Acute Pulmonary Edema - Article Example

Running Head: Acute Pulmonary Edema Acute pulmonary Edema Name Institution Date Acute pulmonary edema Acute pulmonary edema results from the accumulation of fluids within the alveolar cavities in the lungs. The accumulation of fluids normally leads to the impairment of the functions of the lungs. This is so because the fluids will affect the expansion of the lungs and thus the ventilatory ability of the lungs is greatly impared. The fluid that accumulates in the lungs will normally result from the permeability of the alveolar walls being increased hence there is an influx of fluids into the alveolar spaces of the lungs (Kasper, 2005). The clinical presentation of pulmonary edema The features of pulmonary edema will result from the effects that will be resulting from the accumulation of fluids in the alveolar cavity leading to congestion. The clinical features will be exhibited with edema especially of the lower limbs; the jugular venous distention at the neck region will be noted. Most of the patients will also be dyspneac, orthopnea; they will also have cold extremities, and will be cyanosed due to the reduced ventilatory capacity of the lungs. The patients will also develop the use of the intercostals muscles for respiration. On auscultation the patient, there will be the presence of the bilateral rales that will be heard and sometimes the 3rd heart sound may also be gotten (Mayo Clinic, 2011). The presentation features of Mr. Smith make him to be a candidate to be diagnosed of acute pulmonary edema. This is so because of the clinical features that he will be having.Mr. Smith has a productive cough that is pink in colour, Mr. Smith was also noted to be dyspneac, and he is using the intercostal muscles to breath. The percentage saturation is at 92% due to the effect of the condition on the ventilatory capacity of the lungs being impared by the accumulation of the fluid in the alveolar cavity. On auscultation of Mr. Smith, there were crepitations which were heard up to the scapular of the lungs bilaterally and this shows that a considerable volume of fluid has accumulated over time and has now almost reached the apices of the lungs. The failure of the mechanisms that prevent movement of fluids into the interstitium, this will include plasma oncotic pressures and capillary pressures. The failure of these forces will lead to the accumulation of the fluids within the interstitium due to mainly the increase of the lymphatic flow and there will be net increase in the interstitial volumes (Kumar &Clark, 2006). The increase in lymphatic flow will go on till it will cause the obstruction of the drainage of the excess fluid. This is what leads to the accumulation of the fluids in the interstitial spaces. The fluid will accumulate within the spaces of the lungs vasculature. When the fluids continue to accumulate, the pressure will thereby start to build in the interstitial space that will be surrounding the alveoli. The accumulation is what goes ahead to cause the impairment of the gaseous exchange. This tends to be more severe when there is diffuse involvement of the alveoli capillary membranes. The fluids in the lungs tend to accumulate from the base towards the apices and this is purely due to gravity. The accumulation towards the apices will also be precipitated by the rise of the pulmonary venous pressures. This accumulation of the fluids will start to have its first effects to the patient being exhibited and this will range from; the patient will be dyspneac due to the reduced amount of oxygen being supplied to the tissues. The patient will also be forced to use the intercostals muscles to enhance proper ventilation. When the saturation percentage measurement of oxygen is measured, the saturation levels will tend to be low due to the reduced perfusion of the tissues. The fluids will continue to accumulate until they will be able to reach the level of the apices. However by the time fluid level reaches 2/3rds of the lung fields, crepitations will be able to be appreciated by auscultation (Kumar &Clark, 2006). Etiology of acute pulmonary edema The causes of pulmonary edema will range from those caused by the alteration of the permeability of membranes and this mainly from the infections, the toxins which are circulating in the human body, the vasoactive and immunological reactions. The other causes of pulmonary edema will result from the increase in the pulmonary capillary pressures and this will cause involve the causes such as the hypertrophy of the left ventricle and also in the cases of endocarditis. The condition could also arise from non cardiac causes such as congenital stenosis that originates mainly from the pulmonary veins or even in the cases of pulmonary venous thromboembolism.pulmonary edema can also result from mechanism will result from a decrease in oncotic pressures and this will be mainly due to hypoalbominaemia. The obstruction of the lymphatics will lead to the causation of pulmonary edema. In the case study however, the condition of pulmonary edema resulted from the increase in the perm abilities of the capillaries. The permeability of the capillaries will allow influx of fluids into the interstitium. This permeability led to the increased accumulation of