Which of the following assessment findings is most indicative of fluid accumulation in the lungs?

A) Fine crackles at the lung bases

B) Oxygen saturation of 95% on room air

D) Blood pressure of 128/80 mmHg

Based on the initial assessment findings, which nursing diagnosis is most appropriate for this patient?

C) Activity Intolerance related to exertional dyspnea

A) Ineffective Airway Clearance related to wheezing and cough

B) Impaired Gas Exchange related to crackles and mild shortness of breath

C) Activity Intolerance related to exertional dyspnea

D) Risk for Infection related to fluid accumulation in the lungs

What is the primary reason for initiating a low-dose diuretic in the treatment plan for a patient with early-stage pulmonary edema due to poorly controlled hypertension?

B) To reduce fluid accumulation in the lungs

D) To decrease the risk of infection

Which intervention is most important to include in the care plan of a patient with early-stage pulmonary edema secondary to hypertension?

B) Educate on a low-sodium diet

D) Monitor for signs of infection

What is the primary reason for the nurse to monitor the patient's urine output after administering a diuretic?

B) To evaluate the effectiveness of the diuretic therapy

A) To assess for signs of dehydration

B) To evaluate the effectiveness of the diuretic therapy

C) To determine the patient's fluid intake needs

D) To check for the presence of infection

What clinical finding suggests an improvement in the patient's respiratory condition?

B) Decreased bibasilar crackles

D) Weight loss of two kilograms

What is the most appropriate initial nursing intervention for a patient experiencing increased shortness of breath when lying flat?

B) Instruct the patient to sit in a semi-Fowler's position

A) Encourage the patient to lie flat to rest

B) Instruct the patient to sit in a semi-Fowler's position

C) Administer a higher dose of the patient's diuretic without a physician's order

D) Increase the patient's oxygen flow rate without consulting a physician

What is the most appropriate initial nursing intervention for a patient experiencing increased shortness of breath while lying flat?

A) Elevate the head of the bed to a semi-Fowler's position

B) Administer a bronchodilator as prescribed

C) Encourage deep breathing exercises

D) Increase the patient's fluid intake

Pulmonary Edema - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased pulmonary capillary pressure leads to fluid leakage into the alveoli, often due to left-sided heart failure, causing difficulty in breathing and reduced oxygen exchange.

• Secondary mechanism: Damage to the alveolar-capillary membrane, possibly from infections or toxins, increases permeability and allows more fluid to enter the alveoli, exacerbating breathing issues.

• Key complication: Accumulation of fluid in the lungs reduces lung compliance and gas exchange efficiency, leading to hypoxia and respiratory distress, requiring prompt medical intervention.

Patient Profile

Demographics:

52-year-old female, school teacher

History:

• Key past medical history: Hypertension

• Current medications: Lisinopril 10 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild shortness of breath

• Key symptoms: Slight cough, mild exertional dyspnea, occasional wheezing

• Vital signs: Blood pressure 128/80 mmHg, heart rate 78 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 95% on room air

Section 1

Initial Assessment Findings:

Upon conducting a thorough nursing assessment, several key findings were noted. The patient, a 52-year-old female with a history of hypertension, presented with mild shortness of breath and a slight cough. On auscultation, fine crackles were detected at the lung bases, indicating the presence of fluid. The patient reported mild exertional dyspnea, which had been progressively worsening over the past week. Her occasional wheezing was noted to be more pronounced during physical activity but subsided with rest. Despite these respiratory symptoms, the patient was alert and oriented, with no signs of acute distress at the time of the assessment.

The patient's skin was warm and dry, with no signs of cyanosis or pallor, suggesting adequate peripheral perfusion. Her respiratory rate was slightly elevated at 18 breaths per minute, but she maintained an oxygen saturation of 95% on room air, indicating that she was able to maintain adequate oxygenation at rest. Cardiac assessment revealed a regular heart rhythm without murmurs, with a blood pressure of 128/80 mmHg and a heart rate of 78 bpm, both within normal limits for her age and medical history. Given these findings, the patient was evaluated for possible pulmonary edema, considering her background of hypertension and symptoms of fluid accumulation in the lungs. Further diagnostic investigations were planned to confirm the diagnosis and guide treatment.

Section 2

New Diagnostic Results:

Following the initial assessment, the healthcare team proceeded with a series of diagnostic tests to confirm the presence of pulmonary edema and to better understand the extent of the condition. A chest X-ray was conducted, revealing mild interstitial markings consistent with early-stage pulmonary edema. There was no evidence of gross cardiomegaly, which suggested that the patient's heart function was not severely compromised at this stage. An echocardiogram was also performed, showing normal left ventricular ejection fraction, indicating preserved cardiac function. This supported the hypothesis that the fluid accumulation was likely related to the patient's hypertension rather than heart failure.

Laboratory tests included a complete blood count (CBC), basic metabolic panel, and B-type natriuretic peptide (BNP) levels. The CBC was unremarkable, showing no signs of infection or anemia. The basic metabolic panel revealed normal electrolyte levels and renal function, which was reassuring considering her hypertensive history. However, the BNP level was slightly elevated, suggesting some degree of cardiac strain or increased ventricular pressure, which could contribute to the pulmonary congestion despite preserved ejection fraction. These findings pointed towards a diagnosis of early-stage pulmonary edema, likely secondary to poorly controlled hypertension.

