Pulmonary Edema: Pulmonary Edema Conducted by : Ms.

Monika (Clinical instructor ) Army college of nursing ,jalandhar cantt Slide 2: (Type I or hypoxaemic respiratory failure) : (PaO2 <60 mm hg ): Failure of oxygen exchange. Type 2 : Ventilatory failure, characterized by increased paco2, occurs in acute conditions in which retained pulmonary secretions cause increased airway resistance and decreased lung compliance, as in bronchitis. Introduction : Introduction Pulmonary edema is the abnormal accumulation of fluid in the interstitial spaces surrounding the alveoli. The advancement of fluid accumulation in the alveolar sacs. Which leads to dyspnea. Types of pulmonary edema : Types of pulmonary edema Cardiogenic pulmonary edema Noncardiogenic pulmonary edema 1) CARIOGENIC PULMONARY EDEMA : 1) CARIOGENIC PULMONARY EDEMA Pulmonary edema is either due to direct damage to the cardiac tissue or a result of inadequate functioning of the heart or circulatory system Causes Congestive heart failure Severe heart attack with left ventricular failure Severe arrhythmias (tachycardia/fast heartbeat or bradycardia /slow heartbeat) Hypertensive crisis Pericardial effusion with tamponade Fluid overload, e.g., from kidney failure or intravenous therapy 2) NONCARDIOGENIC PULMONARY EDEMA : 2) NONCARDIOGENIC PULMONARY EDEMA Noncardiogenic pulmonary edema is defined as the radiographic evidence of alveolar fluid accumulation without hemodynamic evidence to suggest a cardiogenic etiology . Causes (Alveolar) Inhalation of toxic gases Aspiration , e.g., gastric fluid or in case of drowning Multiple blood transfusions Severe infection Causes (other): Causes ( other) Multitrauma, e.g., severe car accident Neurogenic, e.g., subarachnoid hemorrhage Certain types of medication Upper airway obstruction Arteriovenous malformation Pathophysiology : Pathophysiology It is seen as a complication of myocardial infarction , hypertension, pneumonia, smoke inhalation, and high-altitude pulmonary edema. Pulmonary edema occurs when there are alterations in Starling forces. Pulmonary vessels create an imbalance in the startling forces Due to increased filtration ,it Increases volumes of fluid leak into the alveolar space Contd: Contd The airway pathway becomes overwhelmed, however, fluid moves from the interstitial in the alveolar walls. If the alveolar epithelium is damaged, the fluid accumulates in the alveoli. As fluid fills interstitial and alveolar space, lung compliance decreases . Hypoxemia develops when the alveolar membrane is thickened by fluid that impairs gas exchange of oxygen and CO2. Clinical manifestation : Clinical manifestation The sputum is thin and frothy because it is combined with water . The client may be anxious from dyspnea and restless . Chest auscultation reveals crackles sound, rhonch i , wheezes . Pulse oximetry is commonly less than 85% and arterial Po2 of 30 to 50 mm Hg The chest x ray shows areas of white- out where appears black Tachypnea Breathing pattern shows use of accessory muscle. Hypertension ( if carcinogenic ) Diagnostic evaluation : Diagnostic evaluation Repeated arterial blood gases should be done A CBC Blood volume Serial ECGs, CT scan of the chest lung biopsy pulmonary function tests Consultation with a pulmonologist or cardiologist will be necessary in many cases.

