Pulmonary edema.ppt

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Presentation Transcript

Pulmonary Edema:

Pulmonary Edema Conducted by : Ms.Monika (Clinical instructor ) Army college of nursing ,jalandhar cantt

Slide 2:

(Type I or hypoxaemic respiratory failure) : (PaO2 <60 mm hg ): Failure of oxygen exchange. Type 2 : Ventilatory failure, characterized by increased paco2, occurs in acute conditions in which retained pulmonary secretions cause increased airway resistance and decreased lung compliance, as in bronchitis.

Introduction :

Introduction Pulmonary edema is the abnormal accumulation of fluid in the interstitial spaces surrounding the alveoli. The advancement of fluid accumulation in the alveolar sacs. Which leads to dyspnea.

Types of pulmonary edema :

Types of pulmonary edema Cardiogenic pulmonary edema Noncardiogenic pulmonary edema

1) CARIOGENIC PULMONARY EDEMA :

1) CARIOGENIC PULMONARY EDEMA Pulmonary edema is either due to direct damage to the cardiac tissue or a result of inadequate functioning of the heart or circulatory system Causes Congestive heart failure Severe heart attack with left ventricular failure Severe arrhythmias (tachycardia/fast heartbeat or bradycardia /slow heartbeat) Hypertensive crisis Pericardial effusion with tamponade Fluid overload, e.g., from kidney failure or intravenous therapy

2) NONCARDIOGENIC PULMONARY EDEMA :

2) NONCARDIOGENIC PULMONARY EDEMA Noncardiogenic pulmonary edema is defined as the radiographic evidence of alveolar fluid accumulation without hemodynamic evidence to suggest a cardiogenic etiology . Causes (Alveolar) Inhalation of toxic gases Aspiration , e.g., gastric fluid or in case of drowning Multiple blood transfusions Severe infection

Causes (other):

Causes ( other) Multitrauma, e.g., severe car accident Neurogenic, e.g., subarachnoid hemorrhage Certain types of medication Upper airway obstruction Arteriovenous malformation

Pathophysiology :

Pathophysiology It is seen as a complication of myocardial infarction , hypertension, pneumonia, smoke inhalation, and high-altitude pulmonary edema. Pulmonary edema occurs when there are alterations in Starling forces. Pulmonary vessels create an imbalance in the startling forces Due to increased filtration ,it Increases volumes of fluid leak into the alveolar space

Cont………………d:

Cont………………d The airway pathway becomes overwhelmed, however, fluid moves from the interstitial in the alveolar walls. If the alveolar epithelium is damaged, the fluid accumulates in the alveoli. As fluid fills interstitial and alveolar space, lung compliance decreases . Hypoxemia develops when the alveolar membrane is thickened by fluid that impairs gas exchange of oxygen and CO2.

Clinical manifestation :

Clinical manifestation The sputum is thin and frothy because it is combined with water . The client may be anxious from dyspnea and restless . Chest auscultation reveals crackles sound, rhonch i , wheezes . Pulse oximetry is commonly less than 85% and arterial Po2 of 30 to 50 mm Hg The chest x – ray shows areas of white- out where appears black Tachypnea Breathing pattern shows use of accessory muscle. Hypertension ( if carcinogenic )

Diagnostic evaluation :

Diagnostic evaluation Repeated arterial blood gases should be done A CBC Blood volume Serial ECGs, CT scan of the chest lung biopsy pulmonary function tests Consultation with a pulmonologist or cardiologist will be necessary in many cases.

Outcome management ( medical management) :

Outcome management ( medical management) Medical management : Medical management addresses four areas; (1) correction of hypoxia (2)Reduction in preload (3) Reducing After load (4) Supporting Perfusion .

1) CORRECTING HYPOXEMIA: :

1) CORRECTING HYPOXEMIA: It is important to maintain adequate oxygenation client with severe pulmonary edema commonly require oxygen therapy at high Fi02 level and may require mechanical ventilation of continuous or continuous positive airway pressure ( CPAP) .

(2) Reducing the PRE-LOAD: :

(2) Reducing the PRE-LOAD: the client is placed in an upright position . Usually the client does not lie down because of orthopnea and feeling of chocking when supine. Diuretics are prescribed to promote fluid exertion to promote fluid excretion. Nitrates, such us nitroglycerine are used for their vasodiltative properties.

3) REDUCING AFTER LOAD: :

3) REDUCING AFTER LOAD: After load is reduced to diminish workload on the left ventricle. Antihypertensive agents, such as nitropusside, are prescribed. Morphine is prescribed to reduce after load.

4) SUPPORTING PERFUSION: :

4) SUPPORTING PERFUSION: (3)  SUPPORTING PERFUSION: Using inotropic medication such as dobutamine supports left ventricular failure. Urine output is monitored closely to determine whether renal perfusion is adequate. And intra – aortic Balloon pump may be needed (IABP) with severe heart failure & pulmonary edema.

Cont………..d:

Cont………..d And intra – aortic Balloon pump may be needed (IABP) with severe heart failure & pulmonary edema.

Nursing managements :

Nursing managements Assessment: The client with pulmonary edema is assessed quickly upon admission. Anxiety is often marked. And control of dyspnea is imperative. A complete assessment is carried out over the following hours ,when the client can breathe more comfortably & answer questions. A baseline weight & lung assessment is essential ,because these parameters will assist in determining treatment effectively.

Nursing diagnosis :

Nursing diagnosis IMPAIRED GAS EXCHANGE: OUTCOME MANAGEMENT : the client will demonstrate improved gas exchange, as evidenced by rising Po2 to 55 or 60 mm Hg Oxygen saturation above 90%, normaralizing PH, decreasing anxiety and dyspnea, fewer crackles and rhonchi 12 hours. Monitor vital signs ever 15minutes initially, until the client is stable, and the electrocardiogram Administer oxygen as ordered using a high flow Rebreather bag to maintain oxygenation. Continuous assessment is needed because the client may not be able to tolerate the work of breathing and may require intubations and mechanical ventilation. Mechanical ventilator and all the intubations equipment should be near by. Raising edematous legs increases venous return Preload is reduced with morphine and nitroglycerin. Morphine can be used to reduce anxiety ,

2) Excess fluid volume r/t excess preload.:

2) Excess fluid volume r/t excess preload. Outcome management : the client will demonstrated improved fluid balance. Decreased number of crackles & wheezes , eupnoea & decreased anxiety.

Nursing management :

Nursing management Administer a diuretic as prescribed to promote diuresis. Place an indwelling catheter to monitor response to diuertics. Monitor urine output ,weight & potassium level. Monitor blood pressure to determine whether the client can maintain perfusion .

Thank you :

Thank you