Reflective accounts

Pulmonary oedema

This informative CPD article on acute pulmonary oedema has improved my knowledge of the condition.

This informative CPD article on acute pulmonary oedema has improved my knowledge of the condition.

Picture credit: Science Photo Library

Pulmonary oedema refers to an increase in extravascular fluid in the lungs. In milder forms, the amount of fluid in the interstitial space increases and the alveoli start to flood as oedema becomes more acute, causing potentially life-threatening impairment of gas exchange. In extreme cases, the excess fluid causes a froth to form in the lungs and this blocks the airway. Acute pulmonary oedema is a life-threatening condition and should be treated as a medical emergency.

The article outlined the symptoms of pulmonary oedema, which include mild to severe dyspnoea, particularly when lying down, rales on auscultation, and oxygen desaturation. In more serious cases, patients have a cough that produces pink (blood-tinged) frothy sputum. Pulmonary oedema may have a post-surgery aetiology. An acute coronary syndrome or new onset arrhythmia are other common precipitating factors of acute pulmonary oedema. The most common cause of pulmonary oedema is increased capillary pressure. I was interested to read that oxygen is a powerful vasoconstrictor. This increased my awareness of the risks of oxygen therapy when treating someone with cardiac failure.

I learned that the ABCDE (airway, breathing, circulation, disability, exposure) approach to assessment can be used in various healthcare settings and is particularly useful in time-pressured situations. Nursing care focuses on optimising oxygenation, monitoring and triage. When acute pulmonary oedema is suspected, an early call for help and urgent cardiology review should be made. Early recognition, accurate assessment and successful management can improve the patient’s condition and relieve many of the symptoms.

It is important to be aware that the symptoms of pulmonary oedema can be distressing for patients, and they may require support and reassurance. Patients may experience shortness of breath when lying down and persistent coughing and crackling when breathing, and some patients describe the sensation as feeling like drowning.

The article emphasised the importance of developing a good understanding of patient experiences of symptoms, which enhances empathetic and compassionate care.

Reading the CPD article has refreshed my knowledge of the signs and symptoms of pulmonary oedema, and prompted me to reflect on my experiences of caring for patients with oedema. I was able to use this knowledge in my practice recently to recognise the symptoms of fluid retention in a patient, and as a result I was able to call for an urgent medical review.

Author notes

This reflective account is based on NS829 Powell J et al (2016) Acute pulmonary oedema. Nursing Standard. 30, 23, 51-59.

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