Outcome management ( medical management) : Outcome management ( medical management) Medical management : Medical management addresses four areas; (1) correction of hypoxia (2)Reduction in preload (3) Reducing After load (4) Supporting Perfusion . 1) CORRECTING HYPOXEMIA: : 1) CORRECTING HYPOXEMIA: It is important to maintain adequate oxygenation client with severe pulmonary edema commonly require oxygen therapy at high Fi02 level and may require mechanical ventilation of continuous or continuous positive airway pressure ( CPAP) . (2) Reducing the PRE-LOAD: : (2) Reducing the PRE-LOAD: the client is placed in an upright position . Usually the client does not lie down because of orthopnea and feeling of chocking when supine. Diuretics are prescribed to promote fluid exertion to promote fluid excretion. Nitrates, such us nitroglycerine are used for their vasodiltative properties. 3) REDUCING AFTER LOAD: : 3) REDUCING AFTER LOAD: After load is reduced to diminish workload on the left ventricle. Antihypertensive agents, such as nitropusside, are prescribed. Morphine is prescribed to reduce after load. 4) SUPPORTING PERFUSION: : 4) SUPPORTING PERFUSION: (3) SUPPORTING PERFUSION: Using inotropic medication such as dobutamine supports left ventricular failure. Urine output is monitored closely to determine whether renal perfusion is adequate. And intra aortic Balloon pump may be needed (IABP) with severe heart failure & pulmonary edema. Cont..d: Cont..d And intra aortic Balloon pump may be needed (IABP) with severe heart failure & pulmonary edema. Nursing managements : Nursing managements Assessment: The client with pulmonary edema is assessed quickly upon admission. Anxiety is often marked. And control of dyspnea is imperative. A complete assessment is carried out over the following hours ,when the client can breathe more comfortably & answer questions. A baseline weight & lung assessment is essential ,because these parameters will assist in determining treatment effectively. Nursing diagnosis : Nursing diagnosis IMPAIRED GAS EXCHANGE: OUTCOME MANAGEMENT : the client will demonstrate improved gas exchange, as evidenced by rising Po2 to 55 or 60 mm Hg Oxygen saturation above 90%, normaralizing PH, decreasing anxiety and dyspnea, fewer crackles and rhonchi 12 hours. Monitor vital signs ever 15minutes initially, until the client is stable, and the electrocardiogram Administer oxygen as ordered using a high flow Rebreather bag to maintain oxygenation. Continuous assessment is needed because the client may not be able to tolerate the work of breathing and may require intubations and mechanical ventilation. Mechanical ventilator and all the intubations equipment should be near by. Raising edematous legs increases venous return Preload is reduced with morphine and nitroglycerin. Morphine can be used to reduce anxiety , 2) Excess fluid volume r/t excess preload.: 2) Excess fluid volume r/t excess preload. Outcome management : the client will demonstrated improved fluid balance. Decreased number of crackles & wheezes , eupnoea & decreased anxiety. Nursing management : Nursing management Administer a diuretic as prescribed to promote diuresis. Place an indwelling catheter to monitor response to diuertics. Monitor urine output ,weight & potassium level. Monitor blood pressure to determine whether the client can maintain perfusion . Thank you :

Thank you Pulmonary Embolism: Pulmonary Embolism Conducted by: Ms. Monika joseph Clinical instructor Army college of nursing Introduction : Introduction PE is the occlusion of a portion of the pulmonary blood vessels by an embolus. An embolus is a clot (thrombus) that is carried by the blood stream & it obstruct circulation. Cont..d: Cont..d Pulmonary embolism ( PE ) : is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream ( embolism ). Usually this is due to embolism of a thrombus (blood clot) from the deep veins in the legs , Obstruction is due to the embolization of air , fat or amniotic fluid . The risk of PE is increased in various situations, such as cancer and prolonged bed rest . Etiology & risk factor: Etiology & risk factor All PEs develop from thrombi (clots) ,most of which originates in the deep calf ,femoral ,popliteal ,or iliac veins. Other sources of emboli include tumors ,air ,fat ,bone marrow ,amniotic fluid. Major operations especially hip ,knee , abdominal predispose the client to thrombus formation Pathophysiology : Pathophysiology When emboli travel to the lungs ,they lodge In the pulmonary vasculature. Blood flow is obstructed ,leading to decreased perfusion of the section of the lungs supplied by the vessels. It reduces cardiac output. Pulmonary embolism can lead to right sided failure. Clinical manifestation : Clinical manifestation Tachypnea Dyspnea Anxiety Chest pain Hypoxemia may be present depending on the size of embolism.(loss of o2) Cough Syncope (loss of consciousness) Hemoptysis Crackles Fever edema & cyanosis Diagnostic findings: Diagnostic findings Physical examination Pulse oxymetry ABG analysis Lung perfusion scan Ct scan Pulmonary angiography is the definitive means of diagnosis of PE Medical Management: Medical Management Goals : to stabilize the cardiopulmonary system & reduce the threat of a further PE with anticoagulation therapy. a)Stabilizing the cardiopulmonary system: a)Stabilizing the cardiopulmonary system Maintenance of cardiopulmonary stability is the first priority Hypoxemia can be reversed with low flow oxygen by nasal cannula. Other client requires endotracheal intubation to maintain pa02 greater than 60mm hg. Hypotension is treated with fluids. 2) Anticoagulant therapy: 2) Anticoagulant therapy Anticoagulants begins with IV standard heparin sodium to reduce the risk of further clots & to prevent the extension of existing clot.. PULMONARY TUBERCULOSIS : PULMONARY TUBERCULOSIS Conducted by: Ms.Monika Clinical instructor Army college of nursing INTRODUCTION : INTRODUCTION Tuberculosis has remained an enemy of human society for all ages. TB is not only a problem for the person suffering from it or their families but a public health problem of the entire world. TB is an infectious disease. It mainly effects the lungs. DEFINITION :

