damage to vessel (trauma)
2.) immobility (stasis of blood flow)
3.) hypercoagulability
The best way to manage a DVT is to ….
prevent it!!
use anticoagulant, mobility, SCD’s
asssesment findings for PE
• Resp compromise
• Dyspnea
• Chest pain – stabbing, sharp
◦ heart attack = squeezing, crushing
• Restlessness
• Agitation
• Cough
• Bloody sputum from infarcted lung (Pulmonary Edema = pink frothy)
• Abnormal breath sounds
• Tachypnea
• Tachycardia
• Diaphoresis
• Fever- inflammation
• Petechiae (throwing blood clots, hemorrhaging of small capillaries)
• Showering clots
• Increased O2 demands
• Hypotension from decreased cardiac output
• Abnormal heart sounds
• EKG changes
sputum with PE vs sputum with Pulmonary edema
PE = bloody from infarcted lung
Pulm Edema = pink frothy
