Pulmonary Edema

  1. General information
    1. A medical emergency that usually results from left-sided heart failure. The capillary pressure within the lungs becomes so great that fluid pours from the blood into the alveoli, bronchi, and bronchioles. Death occurs by suffocation if this condition is untreated.
    2. Caused by left-sided heart failure, rapid administration of IV fluids.
  2. Medical management
    1. Oxygen therapy
    2. Endotracheal/nasotracheal intubation (possible)
    3. Drug therapy
      1. Morphine sulfate to induce vasodilation and decrease anxiety; 5 mg IV, administer slowly
      2. Digitalis to improve cardiac output
      3. Diuretics (furosemide [Lasix] is drug of choice) to relieve fluid retention
      4. Aminophylline to relieve bronchospasm and increase cardiac output; 250-500 mg IV, administer slowly
      5. Vasodilators (nitroglycerin, isosorbide dinitrate) to dilate the vessels, thereby reducing amount of blood returned to the heart
    4. Rotating tourniquets or phlebotomy
  3. Assessment findings
    1. Dyspnea
    2. Cough with large amounts of blood-tinged sputum
    3. Tachycardia, pallor, wheezing, rales or crackles, diaphoresis
    4. Restlessness, fear/anxiety
    5. Jugular vein distension
    6. Decreased pO2, increased pCO2, elevated CVP
  4. Nursing interventions
    1. Assist with intubation (if necessary) and monitor mechanical ventilation.
    2. Administer oxygen by mask in high concentrations (40%-60%) if not intubated.
    3. Place client in semi-Fowler's position or over bedside table to ease dyspnea.
    4. Administer medications as ordered.
    5. Apply and monitor rotating tourniquets.
      1. Occlude vessels of each limb for no more than 45 minutes at a time.
      2. Rotate in a clockwise fashion every 15 minutes.
      3. Assess continuously for presence of arterial pulses.
      4. Observe skin for signs of irritation.
      5. When discontinuing, remove 1 tourniquet every 15 minutes to avoid rapid influx of fluid to the heart.
    6. Assist with phlebotomy (removal of 300-500 ml of blood from a peripheral vein) if performed.
    7. CVP/hemodynamic monitoring.
    8. Provide client teaching and discharge planning concerning
      1. Prescribed medications, including name, purpose, schedule, dosage, and side effects
      2. Dietary restrictions: low sodium, low cholesterol
      3. Importance of adhering to planned rest periods with gradual progressive increase in activities
      4. Daily weights
      5. Need to report the following symptoms to physician immediately: dyspnea, persistent productive cough, pedal edema, restlessness