Nursing Case Study: Analysis of Mary Ambrosia's Acute Pulmonary Oedema

This assignment analyzes a case study involving Mary Ambrosia, a 68-year-old patient experiencing acute pulmonary oedema (APO). The analysis begins by identifying the most probable cause of Mary's APO, considering her history of cardiac failure, acute myocardial infarction (AMI), and type 2 diabetes, with shortness of breath as a key symptom. The assignment then details the clinical manifestations observed in Mary, linking them to the pathophysiology of APO, including the complexities of myocardial infarction and heart failure. Furthermore, the assignment identifies and provides rationales for two relevant APO management strategies: non-invasive ventilation and morphine, discussing nursing considerations for each. The document references relevant literature to support the analysis and recommendations for managing the patient's condition.

Pulmonary
oedema

Table of Contents
1) Explain the most likely cause of Mary’s possible APO and also provide a rationale for this
cause, including any risk factors............................................................................................2
2) Identify list of clinical manifestations observed in Mary that are indicative of APO and
explain the pathophysiology of it...........................................................................................2
3) Identify two APO management strategies which are relevant for Mary and also provide a
rationale for each strategy and identify any relevant nursing considerations........................3
REFERENCES................................................................................................................................5
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1) Explain the most likely cause of Mary’s possible APO and also provide a rationale for this
cause, including any risk factors.
The most likely cause of acute pulmonary oedema occur in those patient who have past
heart failure. This can be seen in the patient Mary as she has a past history of cardiac failure and
acute myocardial infarction. As the cardiac failure is a life threatening and distressing condition
along with that develop various other systems (Chioncel and et. al., 2015). The most likely cause
of acute pulmonary oedema in Mary occurs as she is experiencing shortness of breath which is a
sign of cause of it. The importance of this cause is that the heart of patient becomes failure from
which it cannot longer pump blood throughout the body. From this, pressure on vessels of lungs
created from which fluid starting leak from vessels then the shortness of breath occur. There are
some risk factors for Mary from whom development of APO can be occur as she is 68 years old
and has past history of cardiac failure, AMI and type 2 diabetes.
2) Identify list of clinical manifestations observed in Mary that are indicative of APO and
explain the pathophysiology of it.
There are some clinical manifestations are observed in the Mary case. The clinical
manifestations are the indicators of acute pulmonary oedema. There are four clinical
manifestation are observed which are from the past history of patient that includes type 2
diabetes, acute myocardial infarction and cardiac failure. The current symptoms that are
observed in Mary are of shortness of breath what the indicator of acute pulmonary oedema.
 The pathophysiology of acute myocardial infarction occurs as very complex in which the
myocardium impairs loses it viable cardiac function from which output of cardiac reduces. It
became more if the damage is which leads to cardiogenic arrest. As the diastolic and systolic
dysfunction are associated with this disease. If the left part of ventricular becomes impaired
then oedema will develop in pulmonary. In this abnormal rhythm of cardiac occur including
block of conduction from which further impaired function develop which cause life-
threatening for human (Ferré and et. al., 2019).
 The pathophysiology of heart failure is occur when the efficiency of muscle of heart is
damaged or become overload. From this, it causes various conditions such as myocardial
infarction, hypertension, etc (Ellingsrud and Agewall, 2016). The person who has a heart
failure have face overload on ventricle from which the force is reduce of contraction. The
muscles of heart become less efficient from which load on the ventricle develops in order to
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follow the blood from the body. Including this, heart rate of person hard increases along
with increase in other sympathetic activity.
3) Identify two APO management strategies which are relevant for Mary and also provide a
rationale for each strategy and identify any relevant nursing considerations.
There are two management strategies of acute pulmonary oedema relevant to the case of
Mary. These are the two strategies that are initiated by medical emergency team when they
observe the condition of patient.
The first management strategy is non-invasive ventilation. The importance of this strategy is
that it helps in providing oxygenation and also helps in in opening of alloy that becomes flooded.
It also includes two degrees in the dead space ventilation. This strategy decreases the load by
reducing the demand of oxygen due to workload by decreasing afterload and preload. Including
this, the bi level positive airway pressure which is a common form of non-invasive ventilation
also help in decreasing in breathing in patient who are suffering from severe orthopedic. This
strategy also helps in decreasing the complications by decreasing the mortality of pulmonary
oedema within patient. It also helps in decreasing mechanical ventilation invasive. There are also
some consideration for nursing from which they can provide this strategy to their patients
properly. They should apply this treatment with proper application method by applying
noninvasive ventilation mask to their patient. They should rapidly test for or indication so that
they can use this mask for patient from which they can be diagnosed from acute pulmonary
oedema. The Mask should be occur properly and does not strapped on patient's face (Petiot,
Tawk and Ghaye, 2018). The appliance of this mask provides initiative diagnosed from acute
pulmonary oedema. The nurses should apply the pressure of this mask by beginning with
expiratory pressure. After that when the improvement occur then pressure need to be decreased.
Then the requirement of patient needs to be titrated. The nurses must use oro-nasal and nasal
mask from which both improvement can be develop for the avoidance of intubation. From this
gas exchange can be improved to properly with the help of mask.
The other management strategy that can be used by medical emergency team is Morphine.
This strategy is initially used to treat pulmonary oedema. As it cause venodialatation from which
preload can be decreased. This is also help in decreasing pain and it by decreasing the demand of
myocardial oxygen. It is an effective strategy which provides potential benefits in acute heart
failure syndrome. In addition to this, best strategy can cause depression in respiratory system
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from which arrest of respiratory and hypoxia can caused. There are also some side effects of this
strategy such as problem in breathing which can be seen in the case of Mary. They should
consider while providing this strategy within patient treatment. The nurses should ensure that the
dose of this is strategies should communicated so that it cannot overdose from which various
other symptoms can be occur (Moore, 2020). The dose of this should be occur in proper volume
so that concentration can be maintained. While providing the treatment, dose should be
considered within patient. The nurses also should consider the severity and type of pain of
patient. While providing this is strategy by medical emergency team the side effects should be
carefully monitor by nurses so that titrate of patient can be occur slowly. From this the dose of
this is strategy occur in lower amount so that it cannot various other symptoms.
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REFERENCES
Books and journals
Ferré, A., & et. al., (2019). Lung ultrasound allows the diagnosis of weaning-induced pulmonary
oedema. Intensive care medicine. 45(5). 601-608.
Ellingsrud, C., & Agewall, S. (2016). Morphine in the treatment of acute pulmonary oedema—
why?. International journal of cardiology. 202. 870-873.
Petiot, A., Tawk, S., & Ghaye, B. (2018). Re-expansion pulmonary oedema. The
Lancet. 392(10146). 507.
Moore, L. E. (2020). Pregnancy-Associated Pulmonary Oedema. Respiratory Disease in
Pregnancy, 171.
Online
Chioncel. o., & et. al., 2015. Pulmonary Oedema—Therapeutic Targets. Online Available
Through:<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491006/>
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