Case Study: Management of Pulmonary Edema and Venous Thromboembolism

CASE STUDY 1
School of Nursing
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CASE STUDY 2
Introduction:
A 42-year-old indigenous Australian male, named Reggie, residing near Blackall in
Central Queensland, married with three children and the sole worker of his family, came with
acute decompensation of heart failure. In this essay, we report a case of an adult man
categorising it into two priority problems, for which we will discuss further interventions.
The problems discussed in detail will be Pulmonary Edema and Venous Thromboembolism.
Pulmonary edema will be managed by administration of Furosemide and Intra-aortic balloon
pumping. Interventions in Venous Thromboembolism will be anti-coagulant therapy and the
use of graduated compression stockings. In treating this critical case, the nurse has a
significant role in monitoring and clinical reasoning to ensure improvement in Reggie’s
health. The aforementioned interventions will help reduce edema of the alveoli, increasing
cardiac output by reducing blood pressure, resolving stasis and promoting blood flow in the
legs, which will lead to the healing of edema in the legs, which will cause a general
improvement in the condition of the patient that threatens his life.
Body:
The patient presented with pain on inspiration. When examined, he had a high systolic
blood pressure of 184, increased respiratory rate of 28 breaths per minute and coarse
crackling sound on auscultation. Pulmonary Edema is a condition in which there is an
accumulation of fluid in the parenchyma and the alveoli of the lungs. “It is due to either
failure of the left ventricle of the heart to remove blood adequately from the pulmonary
circulation, or an injury to the lung parenchyma or vasculature of the lung” (Arrigo, Parissis,
Akiyama & Mebazaa, 2016; Thompson, Chambers & Liu, 2017). Hence, in this case, it
would be known as Cardiogenic Pulmonary Edema, because Reggie is a patient of Acute
Decompensated Heart Failure which is the rapid deterioration of earlier heart failure. The

CASE STUDY 3
pathophysiology is best understood by the neuro-humoral pathway. "In the presence of
cardiac dysfunction, several neuro-humoral pathways, including the sympathetic nervous
system, the renin-angiotensin-aldosterone system and the arginine-vasopressin system, are
activated to counter the negative effects of HF on oxygen delivery to the peripheral tissues.
Neuro-humoral activation in HF leads to impaired regulation of sodium excretion through
the kidneys which result in sodium and, secondarily, fluid accumulation" (Njist et al., 2015;
Arrigo et al., 2016).
It is essential in Pulmonary Edema for the nurse to diagnose and start the treatment as
early as possible in order to avoid any grave results. The most important intervention here is
the administration of a diuretic, preferably loop diuretic, Furosemide. This is a Dependant
(physician initiated) intervention. Responsibilities that a nurse has in the whole
administration process of this drug are to “Monitor the urine output as well as other vital
signs. Watch for a drop in blood pressure. If your patient is on a cardiac monitor, watch for
any arrhythmias that could be caused by a shift in electrolytes. Monitor labwork: watch for
changes in the BUN and Creatinine and also potassium and other electrolytes” (Wilson,
2017). It is important to listen to the heart and lung sounds since the patient has heart failure.
In case multiple doses are being administered, the nurse should be careful to note any signs of
dehydration and stop or decrease the drug immediately. It is also necessary for the nurse to
make sure that a bathroom is nearby for the patient to go to whenever needed. If a urinary
catheter is placed, he/she should make sure that does not leak or become kinked and also
clean around the area in order to prevent any infection (Wilson, 2017). Furosemide helps
relieve edema by increasing the output of urine. “Furosemide, sold under the brand name
Lasix among others, is a medication used to treat fluid build-up due to heart failure, liver
scarring, or kidney disease” (Still, Davis, Chilipko, Jenkosol & Norwood, 2013). Therefore,
Furosemide will alleviate edema in the alveoli by acting on the kidney and increasing the

CASE STUDY 4
output of urine, causing recovery and prevention of the pulmonary edematous condition that
was causing Reggie to have coarse crackles, high systolic pressure and pain on inspiration.
“Furosemide reduces preload by diuresis in 20-60 minutes” (Sovari, 2017).
The advantages of this intervention include reduction of edema, and drop in high
blood pressure, which would further prevent strokes, heart attacks and kidney problems.
(WebMD) The disadvantages of this drug intervention comprise of dizziness, headache,
vision problems, dehydration, muscle cramps, itching/rash, stomach pain, diarrhea,
constipation, jaundice, and clay coloured stools. There are several adverse effects of the drug
that are caused by its interaction with other drugs such as Sucralfate, Cyclosporine, various
antibiotics, cardiac and hypertension medications, laxatives, salicylates, etc (Lasix Oral,
n.d.). A lactating mother should avoid it as it has the ability to pass into breast milk. It is also
reported to delay the production of breast milk (Cunha, 2018).
Intra-aortic balloon pumping (IABP) is aggressive form care in cardiogenic shock
patients. "Regardless of the cause, when the cardiogenic shock is recognised in the early
stages, the IABP may decrease the high mortality rate significantly” (Cunha, 2018). It is a
collaborative intervention. “An intra-aortic balloon pump is a short-term catheter solution to
help the heart pump blood. IABPs are used to increase blood flow through the coronary
arteries and reduce the heart’s workload by decreasing the afterload” (Intra-Aortic Balloon
Pump, n.d.). The patient’s femoral artery is where the IABP, which is a pumping chamber, is
inserted from. It is then passed into the abdominal aorta ultimately reaching the descending
thoracic aorta. At the start of diastole, the balloon inflates, while the aortic valve closes, to
expand the coronary artery. As the aortic valve opens again, deflation occurs. Therefore, the
workload of the left ventricle is consequently decreased as there is a reduction in the intra-
aortic fluid volume. It is important to note that the balloon should inflate at the accurate time
in the cycle. The nurse must have all the facts and information about the intervention so as to