Pulmonary Edema

When extra fluid collects in the lungs, the condition is known as pulmonary (PULL-mon-air-ee) edema (eh-DEE-ma).

Causes

Many things can cause this illness. Among them are heart disease, allergies to drugs, lung injuries, strokes, head injury, infection, fever, drug overdose, or excess body fluid.

Signs/Symptoms

Early signs may include coughing and restlessness during sleeping. Later you may experience trouble breathing when awake and at night. Coughing usually brings up white or pink-tinged frothy sputum. Noisy breathing (wheezing and bubbly sounds), bluish nailbeds and lips, sweating, and a fast heartbeat are other signs. You also may feel very anxious.

Care

You will need a stay in the hospital. It is important to get rid of the extra fluid in your lungs, while making sure they get enough oxygen.

Risks

This is a serious, life-threatening illness, and treatment should not be delayed or avoided. Untreated, this condition can be fatal.

WHAT YOU SHOULD DO

Call Your Doctor If...

• You are light-headed or dizzy, sweaty, or nauseated after you take your medicine.
• You have gained 2 to 3 pounds in 1 or 2 days.
• You cough up yellow, green, or pink frothy sputum.
• You are wheezing (a high-pitched noise when breathing in or out).
• You have trouble breathing, have swelling in your feet or ankles, or feel more tired than usual.
• You have a high temperature, muscle aches, headache, and dizziness. These are signs of an infection.

Seek Care Immediately If...

• You have these signs of fluid in your lungs or heart failure:
  • You have more trouble breathing than usual, feel weak, cannot sleep or rest because of trouble breathing, or have a fast or uneven heartbeat.
  • You have noisy or bubbly breathing and cough up pink frothy sputum.
  • You have increased swelling in your legs, feet, and abdomen. You feel dizzy. Your lips and nailbeds are a white or blue color.
• You have chest pain that spreads to your arms, jaw, or back, and you are sweating, feel sick to your stomach, and have trouble breathing. These are signs of a heart attack.
• These are emergencies. Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Ventilator: Also called a respirator. This is a special machine to help with breathing.
• ET Tube: A tube, placed in either the mouth or nose, that goes into the lungs. It's usually hooked up to a breathing machine. With this tube in place, you will not be able to talk, but can hear normally.
• Medicines: There are many different medicines that can help remove extra fluid from your lungs, help you breathe easier, and ease your pain.
  • Diuretics (dy-u-RET-iks): Often called ""water pills.'' This medicine helps remove extra water from the body. It may be given by mouth or in your IV.
  • Morphine: Opens up veins to help remove extra fluid, may help relax breathing, and lower anxiety.
  • Antibiotics: Used to fight infection if it is causing the illness.
  • Heart Medicines: May be needed to make the heartbeat stronger.
  • Lung Medicine: May be needed to open the airways in the lungs so you can breathe easier.
• Heart Tubes/Wires: You may be attached to many different tubes and wires. Some may enter your body under your collarbone or in your groin and be threaded into your heart. They are attached to monitors that measure your heart while it's working. These readings help your doctor guide your treatment.
• Chest X-ray: This picture of your lungs and heart will help your doctor determine the seriousness of the problem.
• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Oxygen: You may need extra oxygen during your stay. It is given either by a mask or nasal prongs. Tell your doctor if the oxygen is drying out your nose or if the nasal prongs bother you.
• Pulse Oximeter: While you are getting oxygen, you may be hooked up to a pulse oximeter (ox-IM-ih-ter). It is placed on your ear, finger, or toe and is connected to a machine that measures the oxygen in your blood.
• ECG: Also called a heart monitor, an electrocardiograph (e-LEK-tro-CAR-dee-o-graf), or EKG. The patches on your chest are hooked up to a TV-type screen or a small portable box (telemetry unit). This screen shows a tracing of each heartbeat. Your heart will be watched for signs of injury or damage that could be related to your lung congestion.
• 12 Lead ECG: This test makes tracings from different parts of your heart. It can help your doctor decide whether a heart abnormality is part of the problem.
• Blood Gases: Blood is taken from an artery in your wrist, elbow, or groin. It is tested for the amount of oxygen it contains.
• Blood: Usually taken from a vein in your hand or from the bend in your elbow. Tests will be done on the blood.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.

After You Leave

• Rest in bed until you are breathing easier and feel stronger. Then, slowly return to your normal activities.
• Get at least 7 hours of rest each night. Take a nap during the day if you feel tired. As you get stronger, you will need less rest during the day.
• Exercise daily. It helps make the heart stronger, lowers blood pressure, and keeps you healthy. If your exercise plan seems too hard or too easy, talk to your doctor.
• Always take your medicine as directed by your doctor. If you feel it is not helping, call your doctor. Do not quit taking it on your own.
• If you are taking antibiotics, continue to take them until they are gone--even if you feel better.
• If you have other illnesses such as diabetes or high blood pressure, it is important to control them also. Take medicines for these illnesses as directed. Because of your other illnesses, you have a higher chance of getting fluid in your lungs if you don't take care of yourself.
• Quit smoking. It harms the heart and lungs. If you have trouble quitting, ask your doctor for help.
• Weighing too much can make the heart work harder. If you need to lose weight, ask your doctor for the plan that's best for you.
• Weigh yourself every day, before breakfast. Weight gain can be a sign of extra fluid in your lungs or body. Call your doctor if you have gained 2 to 3 pounds in a day.
• To prevent fluid build-up, your doctor will probably put you on a low-salt diet. Reducing fat and cholesterol is also important. Ask your doctor what you should and should not eat.

Do not drink alcoholic beverages. Alcohol makes the heart and lungs work harder

Nursing Management

impaired Gas Exchange may be related to ventilation perfusion imbalance, alveolar-capillary membrane changes, altered O₂ supply, possibly evidenced by dyspnea, confusion, cyanosis, tachycardia, abnormal ABGs.

excess Fluid Volume may be related to compromised regulatory mechanism, possibly evidenced by shortness of breath, anxiety, edema, abnormal breath sounds, pulmonary congestion.