Case Study: Acute Pulmonary Oedema - Diagnosis and Treatment

This case study examines a patient presenting with acute pulmonary oedema, exploring the causes, clinical manifestations, and appropriate nursing interventions. The patient's history includes a recent appendectomy, rapid breathing, low oxygen saturation, moist lung sounds, and a history of myocardial infarction. The study delves into the pathophysiology of the condition, highlighting the role of cardiac failure, diabetes, and smoking as potential contributing factors. It identifies key symptoms such as moist lungs, high blood pressure, cough, and low oxygen levels. The nursing care section emphasizes the importance of timely diagnosis, oxygen level restoration, and blood pressure management. The study recommends oxygen therapy, appropriate body positioning, and monitoring of vital signs. Medication strategies include vasodilators, ACE inhibitors, morphine, and nitroglycerin. The rationale behind each intervention is provided, along with references to support the evidence-based approach to patient care. The case study underscores the importance of a comprehensive and patient-centered approach to managing acute pulmonary oedema.

Running head: CASE STUDY
Case Study- Acute Pulmonary Oedema
Name of the Student
Name of the University
Author Note

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ANSWER 1.
The cause and risk factors of Acute Pulmonary Oedema
Acute pulmonary oedema is a condition where accumulation of fluid takes place in
the air spaces and the tissues of the lungs (McRitchie, 2017). In the given case, the most
likely causes for development of this acute pulmonary oedema are cardiac failure, acute
myocardial infraction, type 2 diabetes and past smoking habit. Myocardial infraction ruptures
the papillary muscles or the ventricular septum and the pumping of blood is retarded resulting
in back flow of the blood into the lungs. This condition increases the pressure of the blood
vessels pushing the fluid into the air spaces. Type 2 diabetes may result in increased
permeability of the capillary membranes of lungs along with alteration of the intravascular
hydrostatic force. Acute pulmonary oedema can cause due to smoking leading to lung
infections, radiation and inhalation problems. Several risk factors are associated with the
client’s condition like intravascular coagulation, trauma, pneumonia, atrial fibrillation,
obesity and sepsis.
ANSWER 2.
Clinical manifestation of Acute Pulmonary Oedema in the patient
The general signs and symptoms of acute pulmonary oedema are pain in chest, rapid
or breathing shortness, rapid heart rate, fatigue, and cough (Iqbal & Gupta, 2019). The four
clinical symptoms that are identified in the given case are lungs moist, high blood pressure,
sign of cough and low oxygen in the body.
Pathophysiology of two clinical symptoms

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Pulmonary oedema is a state of body where excess amount of fluid accumulates in the
lungs resulting in a wet lung condition. It makes breathing difficult. The lung moist condition
in the patient is an early indication of pulmonary oedema. The lungs are involved in the
filtration of solutes and fluids through the pulmonary capillary endothelium. The fluids and
the solutes moves across the spaces of the building a pressure gradient from the formation
site of the fluids to the removal site with the help of pulmonary channels. The moist condition
of the or the extravascular content of the lungs occurs when the formation of fluid is more
and the removal from the lymphatic channels is less (Murray, 2011).
Acute pulmonary oedema is generally two types cardiogenic and non-cardiogenic.
The history of acute myocardial infraction may lead to pulmonary oedema also known as
cardiogenic oedema. It occurs due to cardiac dysfunction resulting in accumulation of low
protein fluid contain in the lung and elevating the hydrostatic pressure along with increase of
venous pressure inside the pulmonary. The condition can be identified by the radiograph and
the positive condition will show alveolar infiltration, vascular redistribution, indistinct hila. It
is a kind of non-inflammatory oedema, which results in instabilities in the starling force
elevating the capillary pressure more than 10mmHg (Iqbal & Gupta, 2019)..
ANSWER 3.
Nursing care is important for the patient who is at a risk of acute pulmonary oedema.
It requires diagnosis at a correct time along with treatment. Proper evaluation and diagnosis is
done by nurses in addressing the issue, which helps in reducing the mortality rate and
establishing the care with proper medication. The nurse must diagnose the oxygen level of
the body and restoring the same, which will maintain the tolerable blood pressure along with
reduction of extracellular fluid. The nursing diagnosis must start with observation of fluid in
the lungs and also note of pain sensation. The management strategies for the patient in this