DEFINITION TB is an infectious disease that mainly affect the lungs parenchyma Pulmonary tuberculosis (TB) is a contagious bacterial infection that mainly affects the lungs parenchyma, but may spread to other organs Etiology : Etiology Pulmonary tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis (M. tuberculosis). It us also caused by breathing in air droplets from a cough or sneeze of an infected person. This is called primary TB. The bacteria affects mainly the lung parenchyma but it can also affect Other parts that is meninges, kidney, bones, lymph. Risk factors : Risk factors The following people are at higher risk for active TB: Elderly Infants People with weakened immune systems, for example due to AIDS, chemotherapy, or antirejection medicines given after an organ transplant Cont.d : Cont.d Your risk of contracting TB increases if you: Are in frequent contact with people who have the disease Have poor nutrition Live in crowded or unsanitary living conditions Increase in HIV infections Malnourished. Sputum induction procedures like suctioning, coughing. Health care workers Contd : Contd Person who has active TB. Cancer. Transplanted organ. IV drug users and alcoholic. TRANSMISSION OF TB : TRANSMISSION OF TB TB spread from person to person by airborne transmission. Infected person release droplet nuclei (1-5 micro meter in diameter) through : TALKING COUGHING SNEEZING LAUGHING SINGING Classification of Tb : Class 0 : No TB exposure. Class 1 : TB exposure, no infection. Class 2 : Latent TB infection. no disease. Classification of Tb Classification of Tb : Classification of Tb Symptoms : Symptoms The primary stage of the disease usually doesn't cause symptoms. When symptoms of pulmonary TB occur, they may include: Cough Coughing up blood Excessive sweating, especially at night Fatigue Fever Unintentional weight loss Malaise Cont..d : Cont..d Other symptoms that may occur with this disease: Breathing difficulty Chest pain Wheezing DIAGNOSTIC EVALUATION OF TB : DIAGNOSTIC EVALUATION OF TB Examination may show: Clubbing of the fingers or toes (in people with advanced disease) Enlarged or tender lymph nodes in the neck or other areas Fluid around a lung Unusual breath sounds (crackles) Cont..d : Cont..d Tests may include: biopsy of the affected tissue (rare) Bronchoscopy chest ct scan Chest x ray Sputum examination and cultures Thoracentasis Tuberculin skin test Slide 16: Pathophysiology the infectious droplets settle throughout the airways. The majority of the bacilli are trapped in the upper parts of the airways where the mucus-secreting goblet cells exist. The mucus produced catches foreign substances. Bacteria in droplets that bypass the mucociliary system and reach the alveoli are quickly surrounded and engulfed by alveolar macrophages,

Contd : Contd After being ingested by macrophages, the mycobacteria continue to multiply slowly, with bacterial cell division occurring every 25 to 32 hours. Client is infected but not in active disease. Creates a lesion called tubercle which prevent the spread of infection Bacteria can active again. Causing reinfection and active disease. POTENTIAL COMPLICATION : POTENTIAL COMPLICATION Malnutrition. Adverse side effect of medication therapy : hepatitis, skin rash gastrointestinal upset. Multidrug resistance. Spread of TB infection.