Date post: | 13-Apr-2015 |
Category: |
Documents |
Upload: | bee-daniel |
View: | 65 times |
Download: | 10 times |
Acute Pulmonary EdemaAcute Pulmonary Edema
Purwoko Sugeng H.
DEFINITIONDEFINITION
Abnormal accumulation of fluid in the extravascular spaces and tissues of the lung.
ETIOLOGIETIOLOGI
Cardiogenic pulmonary edema Cardiogenic pulmonary edema (also (also termed hydrostatic or hemodynamic edema) termed hydrostatic or hemodynamic edema)
Noncardiogenic pulmonary edema Noncardiogenic pulmonary edema (also (also known as increased-permeability pulmonary known as increased-permeability pulmonary edema, acute lung injury, or acute edema, acute lung injury, or acute respiratory distress syndrome) respiratory distress syndrome)
Difficult to distinguish because of their Difficult to distinguish because of their similar clinical manifestations similar clinical manifestations
Cardiogenic Pulmonary Cardiogenic Pulmonary Edema -- Causes:Edema -- Causes:
Left ventricular failureVolume overloadMechanical obstruction of left outflow tract e.g. Mitral stenosisAortic valvular diseases & also in congestive failure and hypertensionAMIcardiomiopathy
Causes of Non-cardiac Pul. Causes of Non-cardiac Pul. EdemaEdema
Toxins: eg. Smoke, ozone, phosgene, chlorine, Nitrogen dioxide, cadmium
Trauma and burns
Aspiration of gastric contents
Acute radiation Pneumonitis
D.I.C.
Near drowning
Emboli
Multiple transfusion
Drug related: Thiazides, salicylates, interleukin-2, colchicine, chlordiazepoxide
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Microvascular Fluid Exchange in the LungMicrovascular Fluid Exchange in the Lung
Fluid and solutes that are filtered from the circulation into the alveolar interstitial space
Do not enter the alveoli because the alveolar epithelium is composed of very tight junctions
It moves proximally into the peribronchovascular space
The lymphatics remove most of this filtered fluid from the interstitium and return it to the systemic circulation
PATHOPHYSIOLOGY PATHOPHYSIOLOGY
Microvascular Fluid Exchange in the LungMicrovascular Fluid Exchange in the Lung
Increased hydrostatic pressure in the pulmonary capillaries
elevated pulmonary venous pressure increased left ventricular end-diastolic pressure and left atrial pressure
As left atrial pressure rises further (>25 mm Hg)
edema fluid breaks through the lung epithelium flooding the alveoli with protein-poor fluid
PATHOPHYSIOLOGY PATHOPHYSIOLOGY
Microvascular Fluid Exchange in the LungMicrovascular Fluid Exchange in the Lung
Noncardiogenic pulmonary edema increase in the vascular permeability of the lung
resulting in an increased flux of fluid and protein into the lung interstitium and air spaces
HistoryHistory
Interstitial edema causes dyspnea and tachypnea
Alveolar flooding leads to arterial hypoxemia
Cough and expectoration of frothy edema fluid
HistoryHistory
Cardiogenic pulmonary edemaCardiogenic pulmonary edemaischemia with or without myocardial infarctionexacerbation of chronic systolic or diastolic heart failure, and dysfunction of the mitral or aortic valve paroxysmal nocturnal dyspnea or orthopnea
Noncardiogenic pulmonary edema Noncardiogenic pulmonary edema pneumoniasepsisaspiration of gastric contentsmajor trauma associated with the administration of multiple blood-product transfusions
Physical ExaminationPhysical Examination
Cardiogenic pulmonary edema auscultation of an S3 gallop a murmur consistent with valvular stenosis or regurgitation elevated neck veins, an enlarged and tender liver, and peripheral edemacool extremities
Noncardiogenic pulmonary edemaabdominal, pelvic, and rectal examinations are important warm extremities
Clinical ManifestationsClinical Manifestations
DyspneaSuddenOrthopneaCyanotic (central)“air hunger”Tachypnea
CoughCopious sputumFrothyBlood tinged
Pink Frothy Sputum
Clinical ManifestationsClinical Manifestations
PulseTachycardia
Bounding
Breath SoundCrackles
Fine course
Engorged neck & hand veins
Clinical ManifestationsClinical Manifestations
Diaphoretic
Clammy
Anxiety
Confusion
Stupor
InvestigationInvestigation
X-rayPulse oximetry
Electrocardiography Pulmonary-Artery Catheterization Echocardiography
Laboratory TestingLaboratory Testing
Elevated troponin levels
Measurement of electrolytes, the serum osmolarity, and a toxicology screen ABG’s
PaO2 , hypoxia, metabolic acidosis
Serum amylase and lipase
TreatmentTreatment
Goal:
Remove fluid
oxygenation
O2
Mask
Non-rebreather
CPAP
Mech. Vent
PEEP
TreatmentTreatment
DiureticsLasix
Digitalis / Digoxin lanoxin Bronchodilators
Aminophylline
Morphine peripheral resistance pressure in pulmonary capillaries anxiety
Nursing managementNursing management
OxygenationIntubation/mechanical ventilation.I&O Fluid managementDiet
SodiumLow
PotassiumHigh
FluidsDecreased / restricted
Nursing managementNursing management
Position to promote circulation
HOB Pt upright with legs down
Provide psychological supportMonitor medications
1. Penurunan curah jantung yg b/d respons fisiologi gagal jantung payah, peningkatan frekuensi, dilatasi, hipertrofi atau peningkatan isi sekuncup.
2. Penurunan curah jantung yg b/d adanya kerusakan otot miokard akibat dari infark akut, perubahan struktur akut (ruptur otot papilaris, ruptur septal) atau penyakit katup.
3. Kerusakan pertukaran gas yg b/d kongesti paru, hipertensi pulmonal, penurunan perfusi perifer yg mengakibatkan asidosis laktat & penurunan curah jantung.
4. Kelebihan volume cairan yg b/d berkurangnya curah jantung, retensi cairan & natrium oleh ginjal, hipoperfusi ke jaringan perifer & hipertensi pulmonal.
Con’tCon’t5. Kelebihan volume cairan yg b/d berkurangnya curah
jantung, retensi cairan & natrium oleh ginjal, hipoperfusi ke jaringan perifer & hipertensi pulmonal.
6. Risiko tinggi intoleransi aktivitas yg b/d curah jantung rendah, ketidakmampuan utk memenuhi metabolisme otot rangka, kongesti pulmonal yg menimbulkan hipoksemia & dispnea/nutrisi buruk selama sakit kritis.
7. Risiko tinggi kurang pengetahuan yg b/d status penyakit, tindakan, obat2tan, komplikasi & perubahan gaya hidup.
8. Ansietas yg b/d penyakit kritis, takut kematian atau kecacatan, perubahan peran dlm lingkungan sosial, atau ketidakmampuan yg permanen.
SummarySummary
Acute Pulmonary Edema is life-threatening
Progressive assessment, Treatment & nursing management can improve outcome & survive of Acute Pulmonary Edema patients
Thanks YouThanks You