Pulmonary Edema

The client/caregiver can define pulmonary edema.
1. It is the abnormal accumulation of fluid that results when the heart cannot pump enough blood from the lungs to the rest of the body.
2. Fluid from the small blood vessels of the lungs rapidly oozes from the vessels into the lungs.
3. It typically occurs at night after lying down for several hours.
4. Acute pulmonary edema is a medical emergency.
The client/caregiver can list some of the possible causes of pulmonary edema.
1. Heart failure (most common)
2. Complications of heart attack
3. Mitral or aortic valve disease
4. Kidney failure
5. Intravenous overload
6. Intravenous drug overdose
7. Drowning
8. Acute respiratory distress syndrome
9. Severe allergic reactions (anaphylaxis)
10. Exposure to toxins
11. High-altitude pulmonary edema
The client/caregiver can recognize the signs and symptoms of pulmonary edema.
1. Severe and sudden onset symptoms
  - Extreme shortness of breath or difficulty breathing
  - A feeling of suffocating or drowning
  - Wheezing or gasping for breath
  - Anxiety and restlessness
  - A cough that produces frothy sputum (possibly tinged with blood)
  - Excessive sweating
  - Pale skin
  - Chest pain (if caused by coronary artery disease)
2. Symptoms that develop more gradually include
  - Difficulty when you are lying flat
  - Awakening at night with breathless feeling
  - Increased shortness of breath when physically active
  - Significant weight gain (if result of congestive heart failure)
The client/caregiver can list measures to prevent a recurrence of pulmonary edema.
1. Follow activity as ordered with planned rest periods.
2. Eat a heart healthy diet.
  1. Restrict sodium.
  2. Eat plenty of fresh fruits and vegetables.
  3. Restrict cholesterol and fat in diet to prevent hypertension and elevated cholesterol levels.
  4. Limit alcohol and caffeine.
3. Weigh daily (mornings preferred) for early detection of fluid retention. Report a gain of 2 to 3 pounds over one 24-hour period.
4. Exercise regularly as directed by physician.
5. Consult physician before activities that will be at high altitudes (climb or travel).
6. Notify the doctor if the following symptoms occur:
  - Trouble breathing or feeling of suffocating
  - A bubbly, wheezing, or gasping sound when you breathe
  - Pink, frothy sputum when you cough
  - Profuse sweating
  - Lightheadedness
  - A blue or gray tone to your skin
The client/caregiver will know what to do if pulmonary edema occurs.
1. Call 911 and seek emergency assistance. Do not attempt to drive.
2. Sit with head and shoulders up and feet down to favor pooling of the blood to lower dependent portions of the body.
3. Do not panic. Have list of your emergency contacts, list of medical conditions, and current medications ready and by the phone.
The client/caregiver is aware of possible complications.
1. Respiratory failure
2. Cardiac arrest

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.

Cohen, B. J., & Taylor, J. J. (2005). Memmler’s the human body in health and disease (10th ed.). Philadelphia: Lippincott Williams and Wilkins.

Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.

Nursing 2006 drug handbook. (2006). Philadelphia: Lippincott Williams and Wilkins.

Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.

Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.

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