Pulmonary edema

ICD-9: 514


Pulmonary edema is a diffuse extravascular accumulation of fluid in the pulmonary tissues and air spaces. Most commonly, it represents the projection of cardiac disease processes, such as atherosclerosis, hypertension, or valvular disease. The condition is usually a direct consequence of left ventricular failure. Pulmonary edema can occur as a chronic condition, or it can develop quickly. Pulmonary edema is considered a medical emergency.


When the alveoli fill with fluid instead of air, preventing oxygen from being absorbed into the bloodstream, more blood is added to the pulmonary circulation than can be adequately removed. In addition to the cardiac problems already mentioned, pulmonary edema may also be the result of lung infections, living at high altitudes, smoking, certain toxin exposure, pneumonia, and acute respiratory diseases.

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Signs and Symptoms

The onset of pulmonary edema frequently occurs at night, after the person has been lying down for a while. In the more acute form, clients exhibit dyspnea, coughing, and difficulty breathing unless sitting erect or standing (orthopnea). Tachycardia, tachypnea, diffuse rales, and frothy bloody sputum also may occur. A decrease in blood pressure; a fine, barely perceptible thready pulse; and cold, clammy skin occur as cardiac output fails. These symptoms of cardiac output failure constitute a medical emergency

Diagnostic Procedures

Clinical features indicate the diagnosis. Arterial blood gas analyses and chest x-rays are useful in diagnosing this condition. Electrocardiogram, regular echocardiogram, and transesophageal echocardiogram are often performed. Pulmonary artery catheterization may be used to confirm left ventricular failure.

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Oxygen is typically administered along with bronchodilators and diuretics. Digitalis may be administered to stimulate heart action, and medication may also be prescribed to relieve anxiety. Aspirin and blood pressure medications may be given. Fluid intake may be limited, and mechanical ventilation may be necessary.

Complementary Therapy

No significant complementary therapy is indicated.


Clients will be anxious, so reassure them as much as possible. Using a calm voice, explain all procedures. Provide emotional support to all family members. Remind clients to report any weight gain of even 2 to 3 lb, to rest periodically during the day, and to avoid drinking alcohol.

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Edema in the legs, abdomen, or pleural membranes is serious. Acute pulmonary edema can be fatal. The outcome depends on the condition of the heart and lungs before the edema develops. Drug-induced pulmonary edema can be a cause of death in individuals who abuse narcotics.


There is no known prevention, but certain steps can reduce risk. They include lowering blood pressure and cholesterol, eating a healthy diet, exercising regularly, not smoking, managing stress, and making certain there is sufficient folic acid in the diet.

BRONCHIECTASIS (ACQUIRED) ICD-9: 490.0 Description Bronchiectasis is the widening and destruction of the large airways or bronchi, usually in the lower lung portions. Etiology The common cause is recurrent inflammation or infection of the airways. Cystic fibrosis is a cause in nearly half of all cases. Risk factors include recurrent lung infections, tuberculosis, and obstruction of the airways by a foreign body or tumor. Signs and Symptoms Symptoms may develop gradually and can include chronic cough with large amounts of foul-smelling sputum, bluish skin color, hemoptysis, fatigue, paleness, shortness of breath, weight loss, and wheezing. Diagnostic Procedures Auscultation reveals small clicking, wheezing, bubbling, rattling sounds, usually in the lower lung lobes. Chest x-ray, CT scan, complete blood count (CBC), and tuberculin skin test are often ordered. Treatment Treatment aims at controlling infections and bronchial secretions and relieving airway obstruction. Antibiotics, bronc...
Atelectasis ICD-9: 518.0 Description Atelectasis is a collapsed or an airless condition of all or part of a lung that allows unoxygenated blood to pass unchanged through the area; this produces hypoxia. The condition may be acute or chronic. Etiology The condition may be caused by obstruction of the lung by foreign matter, mucus plugs, or excessive secretion. It is seen in many clients with COPD or cystic fibrosis and those who smoke heavily. Compression of the lung by tumors, aneurysms, enlarged lymph nodes, or pneumothorax also may cause lung collapse (see Pneumothorax). Atelectasis is sometimes a complication of abdominal surgery or a general consequence of postoperative immobilization. Signs and Symptoms Chronic atelectasis may be marked only by the gradual onset of dyspnea. Acute atelectasis typically includes marked dyspnea, cyanosis, fever, tachycardia, anxiety, and diaphoresis (profuse sweating). There may be a decrease in chest motion on the affected side. Chronic atelecta...
Lung abscess ICD-9: 513.0 Description A lung abscess is an area of necrotized lung tissue containing purulent material. Abscesses are more frequent in the lower dependent portions of the lungs and in the right lung, which has a more vertical bronchus. Etiology Lung abscesses caused by infectious organisms may be a complication of pneumonia. Aspiration of infectious material is the most frequent etiology; however, aspiration due to dysphagia or compromised consciousness (e.g., seizure, cerebrovascular accident, head trauma, alcoholism) appears to be a predisposing factor. Poor oral hygiene, dental infections, and gingivitis are also common indicators. Antibiotic therapy has greatly decreased the number of deaths caused by lung abscess. However, the increased use of corticosteroids, immunosuppressive drugs, and chemotherapeutic agents in the past couple of decades has changed the natural environment of the oropharyngeal cavity and contributed to increased frequency of opportunistic lung abs...
Respiratory mycoses ICD-9: 177.x Description Mycoses (fungal infections) are classified as either superficial or deep. Superficial mycoses affect only the skin and are discussed in Chapter Skin Diseases and Disorders. Deep mycoses are systemic and may complicate other illnesses. The mycoses considered here are deep, systemic fungal infections that extensively affect the lungs: histoplasmosis, coccidioidomycosis, and blastomycosis. Etiology Histoplasmosis, also called Darling disease, is caused by Histoplasma capsulatum. The fungus is found in soil, especially soil contaminated by bird and chicken droppings. The spores become airborne when the contaminated soil is disturbed. The disease is transmitted when the fungal spores are inhaled or penetrate the skin following injury. The primary lesion is in the lungs. Coccidioidomycosis, also called San Joaquin valley fever, is caused by Coccidioides immitis, a fungus common in the dry desert soils of California, New Mexico, Nevada, and Arizona. The d...
Adenoid hyperplasia ICD-9: 474.12 Description Adenoid hyperplasia is the enlargement of the lymphoid tissue of the nasopharynx, causing partial breathing blockage. Etiology The cause is essentially unknown. Circumstances that may cause the adenoids to continue to grow when they normally would atrophy (approximately ages 5 to 8) may include repeated infection and nasal congestion, chronic allergies, and heredity. Signs and Symptoms The most common symptoms are chronic mouthbreathing, snoring, and frequent head colds. The child’s speech has a nasal quality. Diagnostic Procedures Diagnosis is usually made by visualizing the hyperplastic adenoidal tissue or by the use of lateral pharyngeal x-ray films. Treatment The treatment of choice is adenoidectomy, often performed in conjunction with a tonsillectomy. Complementary Therapy No significant complementary therapy is indicated. CLIENT COMMUNICATION Explain in simple terms the surgical procedure to a child. Be sympathetic...