fluids within the interstitium. This permeability was brought by the pneumonia the patient was having. The fluid will start to accumulate in the lungs from the bases and will start to gradually rise towards the apices of the lungs. The continued accumulation will be able to be felt by auscultation when it reaches at about two thirds of the lungs. The patient will also start to exhibit features such as a dry cough that will be productive and pink, dyspnea and tachycardia (Kumar & Clark, 2006). The investigations to be carried out The chest radiograph will be useful in the diagnosis of pulmonary edema. The chest radiograph will be able to show the visualization of the Kelly B lines which is characteristic of the pulmonary edema. The lungs will also take the form of a butterfly appearance of a butterfly pattern which will have the central predominance of the shadows with clear zones at the peripheries. There will also be a drop in the partial concentration of oxygen in the blood (Kumar &Clark, 2006). The management of pulmonary edema will start as soon as the diagnosis has been made due to it being medical emergency.100% oxygen should be delivered to the patient by the use of a mask. Morphine will also be administered to reduce anxiety which is achieved by decreasing the sympathetic outflow and as a result causing venodilation and decrease in the preload. Loops diuretics such as furosemide could also be administered to bring about venodilation and diuresis. Digoxin will be used too to help relieve atrial fibrillations. The nitroglycerines will also be used to bring about venodilation. On the other hand, aminopheline will be used to bring about an increase in renal plasmatic flow, the continued excretion of sodium and increasing cardiac contractions hence these results in venodilation and decreased peripheral vascular resistance Nitroglycerines will be administered in order to reduce pulmonary edema and to also cause venodilation. It is given when the patients’ systolic blood pressures are above the levels of 120mmhg.The sublingual tablets or IV drip at 0.4mg.Although Mr. Smith is likely to have atrial fibrillations which will be relieved by the use of digoxin 0.25mg slow IV push to slow the ventricular rates. Beta-adrenergic agonists or aminophyline IV will be administered with an aim of relieving bronchospasms that may occur in pulmonary edema and also an increase the severity of hypoxemia and dyspnea (Kumar & Clark, 2006). The interventions to be put in place in the management of acute pulmonary edema Provision of mouth care: The oral cavity should be regularly cleaned as this will enable the prevention of the infection of the gums and also the rest of the oral cavity due to the proliferation of the bacteria in the oral cavity. The checking of the oral cavity for any possible sores is also done (Mayo clinic, 2010). The position semi fowlers There are various types of the fowler positions, the low, semi and the high fowlers. The fowlers are classified basing on the angle the head will be positioned. This will involve the patient being able to relax the tension being exerted in the abdominal muscles to allow for improved breathing by the patient who is bed ridden. This will be as a result of the reduction of the congestion of the fluids in the lungs which would prevent the maximum expansion of the lungs and will g ahead to limit the amount of oxygen that is available for circulation to the body tissues (Mayo clinic, 2010). The patient should be made to sit on the bed with his legs dangling on the other side of the bed as this will bring about the reduction of the venous return and hence will go a long way in the reduction of congestion (Mayo clinic, 2010). Monitoring of the cough and secretions frequently This will enable the removal of the secretions which if left will offer a culture medium for the harmful microorganisms. The removal will also prevent the secretions from blocking the airways as this will hamper the breathing of the patient. The coughing of the patient should also be monitored to root out whether the cough is productive or not and if there are any changes during the management of the patient’s condition (Gray A, et al, 2008). Assessment of the respiratory rates, saturations and the level of consciousness should be done from time to time because they will be used to offer the direction in terms of the management plan. The respiratory rate will be done by the counting of the respiratory cycles per minute. The level of saturation on the other hand will be done using the pulse oximetry and hence will determine the effectiveness of the amount of oxygen being administered. The level of consciousness will be determined by the use of the Glasgow coma scale as this will quantify the well being of the central nervous system in relation to acute pulmonary edema the patient is having. The mask should also be monitored to avoid complications that are associated with it which include its fitting being tight as this would cause claustrophobia for instance. The skin of the patient should also be frequently assessed for the development of the pressure sores due to being bed ridden. When the pressure sores are identified to be developing, the patient should be turned every two hourly to avoid the pressure sore