Test 4 Ch. 20 Pulmonary Edema Flashcards
Pulmonary edema results from movement of
fluid from the pulmonary vascular to the extravascular system and air spaces of the lungs
Most of the fluid that accumulates in tb tree is churned into
frothy white (sometimes blood-tinged or pink) sputum as a result of air moving in and out of the lungs
Pathologic or structural changes of the lungs associated with pulmonary edema are:
- Interstitial edema, including fluid enforcement of the perivascular and peribronchial spaces and the alveolar wall interstitium
- Alveolar flooding
- Increased surface tension of the alveolar fluids
- Alveolar shrinkage and atelectasis
- Frothy white (or pink) secretions throughout the TB tree
The causes of pulmonary edema can be divided into two groups:
- Cardiogenic
- Noncardiogenic
Heart disease is the #__ of death in the U.S
1
Cardiac pulmonary edema occurs when the
left ventricle is unable to pump out a sufficient amount of the blood during each ventricular contraction
What is Starling equation
J=K(Pc- Pi)- (pie[c]-pie[I])
Common causes of Cadiogenic (🫀) Pulmonary Edema
- Arrhythmias
- Systemic hypertension
- Congenital heart defect
- Excessive fluid accumulation
- Myocardial Infarction
- Cardiac tamponade
- Renal failure
Risks Factors for Coronary Heart Disease (CHD)
- Age
- Males order than 45
- Females older than 55
- Family history of CHD
- Obesity
- Cigarette smoker
Noncardiogenic Pulmonary Edema is less
common and develops as a result of damage to the lungs
The lung tissues becomes inflamed and swollen and fluid can readily
leak from the pulmonary capillaries into the the alveoli
The more common causes of noncardiogenic pulmonary edema are
- Increased capillary permeability
- Lymphatic Insufficiency
- Decreased Intrapleural pressure
- High-Altitude Pulmonary Edema
- Decreased Oncotic Pressure
Causes of increased capillary permeability
- Alveolar hypoxia (e.g high altitude)
- ARDS
- Inhalation of toxic agents such as chlorine, sulfur dioxide, nitrogen dioxides, ammonia, and phosgene
- Pulmonary infections
- Therapeutic radiation
- Acute head injury (also known as cephalogenic pulmonary edema)
High-altitude pulmonary edema (HAPE) can occur in people who
exercise at altitudes above 8000 feet
Cardiogenic is
CHF left side heart failure
Other causes of noncardiogenic pulmonary edema
- Allergic reaction to drugs
- Excessive sodium consumption
- Drug overdose
- Aspiration (near drowning)
- Transfusion-related acute lung injury
- Pulmonary embolism
Clinical manifestation for Pulmonary edema
- atelectasis
- increased alveolar- capillary membrane
- in severe cases, excessive bronchial secretions
Vital signs
Increased RR
Increased HR
Cheyenne- Stokes Respirations is associated w/
CHF and pulmonary edema
Chest assessment findings
- Increased and vocal fremitus
- Crackles and wheezing
Abnormal Lab Test
- Serum potassium: Low
- Serum sodium: Low
- Serum chloride: Low
- Brain natriuretic peptide (BNP): Elevated
BNP levels below 100 pg/mL indicate
no heart failure
BNP level of 100 to 300 pg/mL suggest
heart failure may be present
BNP levels above 300 pg/mL indicates
mild heart failure
BNP levels above 600 pg/mL indicates
moderate heart failure
BNP levels above 900 pg/mL indicates
severe heart failure
Radiologic Findings
- Bilateral fluffy opacities
- Kerly B lines
- Bat wings or butterfly pattern
- cardiomegaly
Questions from the back
Which of the following is an after load reducer
a. Procainamide
b. Dopamine
c. Furisemide
d. Nitroprusside
d. Nitroprusside
What is the normal hydrostatic pressure in the pulmonary capillaries?
a. 5 to 10 mm Hg
b. 10 to 15 mm Hg
c. 15 to 20 mm Hg
d. 20 to 25 mm Hg
b. 10 to 15 mm Hg
Which of the following are causes of cariogenic pulmonary edema
1. Excessive fluid administration
2. Right ventricular failure
3. Mitral valve disease
4. Pulmonary embolus
- Excessive fluid administration
- Mitral valve disease
- Pulmonary embolus
As a result of pulmonary edema, the patient’s
1. RV is decreased
2. FRC is increased
3. VC is increased
4. TLC is increased
- RV is decreased
The left ventricular ejection fraction
1. Normally is greater than 75%
2. Is a good measure of alveolar ventilation
3. Correlates well w/ the brain natriuretic peptide values
4. Provides a noninvasive measurement of cardiac contractility
- Correlates well w/ the brain natriuretic peptide values
- Provides a noninvasive measurement of cardiac contractility
What is the normal oncotic pressure of the blood
a. 10 to 15 mm Hg
b. 15 to 20 mm Hg
c. 20 to 25 mm Hg
d. 25 to 30 mm Hg
d. 25 to 30 mm Hg
Normal LVEF
55-70%
LVEF less than 40%
May confirm heart failure
LVEF less than 35
Severe
