Module 05 Mini Case Studies – Pulmonary Edema

Read the scenarios below and answer the questions. If you use sources, site them using APA format. Please use the rubric as a guide when writing this paper.

Case Studies – Pulmonary Edema

Case 1

Answer 1

Pulmonary edema is characterized by excess fluid accumulating in the alveoli. The fluid hinders the transfer of respiratory gases thus making it hard to breathe.  Intravenous fluid administration using 0.9% saline is essential to rehydrate patients. However, the use of IV pumps is essential to control the amount of the infused saline. Failure to use an IV pump may cause volume overload increasing the risk of pulmonary congestion (observed crackles in the lower half of the lungs).  If the nurse could have stopped the infusion when the patient started feeling better at 500ml, rather than infusing the entire bag. The flow of IV fluids can be regulated manually whereby the nurse should check regularly to ensure both deliveries of correct dosage and rate of fluid flow. However, it was a good decision to use Lasix because it reduced the amount of fluid in the lungs thus lowering the risk of developing further pulmonary edema complications.Module 05 Mini Case Studies – Pulmonary Edema

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Answer 2

Administration of IV requires control of the given amount. By hanging the 0.9% Normal Saline, the rate of administration would rely on gravity which can result in the patient receiving excessive fluid. Administering an excessive amount of 0.9% saline may cause pulmonary congestion due to fluid overload which means that there will be too much fluid in the patient’s body. An excessive amount of fluid in the circulatory system that results from fluid overload may cause congestive heart failure. Congestive heart failure is the major cause of pulmonary edema (Iqbal & Gupta, 2020). When the heart fails to pump blood efficiently, a backup in the veins takes blood to the lungs. As the pressure in the vessels increases, fluid is pushed into the alveoli resulting in acute pulmonary edema. This fluid also prevents normal oxygen movements, which causes short breathe as witnessed in the patient.

Case 2

Answer 3:

It is necessary to ensure that patients are administered the correct dosage of medication. Hence calculating the number of IV fluids based on body weight is essential to prevent complications that may arise due to fluid overload. Bodyweight is essential when calculating drip rates. This patient has a small body size. Hence, the amount of IV should be less. Administering large amounts of IV fluids puts the patient at risk. This patient is treated as an adult using a fixed-dose regimen.  The patient’s small body size cannot hold a lot of fluids compared to individuals with high body weight. Hence, there are high risks of developing fluid-overload increasing the risk of pulmonary edema.Module 05 Mini Case Studies – Pulmonary Edema

Answer 4:

Pulmonary edema in this patient could have been prevented by administering small amounts of IV fluids and the rest through oral intake. This patient is already suffering from pneumonia which is a risk factor for pulmonary edema. Pneumonia progresses following specific sets of events. At the congestion stage, the lungs are usually filled with fluid, resulting from inflammatory processes and leaky blood vessels. Hence the patient shows symptoms consistent with pulmonary edema such as shortness of breath. In this case administration of IV fluids over three days could have made the situation even worse. The integrity of blood vessels around the lungs could have been compromised, which means that fluid overload in circulation would easily leak into the alveoli. Therefore, by using alternative routes of fluid administration, hydration will be achieved while keeping the amount of fluid in circulation at normal levels.

Case 3

Answer 5

The patient’s medical history of cardiomyopathy is a risk factor for pulmonary edema. Cardiomyopathy affects heart muscles which affect the ability of the heart to pump blood to the rest of the body (Iqbal & Gupta, 2020). Cardiomyopathy can lead to heart failure increases the risk of pulmonary edema. When multiple bags of 0.9% Normal Saline are administered, the amount of fluid in circulation increases steadily. Since the heart’s ability to pump this large of fluid through the arteries, a backlog of blood is created resulting in increased pressure on the left side of the heart. Subsequently, there will be increased pulmonary venous pressure, elevated capillary pressure in the lungs, and ultimately, fluid is forced into the alveolar spaces and alveolar walls of the lungs. The result of altered blood flow is the development of pulmonary edema characterized by fluid in the lungs and shortness of breath.

References

Alwi, I. (2010). Diagnosis and management of cardiogenic pulmonary edema. Acta Med Indones. 2010 Jul;42(3):176-84. https://pubmed.ncbi.nlm.nih.gov/20973297/Module 05 Mini Case Studies – Pulmonary Edema

Iqbal, M. A., & Gupta, M. (2020). Cardiogenic Pulmonary Edema. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544260/

Purpose

To recognize risk factors for pulmonary edema/fluid overload.

Competency

Explain care for the client with lower respiratory disorders.

Instructions

Read the scenarios below and answer the questions. If you use sources, site them using APA format.

 Case # 1

An elderly woman comes into the ER with severe dehydration after spending the day at the beach. The client is weak and feels like she is going to faint. An IV is started and the RN hangs 0.9% Normal Saline. There are no IV pumps available. The client begins to feel better after 500 mL’s are infused and the rest of the IV bag is infused. The client begins to have difficulty breathing. Auscultation of the lungs reveals crackles to ½ of the lower lung fields. The provider diagnoses pulmonary edema and the client is treated with Lasix. She is stabilized but needs to be admitted to the ICU.

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Question # 1: What nursing action could have prevented the client from having pulmonary edema? (5-10 sentences)

Question # 2: What makes this client at risk for pulmonary edema? (5-10 sentences)

 Case # 2

A 22-year-old special-needs client comes to the ER with fever, and difficulty breathing. The client weighs 66 LBS. The client is admitted with pneumonia and IV fluids, antibiotics, and respiratory treatments are started. The client is dehydrated so the she receives several bags of IV fluids over three days. On the third day the client has worsening shortness of breath and an X-ray is ordered that shows pulmonary edema. An echocardiogram is ordered that shows normal cardiac function. The client is given Lasix and the shortness of breath resolves.

Question # 3: How did the client’s size (body weight) put her at risk for pulmonary edema? (5-10 sentences)

Question # 4: How could pulmonary edema have been prevented in this client? (5-10 sentences)Module 05 Mini Case Studies – Pulmonary Edema

 Case # 3

A 32-year-old male with a history of cardiomyopathy is admitted to the medical-surgical floor with a diagnosis of flu. The client has a high fever and receives multiple bags of 0.9%NS. One day into the admission the client develops severe shortness of breath. An X-ray shows pulmonary edema.

Question # 5: What puts this client at risk for pulmonary edema? (5-10 sentences)

Format

• Standard American English (correct grammar, punctuation, etc.)
• Logical, original and insightful
• Professional organization, style, and mechanics in APA format
• Submit document through Grammarly to correct errors before submission

Resources

APA Online Guide

Module 05 Mini Case Studies – Pulmonary Edema