developing (Gray A, et al, 2008). Maintaining oxygen therapy The maintenance of the oxygen therapy will ensure that the perfusion of tissues is maintained by the patient. The oxygen should be that of 100% concentration and this will go in the long run to deliver the oxygen which the patient was being deprived off by the acute pulmonary edema. The patients should be constantly be examined to check whether the patient is dyspneac or having pallor and also if the patient’s condition detoriates.The patients breathing pattern assessment should also be put under consideration to enable the identification of the early and late warning sign (Gray A, et al, 2008). Other interventions will include The patients should be constantly assessed for their confort.This is done to help eliminate any form of discomfort such as claustrophobia which normally results when the mask is fitted too tightly on the face to minimize leakage. The prevention of pressure sores around the face and this will normally be done by the placement of a piece of hydrocolloid in the pressure prone areas (e.g. at the bridge of the nose).The dryness of lips and nasal passages due to the dehydration, this will result from the delivery of dry air which will be done under high pressure. This will be solved by the application of the lip balm or by the use of nasal sprays. (Gray A, et al, 2008). The swallowing of air in this condition could also lead to gastric distention. This will be solved by the use of the nasogastric tube being inserted. The other possible cause of gastric distention will be as a result of aspiration. This will be solved by examination of the patient for the following features; the presence of nausea, an increase in the abdominal girth. On percussion, tympanity will be appreciated. This gastric distention results from the aspiration will resolved by the use of the antiemetics (Gray A, et al, 2008).The other complication will be corneal irritation and this will result from the continuous blowing of air into the eyes. This will be solved by ensuring the use an adequate mask seal on the face, the eyes will also be kept moist by the use of the drops or ophthalmic ointment. In pulmonary edema, hypoventilation could arise. This will be mainly due to the leaking of air. Hypoventilation will also arise due to the leaking of the air and this will also be solved using an adequate mask seal on the face (Gray A, et al, 2008). Benefits of non invasive ventilation in the management of pulmonary edema The use of the Non Invasive Ventilation helps in the preservation on the airways defense mechanisms which would otherwise be compromised while using the other methods that are invasive in the provision of oxygen. Non Invasive Ventilation goes a long way to offer timely early ventilator support to the patient. Use of Non Invasive Ventilation offers will go a long way in the resolving of the dyspneac spells the patient might be undergoing. The non invasive ventilation will also enable the patient to be able to feed orally, to drink and even to communicate (Sandham J, 2011). When compared to other methods of the delivery of oxygen, the application or use of Non Invasive Ventilation will be done with ease in addition also the Non Invasive Ventilation removal will not be cumbersome as compared to the other methods in relation to the patients comfort. Moreover there will be less sedation being required while using the Non Invasive Ventilation with intubation being avoided since it is associated with complicates. The Non Invasive Ventilation also generally improves the patients comfort (Sandham J, 2011). The application of Non Invasive Ventilation will be done with a lot of ease compared to the other method the patients comfort. However less sedation is required while using the Non Invasive Ventilation with intubation being avoided since it is associated with complications. The Non Invasive Ventilation also generally improves the patients comfort (Sandham J, 2011). Conclusion Acute pulmonary edema will involve the accumulation the fluids in the alveoli cavities and this will make the lungs to be impared in their function. The fluid tends to continuously accumulate and the condition only gets worse as the accumulation of the fluid increases. This condition will mostly set in due to increased permeability of the capillaries which results from infections such as pneumonia. The management will be mainly aimed at lowering the venous return and to also help in the elimination of the fluid that had already started accumulating in the cavities of the lungs. The basic management of the condition will involve the delivery of oxygen and also the use of diuretics to help in the elimination of the accumulated fluids within the lung cavities. Other alternative managements will be mainly aimed at reducing the venous flow of blood. References Gray A, et al, 2008. Non invasive ventilation in acute cardiogenic pulmonary edema, The England Journal of Medicine. Sandham J, 2011 the need for mechanical ventilation, Non-invasive ventilation http://www.ebme.co.uk/arts/ni_vent/ Mayo clinic, 2010 Pulmonary edema, symptoms http://www.mayoclinic.com/health/pulmonary- edema/DS00412/DSECTION=symptoms Kumar & Clark, 2006 acute pulmonary edema, clinical medicine, 7th edition. Elsevier Inc. Read More