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case be supplement of oxygen mask to enhance the oxygen level in the body and also will be
effective in proper respiratory rate, the body posture must be maintained in a comfortable
position in order to provide easiness in breathing and finally monitoring of vital signs
especially the heart blood and heart rate.
The nursing interventions must follow person-centred care, knowledge about the
disease and medication and also follow the code of ethics. The nurse must promote relaxation
prior to the application of oxygenation. The nurse must fix the body posture to enhance the
expansion of the lungs. Proper observation and documentation of the electrolyte balance in
the body needs to done. The nurse must encourage the patient and provide proper information
about the disease and assists to consume medicines and healthy lifestyle to reduce further
complication (Powell et al., 2016).
The main strategies for reducing the symptoms of acute pulmonary oedema in the
patient is by providing oxygen therapy to restore the normal level of oxygen in the body and
also planning of medications such as vasodilators, angiotensin converting enzyme inhibitors,
morphine and also applying nitro-glycerine (Purvey & Allen, 2017).
Rationale
The application of oxygen therapy is being planned early, as it will be helpful in
achieving in 95% of arterial oxygen saturation in the patient. It is helpful in transferring the
breathing oxygen into the lungs. Positive pressure ventilation mask will enhance the chance
of cure along with medication as it will be helpful in upgrading of hypoxemia, reduction of
ventricular pre and after load, increase in pulmonary compliance. There are several methods
of application of oxygen mask, which supports both inspiration and expiration (Brill &
Wedzicha, 2014). The nurse must have a proper knowledge about the technique of

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administration and also check the vital signs at a regular interval in order to reduce the
complication and side effects.
The vasodilators are useful in addressing the condition as it helps in lowering of the
systolic blood pressure; reduce the filling pressure of right and left side of the heart. It also
reduces the vascular resistance and finally gives relieves from dyspnoea. The nurses must
keep a proper observation and provide optimal dose to the patient. It also important for the
nurse to have a proper knowledge about the medicine and also about the optimal dosage.
Detoriation of condition must be reported to the higher authority of the health care.
The application of morphine is helpful as this reduces the dyspnoea in-patient. It
results in venous pooling and reduction in preload. It is also helpful in reducing the activity of
sympathetic nervous system. It also reduces the cardiac output and also facilitates non-
invasion ventilation (Ellingsrud & Agewall, 2016).
The planning of including ACE inhibitors in the medication will be effective in
reduction of afterload that happens due to the raised catecholamine level in the body. it helps
in reducing the endotracheal intubation rates. It also reduces systemic vascular resistance,
improves in pulmonary capillary wedge pressure and finally improves stroke and cardiac
output of the heart. The applicable of nitro-glycerine helps in reducing the preload pressure of
the lungs (Lopez-Rivera et al., 2019).

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References
Brill, S. E., & Wedzicha, J. A. (2014). Oxygen therapy in acute exacerbations of chronic
obstructive pulmonary disease. International journal of chronic obstructive
pulmonary disease, 9, 1241–1252. https://doi.org/10.2147/COPD.S41476
Ellingsrud, C., & Agewall, S. (2016). Morphine in the treatment of acute pulmonary oedema
—why?. International journal of cardiology, 202, 870-873.
Iqbal, M. A., & Gupta, M. (2019). Cardiogenic Pulmonary Edema. In StatPearls [Internet].
StatPearls Publishing.
López-Rivera, F., Cintrón Martínez, H. R., Castillo LaTorre, C., Rivera González, A.,
Rodríguez Vélez, J. G., Fonseca Ferrer, V., Méndez Meléndez, O. F., Vázquez
Vargas, E. J., & González Monroig, H. A. (2019). Treatment of Hypertensive
Cardiogenic Edema with Intravenous High-Dose Nitroglycerin in a Patient Presenting
with Signs of Respiratory Failure: A Case Report and Review of the Literature. The
American journal of case reports, 20, 83–90. https://doi.org/10.12659/AJCR.913250
McRitchie R. (2017). Acute pulmonary oedema. Australian prescriber, 40(4), 126.
https://doi.org/10.18773/austprescr.2017.051
Murray, J. F. (2011). Pulmonary edema: pathophysiology and diagnosis. The International
journal of tuberculosis and lung disease, 15(2), 155-160.
Powell, J., Graham, D., O'Reilly, S., & Punton, G. (2016). Acute pulmonary oedema. Nursing
Standard (2014+), 30(23), 51.
Purvey, M., & Allen, G. (2017). Managing acute pulmonary oedema. Australian
prescriber, 40(2), 59–63. https://doi.org/10.18773/austprescr.2017.012

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