With these diagnostic results, the healthcare team developed a treatment plan focusing on managing the patient's blood pressure and minimizing fluid overload. The patient was started on a low-dose diuretic to help reduce the fluid in her lungs, along with adjustments to her antihypertensive regimen to achieve better blood pressure control. Education on lifestyle modifications, including a low-sodium diet and regular follow-up for blood pressure monitoring, was emphasized to prevent further complications. The plan was to reassess her symptoms and lab results in the coming days to evaluate the response to these interventions and to make any necessary adjustments to her treatment plan.

Section 3

Response to Interventions:

Over the next few days, the patient was closely monitored to assess her response to the newly implemented treatment regimen. The nursing team observed a gradual improvement in her respiratory status, with reports of decreased dyspnea and a reduction in the frequency of her coughing episodes. Her vital signs were stable; blood pressure readings showed a downward trend, consistently averaging around 130/85 mmHg, indicating a positive response to the adjusted antihypertensive therapy. The use of the low-dose diuretic appeared effective, as evidenced by an increase in urine output and a decrease in her weight by two kilograms, suggesting a reduction in fluid retention.

On physical examination, auscultation of the lungs revealed a noticeable decrease in bibasilar crackles, indicative of reduced pulmonary congestion. The patient expressed feeling more comfortable and was able to engage in light activities without significant shortness of breath. Follow-up laboratory tests were encouraging; the BNP level had decreased slightly, signaling a reduction in cardiac strain. Repeat chest X-ray confirmed the clinical findings, showing a slight improvement in interstitial markings.

The nursing staff continued to reinforce the importance of lifestyle modifications, emphasizing adherence to a low-sodium diet and the need for regular exercise to manage her blood pressure effectively. The patient was scheduled for an outpatient follow-up in one week to ensure ongoing evaluation of her condition and to make any further adjustments to her treatment plan if necessary. The healthcare team remained vigilant for any signs of potential complications, such as electrolyte imbalances or worsening respiratory symptoms, to promptly address any issues and maintain the patient's progress.

Section 4

Despite the initial positive response to the treatment regimen, the nursing staff observed a slight change in the patient's condition on the fourth day of her hospital stay. During the morning assessment, the patient reported experiencing mild dizziness and some tingling in her fingers, which were new symptoms. Her vital signs remained mostly stable, with a blood pressure of 128/82 mmHg and a heart rate of 78 beats per minute; however, her serum potassium level was found to be slightly decreased at 3.2 mEq/L, indicating mild hypokalemia, likely a side effect of the diuretic therapy.

The nursing team promptly informed the physician of these findings, and a decision was made to adjust the patient's medication regimen. A potassium supplement was ordered to address the electrolyte imbalance, and the patient was advised to consume foods rich in potassium, such as bananas and oranges, as part of her diet. The nursing staff continued to emphasize the importance of reporting any new symptoms and encouraged the patient to maintain adequate fluid intake to support the body's electrolyte balance.

As the day progressed, the patient's symptoms of dizziness and tingling began to subside, and her potassium levels showed signs of improvement with supplementation and dietary adjustments. The nursing team remained attentive to her condition, conducting regular assessments and providing education on managing potential side effects of her medications. The patient expressed gratitude for the care she received and felt reassured by the proactive approach of the healthcare team. She looked forward to her upcoming outpatient follow-up, where further evaluation would ensure continued progress in her recovery journey.

Section 5

As the week progressed, the nursing staff conducted a thorough assessment of the patient to monitor her response to the interventions and to ensure no new complications arose. During the evening check, the patient mentioned feeling a slight increase in shortness of breath, especially when lying flat, which was a change from the prior days when she had reported improvement in her breathing. Her vital signs remained within stable limits, with a blood pressure of 126/80 mmHg and a heart rate of 76 beats per minute, but her respiratory rate had increased slightly to 22 breaths per minute. Upon auscultation, the nurse noted faint crackles at the bases of the lungs, suggesting a mild recurrence of pulmonary congestion.

The nursing team promptly reviewed the patient's current treatment plan and communicated these findings to the physician. In response, the physician decided to adjust the diuretic dosage slightly, aiming to optimize fluid balance without causing further electrolyte imbalances. Additionally, the respiratory therapist was consulted to provide breathing exercises to help the patient manage her symptoms and improve her lung function. The patient was encouraged to sit in a semi-Fowler's position to facilitate easier breathing, and oxygen saturation was monitored closely to ensure it remained within a safe range.

By the next morning, the patient reported feeling more comfortable and less short of breath. Her repeat chest auscultation revealed a reduction in crackles, indicating that the adjustments to her treatment plan were effective. The nursing staff continued to educate the patient on recognizing early signs of fluid overload and the importance of adhering to her medication regimen and dietary recommendations. This proactive approach aimed to prevent further complications and ensure a smooth transition to her outpatient follow-up care, where her progress would be reassessed and adjustments to her long-term management plan could be made.