Sunday, January 15, 2006

pulmonary edema, acute

Acute pulmonary edema is the accumulation of excessive fluid in cells, tissues, or serous cavities. Acute pulmonary edema is an acute emergency condition most often associated with heart disease. It can also be caused by inhalation of an irritant and too rapid an administration of plasma or intravenous fluids. In pulmonary edema, cardiac output is decreased, causing an increase in left atrial pressure. This results in an increase in pulmonary vein and capillary pressure. As the pulmonary capillary pressure exceeds the intravascular osmotic pressure, serous fluid is rapidly forced into the lung. The person literally begins to drown in his or her own secretions.
Symptoms of acute pulmonary edema include profound dyspnea (shortness of breath), pallor, cyanosis (bluish color due to deficient oxygen of blood), tachycardia (rapid heart beat), wheezing, anxiety, restlessness, productive cough (pinkish, frothy sputum), and moist respirations (gurgling).
The goals of treatment for pulmonary edema include physical and mental relaxation, improvement of cardiovascular function, relief of hypoxemia (lack of oxygen in arterial blood), and decreased venous return. Morphine or Demerol is given intravenously to provide relaxation. Supplemental oxygen is administered and aminophylline may be used to dilate the bronchi and make breathing easier. Measures to retard venous return to the heart include a wet phlebotomy (the removal of blood from a vein), or a dry phlebotomy (rotating tourniquets). The purpose of rotating tourniquets is to pool blood in the extremities, causing a reduction in cardiac load. The tourniquets are placed on three extremities and rotated every 15 minutes. Since acute pulmonary edema is frequently a complication of congestive heart failure, the treatment for congestive heart failure is also necessary. This treatment includes the administration of diuretics and digoxin, bed rest, and a salt-restricted diet.
See also CONGESTIVE HEART FAILURE.
Phipps, W. J., et al. Medical Surgical Nursing. St. Louis: C. V. Mosby Co., 1983.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.

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