Chapter 19

Question 0

Depending on the degree of severity, where may fluid progressively move into?

Answer 0

The alveoli, bronchioles, and bronchi

Question 1

Where does the fluid from the pulmonary vascular system first seep into?

Answer 1

Perivascular and peribronchial interstitial spaces

Question 2

What does alveolar swelling and increased alveolar surface tension cause within the lung?

Answer 2

Alveolar shrinkage and atelectasis

Question 3

What kind of pulmonary disorder is pulmonary edema?

Answer 3

Restrictive

Question 4

What are the major pathological or structural changes of the lungs associated with pulmonary edema?

Answer 4

Interstitial edema, alveolar flooding, increased surface tension of alveolar fluids, alveolar shrinkage and atelectasis, frothy white (or pink) secretions

Question 5

What are the two major categories of pulmonary edema?

Answer 5

Cardiogenic and non-cardiogenic

Question 6

What is the most common cause of cardiac pulmonary edema?

Answer 6

CHF (congestive heart failure)

Question 7

What demographic is heart failure most common?

Answer 7

People over the age of 65; and African Americans

Question 8

How does cardiac pulmonary edema occur?

Answer 8

Blood cannot be pumped because of left ventricular failure, which increases the hydrostatic pressure inside the pulmonary veins and capillaries

Question 9

What is normal hydrostatic pressure?

Answer 9

10-15 mm Hg

Question 10

What does normal hydrostatic pressure tend to do with the pulmonary capillaries?

Answer 10

It tends to move fluid out of the pulmonary capillaries into the interstitial space

Question 11

What offsets normal hydrostatic forces?

Answer 11

Oncotic pressure

Question 12

What are normal oncotic pressures?

Answer 12

25-30 mm Hg

Question 13

What happens when hydrostatic pressure within the pulmonary vascular system rises to more than 25 to 30 mm Hg?

Answer 13

Oncotic forces lose its holding force and capillary fluid spills into the interstitial and air spaces of the lungs

Question 14

What are some clinical signs for the patient with left ventricular failure?

Answer 14

Anxiety, delirium, cough, fatigue, and adventitious breath sounds, cool skin, diaphoresis, cyanosis of the digits and peripheral pallor

Question 15

What are some non-cardiac causes of Cardiogenic Pulmonary Edema?

Answer 15

Systemic Hypertension, excessive fluid administration, pulmonary embolus, renal failure

Question 16

In non cardiogenic pulmonary edema, what can happen even in the absence of the back pressure caused by an abnormal heart?

Answer 16

Fluid easily flows from the pulmonary capillaries into the alveoli.

Question 17

What are four common causes of noncardiogenic pulmonary edema?

Answer 17

Increased capillary permeability, lymphatic insufficiency, decreased intrapleural pressure, decreased oncotic pressure

Question 18

What are some causes of increased capillary permeability?

Answer 18

Alveolar hypoxia, ARDS, inhalation of toxic agents, pulmonary infections (ie pneumonia), acute head injury (aka cephalogenic pulmonary edema)

Question 19

What may cause a decreased oncotic pressure?

Answer 19

Overtransfusion and/or rapid transfusion of intravenous fluids, uremia, hypoproteinemia, acute nephritis, and polyarteritis nodosa

Question 20

What are some common therapeutic interventions for managing pulmonary edema?

Answer 20

Antidysrhythemic agents, positive inotropic agents, cardiac workload reduction, sodium and fluid retention therapy, albumin and mannitol

Question 21

What is the most frequently prescribed inotropic agent for heart failure?

Answer 21

Digitalis

Question 22

What is the most effective way to decrease the cardiac workload?

Answer 22

Reduce the cardiac afterload (afterload reduction)

Question 23

What are some examples of direct acting vasodilators?

Answer 23

Nitroglycerin, nitroprusside, and isosorbide

Question 24

What are some indirect-acting vasodilators?

Answer 24

Alpha -adrenergic receptor blocking agent such as Prazosin or trimazosin

Question 25

What do angiotension converting enzyme (ACE) inhibitors do?

Answer 25

Vasodilation and afterload reduction

Question 26

What does bed rest in the supine position do?

Answer 26

Enhances natural diuresis by the kidneys, reducing sodium and fluid retention

Question 27

What will a restriction of sodium and water intake, and a high-dose diuretic therapy do for a patient with pulmonary edema?

Answer 27

Reduce sodium and fluid retention

Question 28

Why is albumin and mannitol sometimes administered for patients with pulmonary edema?

Answer 28

To increase the patient's oncotic pressure in an effort to offset the increased hydrostatic forces of cardiogenic pulmonary edema

Question 29

What are some of the physical manifestations for pulmonary edema?

Answer 29

Tachypnea, tachycardia, increased blood pressure, Cheyne-Stokes Respiration, cyanosis, cough and sputum,

Question 30

What are some common breath sounds found in patients with pulmonary edema?

Answer 30

Crackles, rhonchi, and wheezing

Question 31

What kind of patients have results of hypokalemia, hyponatremia, and hypocholemia?

Answer 31

Patients with left-sided heart failure

Question 32

What are common radiologic findings in patients with pulmonary edema?

Answer 32

Bilateral fluffy opacities, diluted pulmonary arteries, cardiomegaly, Kerley A and B lines, bats wing or butterfly pattern, pleural effusion

Question 33

Pulmonary venous congestion, Kerley A and B lines and cardiomegaly are examples of what sort of pulmonary edema?

Answer 33

Cardiogenic

Question 34

Fluffy densities, without an enlarged cardiac silhouette are common with which kind of pulmonary edema?

Answer 34

Noncardiogenic