Chapter 19 Flashcards
Depending on the degree of severity, where may fluid progressively move into?
The alveoli, bronchioles, and bronchi
Where does the fluid from the pulmonary vascular system first seep into?
Perivascular and peribronchial interstitial spaces
What does alveolar swelling and increased alveolar surface tension cause within the lung?
Alveolar shrinkage and atelectasis
What kind of pulmonary disorder is pulmonary edema?
Restrictive
What are the major pathological or structural changes of the lungs associated with pulmonary edema?
Interstitial edema, alveolar flooding, increased surface tension of alveolar fluids, alveolar shrinkage and atelectasis, frothy white (or pink) secretions
What are the two major categories of pulmonary edema?
Cardiogenic and non-cardiogenic
What is the most common cause of cardiac pulmonary edema?
CHF (congestive heart failure)
What demographic is heart failure most common?
People over the age of 65; and African Americans
How does cardiac pulmonary edema occur?
Blood cannot be pumped because of left ventricular failure, which increases the hydrostatic pressure inside the pulmonary veins and capillaries
What is normal hydrostatic pressure?
10-15 mm Hg
What does normal hydrostatic pressure tend to do with the pulmonary capillaries?
It tends to move fluid out of the pulmonary capillaries into the interstitial space
What offsets normal hydrostatic forces?
Oncotic pressure
What are normal oncotic pressures?
25-30 mm Hg
What happens when hydrostatic pressure within the pulmonary vascular system rises to more than 25 to 30 mm Hg?
Oncotic forces lose its holding force and capillary fluid spills into the interstitial and air spaces of the lungs
What are some clinical signs for the patient with left ventricular failure?
Anxiety, delirium, cough, fatigue, and adventitious breath sounds, cool skin, diaphoresis, cyanosis of the digits and peripheral pallor
What are some non-cardiac causes of Cardiogenic Pulmonary Edema?
Systemic Hypertension, excessive fluid administration, pulmonary embolus, renal failure
In non cardiogenic pulmonary edema, what can happen even in the absence of the back pressure caused by an abnormal heart?
Fluid easily flows from the pulmonary capillaries into the alveoli.
What are four common causes of noncardiogenic pulmonary edema?
Increased capillary permeability, lymphatic insufficiency, decreased intrapleural pressure, decreased oncotic pressure
What are some causes of increased capillary permeability?
Alveolar hypoxia, ARDS, inhalation of toxic agents, pulmonary infections (ie pneumonia), acute head injury (aka cephalogenic pulmonary edema)
What may cause a decreased oncotic pressure?
Overtransfusion and/or rapid transfusion of intravenous fluids, uremia, hypoproteinemia, acute nephritis, and polyarteritis nodosa
What are some common therapeutic interventions for managing pulmonary edema?
Antidysrhythemic agents, positive inotropic agents, cardiac workload reduction, sodium and fluid retention therapy, albumin and mannitol
What is the most frequently prescribed inotropic agent for heart failure?
Digitalis
What is the most effective way to decrease the cardiac workload?
Reduce the cardiac afterload (afterload reduction)
What are some examples of direct acting vasodilators?
Nitroglycerin, nitroprusside, and isosorbide
What are some indirect-acting vasodilators?
Alpha -adrenergic receptor blocking agent such as Prazosin or trimazosin
What do angiotension converting enzyme (ACE) inhibitors do?
Vasodilation and afterload reduction
What does bed rest in the supine position do?
Enhances natural diuresis by the kidneys, reducing sodium and fluid retention
What will a restriction of sodium and water intake, and a high-dose diuretic therapy do for a patient with pulmonary edema?
Reduce sodium and fluid retention
Why is albumin and mannitol sometimes administered for patients with pulmonary edema?
To increase the patient’s oncotic pressure in an effort to offset the increased hydrostatic forces of cardiogenic pulmonary edema
What are some of the physical manifestations for pulmonary edema?
Tachypnea, tachycardia, increased blood pressure, Cheyne-Stokes Respiration, cyanosis, cough and sputum,
What are some common breath sounds found in patients with pulmonary edema?
Crackles, rhonchi, and wheezing
What kind of patients have results of hypokalemia, hyponatremia, and hypocholemia?
Patients with left-sided heart failure
What are common radiologic findings in patients with pulmonary edema?
Bilateral fluffy opacities, diluted pulmonary arteries, cardiomegaly, Kerley A and B lines, bats wing or butterfly pattern, pleural effusion
Pulmonary venous congestion, Kerley A and B lines and cardiomegaly are examples of what sort of pulmonary edema?
Cardiogenic
Fluffy densities, without an enlarged cardiac silhouette are common with which kind of pulmonary edema?
Noncardiogenic
