NCM ASSIGHNMENT

NAME: DANILO N. ECARMA JR.

PULMONARY EDEMA

Manifestations:
Depending on the cause, pulmonary edema symptoms may appear suddenly or
develop over time.

Sudden (acute) pulmonary edema symptoms

Extreme shortness of breath or difficulty breathing (dyspnea) that worsens

when lying down

A feeling of suffocating or drowning

Wheezing or gasping for breath

Anxiety, restlessness or a sense of apprehension

A cough that produces frothy sputum that may be tinged with blood

Chest pain if pulmonary edema is caused by heart disease

A rapid, irregular heartbeat (palpitations)

If you develop any of these signs or symptoms, call 911 or emergency medical
assistance right away. Pulmonary edema can be fatal if not treated.

Long-term (chronic) pulmonary edema symptoms

Having more shortness of breath than normal when you're physically active.

Difficulty breathing with exertion.

Difficulty breathing when you're lying flat.

Wheezing.

Awakening at night with a breathless feeling that may be relieved by sitting

up.

Rapid weight gain when pulmonary edema develops as a result of congestive

heart failure, a condition in which your heart pumps too little blood to meet your
body's needs. The weight gain is from buildup of fluid in your body, especially in
your legs.

Swelling in your lower extremities.

Fatigue.

High-altitude pulmonary edema symptoms

Shortness of breath after exertion, which progresses to shortness of breath at

rest

Cough

Difficulty walking uphill, which progresses to difficulty walking on flat surfaces

Fever

A cough that produces frothy sputum that may be tinged with blood

A rapid, irregular heartbeat (palpitations)

Chest discomfort

Headaches, which may be the first symptom

Diagnostic test:
Tests that may be done to diagnose pulmonary edema or to determine why
you developed fluid in your lungs include:

1.
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4.
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6.
7.
8.

Chest X-ray
Pulse oximetry
Blood tests
Electrocardiogram (ECG)
Echocardiogram
Transesophageal echocardiography (TEE)
Pulmonary artery catheterization
Cardiac catheterization

Medication/Surgical:

Giving oxygen is the first step in the treatment for pulmonary edema. You
usually receive oxygen through a face mask or nasal cannula a flexible plastic
tube with two openings that deliver oxygen to each nostril. This should ease some
of your symptoms. Your doctor will monitor your oxygen level closely. Sometimes it
may be necessary to assist your breathing with a machine such as a mechanical
ventilator.
Depending on your condition and the reason for your pulmonary edema, you may
also receive one or more of the following medications:

Preload reducers. Preload reducing medications decrease the pressure

caused by fluid going into your heart and lungs. Doctors commonly prescribe
nitroglycerin and diuretics such as furosemide (Lasix) to treat pulmonary edema.
Diuretics may make you urinate so much initially that you may temporarily need a
urinary catheter while you're in the hospital. The drug nifedipine (Procardia) may
sometimes be prescribed.

Morphine (Avinza, MS Contin). This narcotic may be used to relieve

shortness of breath and anxiety. But some doctors believe that the risks of
morphine may outweigh the benefits and are more apt to use other more-effective
drugs.

Afterload reducers. These medications, such as nitroprusside (Nitropress),

dilate your blood vessels and take a pressure load off your heart's left ventricle.

Blood pressure medications. If you have high blood pressure when you
develop pulmonary edema, you'll be given medications to control it. Alternatively,
if your blood pressure is too low, you're likely to be given medications to raise it.
If your pulmonary edema is caused by another condition such as a nervous system
condition, your doctor will treat the condition that is causing it and the pulmonary
edema.

Treating high-altitude pulmonary edema (HAPE)

If you're climbing or traveling at high altitudes and experience mild symptoms of
HAPE, descending 2,000 to 3,000 feet (about 600 to 900 meters) as quickly as you
can, within reason, should relieve your symptoms. You should also reduce physical
activity and keep warm, as physical activity and cold can make your condition
worse.
Oxygen is usually the first treatment and can often relieve your symptoms. If
supplemental oxygen isn't available, you may use portable hyperbaric chambers,
which imitate a descent for several hours until you can descend to a lower
elevation.

In addition to oxygen and descending to a lower elevation, the medication

nifedipine (Procardia) may help reduce pressure in the pulmonary arteries and
improve your condition.
When symptoms are more severe, you'll likely need help in your descent. A
helicopter rescue may be necessary for the most serious cases because HAPE can
be life-threatening.
Some climbers take prescription medications such as acetazolamide (Diamox
Sequels) or nifedipine to help treat or prevent symptoms of HAPE. To prevent HAPE,
medication is started at least one day before ascent.

Nursing Management:

The immediate objective of treatment is to improve oxygenation and reduce

pulmonary congestion.
Medical treatment for pulmonary edema is considered an emergency
If possible, find and treat the underlying cause of pulmonary edema
Identification and correction of precipitating factors and underlying conditions
are then necessary to prevent recurrence
Oxygen therapy
High fowlers position
Diuretic therapy
Vasodialator therapy
Contractility enhance therapy
aminophylline