Case Study Analysis:

Pulmonary Edema
INTRODUCTION

The main problem that this case study addresses is acute pulmonary edema which is defined as excessive fluid in
the alveoli therefore obstructing gas exchange and causing difficulty in breathing. It is usually secondary to left heart
failure where in brought about by the decreased pumping ability of the heart, lowers the pressure in pulmonary
circulation systems forcing the flow of blood into the lungs. The significant concern in such scenario is quick
development of some stigmata such as mimic severe shortness of breath and crackles on lung evaluation
accompanied with low oxygen levels on the patient. It is equally important to state that such information is critical in
timing which is vital for restoring oxygenation and averting respiratory failure.

In assessment and analysis of patient’s prognosis, the major determinants of the outcome will be adequate use of
diuretics, application of oxygen as well as support of cardiac performance. The goal is to decongest the lungs and
maintain adequate respiratory dynamics by controlling the fluid overload and optimizing the functioning of the heart.

BACKGROUND
A case history for this clinical scenario involves a 68-year-old patient diagnosed with chronic heart failure,
hypertension and recent decompensated heart failure. The patient went to the emergency department
complaining of sudden inability to breathe, orthopnea and feeling of air hunger (suffocation) . Crackles are
auscultated over the lung fields and the patient’s oxygen saturation is 82% on room air. Chest X-ray
demonstrates pulmonary congestion and destructive changes in the heart are reflected by noticeably
elevated levels of the B-type natriuretic peptide in a blood test.

BACKGROUND

The most important problem presented in this case is interstitial fluid overload that quickly develops in the lungs
because of ineffective cardiac output. The patient has untreated heart failure which leads to fluid buildup in the
lungs as the heart cannot pump blood around the body effectively. The frontal approach to the case assessment
consists of cardiac and respiratory function evaluation, fluid status assessment, and fluid management in
accordance with the ‘golden standard’ of treatment of pulmonary edema due to heart failure

PATIENT MANAGEMENT

The medical and nursing management of patients with pulmonary edema depends on the administration of
therapies aimed at removing fluid excess and enhancing the ventilation of the lungs. The most common
measures include:
Diuretics: An injection of furosemide (Lasix) is usually given into the vein, owing to the need to reduce
pulmonary congestion to increase urine output that will decrease the fluid volume in circulation.
Oxygen therapy: The patient is also given high flow oxygen in order to increase oxygen saturation of
the patient and relieve dyspnea.
Nitroglycerin: This drug is a vasodilator and has the effect of decreasing preload and afterload increasing
perfusion of the heart muscle and decreasing the oxygen demand of the heart.

PATIENT MANAGEMENT
Morphine (optional in some cases): Anxiety, oxygen consumption, and vascular tone may all be reduced
by the use of medications, but the recent argument indicates that this drugs usage is patient-specific and
varies from case to case.
Non-invasive ventilation (CPAP or BiPAP): If the addition of oxygen does not allow for a sufficient
increase in oxygenation then CPAP or BiPAP can be performed in order to improve oxygen
concentration and potential pulmonary edema.
 Evaluation
1. What was done: Administration of diuretic drugs was timely commenced, oxygen therapy begun, and
increased closely monitored given to the patient with regard to respiratory progress.
2. What is working: High flow oxygen has improved saturation levels to approximately 90% and diuretic
use have led to increased urine output denoting effective fluid removal.
3. What is not working: Despite these interventions, the patient’s blood pressure remains high and that
it is essential to further limit the cardiac workload, such measures not proving effective. Adjustments to
vasodilator therapy may be warranted.
Involvement of some of the patient’s management, for example, morphine utilization or engaging
and controlling blood pressure more aggressively, may not be as effective or helpful in this particular
situation. One of the effects of morphine – suppression of the respiratory drive – is inapplicable for the
majority of patients with increased risk of respiratory depression.

PLAN OF CARE

Nursing management plan should incorporate intervention that aims at improvement of respiratory
status, maintenance of cardiac activity, and keeping the fluids balanced. Some of the important
activities include:
Respiratory monitoring: Constant monitoring of respiratory rate, lung sounds and oxygen
saturation is very pertinent to recognize the signs of improvement or negative inclination.
Medication administration: Concerning antibiotics, diuretics, vasodilators and any other
prescribed medications that concern in administering fluids, timely and appropriate usage
should be maintained and effects on fluid balance and blood pressure recorded.

Positioning: The patient should be placed in semi-fowler’s or high-fowler’s position to enhance breathing and
expand the lungs

PLAN OF CARE

Fluid intake restriction: Fluid intake will have to be restricted potentially enhancing diuretic therapy
in this stage as the patient gets to the goal.

Patient education and support: Explain the patient or the family regarding heart failure disease,
restriction of fluids and diet, fluid overload warning symptoms.

Evidence-Based Support:

1.Theoretical concept: In the context of heart failure, pulmonary edema can be viewed as the consequence of
heart-related factors increasing pressure within the pulmonary circulation. Diuretic drugs relieve this pressure by
inducing the loss of water while vasodilative drugs reduce the amount of work done by the heart. (1)
2.Research: In clinical scenarios, it has been evidenced that early administration of diuretics in acute heart failure
improves outcomes by rapidly reducing pulmonary congestion and subsequently avoiding reliance on invasive
mechanical ventilation facilitation. Non-invasive ventilation has equally been reported to assist in the
management of acute pulmonary edema by enhancing oxygen supply and decreasing mortality rates. (2)(3)
3. Experience: Clinical experience with similar cases shows the importance of early administration of
diuretics and oxygen in the treatment of respiratory failure to shorten the length of hospitalisation.
(4)(5)

Conclusion

In this case, the approach to treating acute

pulmonary oedema has In this case, the approach to treating acute
pulmonary oedema has been effective leading to the stabilisation of respiration through diuretics, oxygen
supplementation and vasodilation of the patients vasculature. However, further modification of the strategy
for blood pressure regulation, with the aim of enhancing heart function and preventing further occurrences,
may be required. The nursing outcome for this patient is good since the

congestion and adequate follow up will prevent any gradual instability in fluid homeostasis
and respiration.

References
1. Gubrud, P., Bauldoff, G., & Carno, M. (2019). LeMone and burke’s medical-surgical nursing: Clinical
reasoning in patient care (7th ed.). Upper Saddle River, NJ: Pearson.
2. Iqbal MA, Gupta M. Cardiogenic Pulmonary Edema. [Updated 2023 Apr 7]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK544260/
3. Malek R, Soufi S. Pulmonary Edema. [Updated 2023 Apr 7]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK557611/
4. Zanza, C., Saglietti, F., Tesauro, M., Longhitano, Y., Savioli, G., Balzanelli, M. G., … Racca, F. (2023).
Cardiogenic pulmonary edema in emergency medicine. Advances in Respiratory Medicine, 91(5), 445–463.
doi:10.3390/arm91050034
5. Journal Article. (2021, October 17). Cardiogenic pulmonary edema treatment & management.
Retrieved September 25, 2024, from Medscape.com website:
https://emedicine.medscape.com/article/157452-treatment

Thank you