Other Causes of Pulmonary Edema (Nursing)

00:01 Okay, now that you're a rockstar about how congestive heart failure causes pulmonary edema, I want to introduce you to some other causes.

00:09 So if someone's had a heart attack or other heart diseases, that can cause pulmonary edema because a heart that can't pump as strong as it used to because it has damage from a heart attack or a myocardial infarction or some other damage to the heart that's gonna cause a risk of heart not being able to function efficiently, fluid's gonna back up and where it backs up is in the lungs.

00:32 You can also have problem with damaged heart valves.

00:35 Now the purpose of heart valves, if you've ever looked at this, you see like they're supposed to keep blood flowing in one direction.

00:42 So when your systole, right? These valves in the top they open up and blood pushes through but in diastole, when the heart relaxes, those valves close, other valves open.

00:53 So if those valves are leaking or they're narrowed or they're damaged in any way, blood is not gonna flow efficiently because of the problem with the heart valves.

01:04 Any problem that makes the heart less efficient put your patient at risk for stuff backing up and pulmonary edema.

01:12 That's why shortness of breath is so associated with anyone with heart problems.

01:18 If someone has super high blood pressure, that might also be a problem.

01:22 Aah yeah, this is an easy one.

01:24 You already know that right? because we talked about chronic hypertension.

01:27 It causes that left ventricle to have to work really hard.

01:30 Well if someone has super high blood pressure really quickly, again the ventricles are going like, "hey what is going on here?" So again blood may back up and cause pulmonary edema.

01:40 Now high altitude, holy cow! if you've ever been up to like the mountains of Colorado you've experienced something like this you don't ever forget it.

01:50 I'll break that down a little more for you.

01:52 Also kidney failure, they're very involved in fluid volume balance so patient in kidney failure can also develop pulmonary edema.

02:00 Now lung damage if they've got a really bad infection can also trigger pulmonary edema and fluid leaking into spots we don't want it to.

02:09 Lastly, severe sepsis.

02:12 Okay, that's a really significant infection of the blood or blood poisoning as caused by an infection, also leads to pulmonary edema and all kinds of complications.

02:23 So woah, that's a big list.

02:26 Don't you hate it when you're trying to study and you look at this, you're like, "Okay there is no way I'm gonna remember 4000 things".

02:31 You don't have to What you need to remember is causes of pulmonary edema can be damage to the heart or direct damage to the lungs or kidneys.

02:41 So pulmonary edema, never good sign, it's always a sign of fluid volume overload.

02:48 Either I took a healthy person with a normally functioning heart and I just was slam them with way too much fluid or I have a heart that's sick and you can't pump the amount of fluid it has around in the body.

03:02 So it's all about organ failure right? Heart, lung or kidney damage can give us a real issue.

03:10 In sepsis, I've got inflammation and problems everywhere.

03:13 so think about chunking information, putting big pieces together because I promise you, you can make up all the kind of mnemonics you want to for all these things but once you get like 400 mnemonics in your head, you can't remember it all.

03:28 So understanding, that's why you were so careful to step through .

03:32 reminding you how the blood flow works in the heart, why it would be very clear to you, why back up on that left side is gonna cause pulmonary edema and the other should more easily fall into place with just simple periods of practicing this in your own time.

03:47 Okay, so let's talk about heart attack.

03:50 You already know, I see you already have this, I love it, you're doing really well staying up with us.

03:55 So heart attack, myocardial infarction.

03:59 Infarction means dead tissue.

04:02 So see we've got a close-up for you there, that kind of a black stuff, yeah that's tissue, that's no bueno.

04:08 And remember, dead tissue can't conduct those electrical signals anymore.

04:12 You know in your heart it pumps because, SA node, AV node, bundle of His, Purkinje fibers It doesn't matter what your purkinje fibers going through your body, I mean your heart It can't send a signal there to tell that muscle to contract so that muscle is essentially stiff and useless.

04:30 So the larger the heart attack or the larger than myocardial infarction, the worst problems your patient's gonna have.

04:38 So because infarcted tissue is dead tissue.

04:42 Dead tissue is stiff tissue so the heart can't contract and expand efficiently, can't respond to the electrical pacemaker of the heart that's why a heart attack, patients afterwards can really be at risk for pulmonary edema and even congestive heart failure.

05:00 Now let's look at those valves.

05:01 You already know why this is a problem, right? See, you are learning so quickly, well done.

05:07 So the valves, look we've showed you what normal valves are supposed to look like and then when they're not normal.

05:13 These are some weird-looking valves.

05:16 But remember a valve's job is to be, let blood go one direction, not allow stuff to back up or flow the opposite direction.

05:25 So when valves are damaged, blood flow backs up and causes pulmonary edema mostly from the left atrium, mitral valve, left atrium back into the lungs.

05:35 Yeah, I told you, you've got this, good job.

05:39 NowI iwant to talk to you about high altitudes, I've had altitude sickness one time Again, would I recommended it? Severe headache, I was nauseated, super dehydrated but this is one step worse.

05:54 High altitude pulmonary edema.

05:57 This was my first adventure being a camp nurse.

06:00 And I was on one side of the camp and my colleague called me to the other side of the camp and they asked me to look at this kid whose name was Dusty.

06:09 Wow that was appropriately name because I walked into his room and thought, Oh my goodness, here is this junior high boy looking blue.

06:19 He looked horrible and you know when someone's blue, it's really really bad, we've missed some earlier signs Well Dusty was experiencing high altitude pulmonary edema.

06:31 My first thought was, if I was at work I'd be running the crash cart into this gentleman's room but I wasn't at work I was in a camp in the mountains.

06:40 So this boy ended up being ambulanced out in the hospital to intensive care.

06:46 Here's what happened to Dusty: he had high altitude pulmonary edema, so he had really low oxygen in the blood which we are all experiencing, right? Because the altitude causes a hypoxic pulmonary vasoconstriction.

07:02 Okay, so high altitudes, we have lower oxygen in the blood and you've got this hypoxic pulmonary vasoconstriction.

07:11 Well anytime those vessels constrict, I know that in my blood pressure, my blood pressure goes up.

07:18 Same thing happens in your lungs because of the low oxygen that's available in the mountains then you have this pulmonary vasoconstriction.

07:28 That means a pulmonary artery pressure is also elevated.

07:33 Okay, high altitude low oxygen hypoxic pulmonary vasoconstriction is a result of that low oxygen then you have elevated pulmonary artery pressure, now fluid leaks from the vessels into the alveoli.

07:48 So here was this junior high boy in severe pulmonary edema that's why he was blue.

07:56 He struggled with this during the night before they came to get the nurse so we saw him, we knew it was time to go.

08:03 Now this story has a great ending because he recovered, he did well Of course, this patient's raced up to Colorado to see him, he did well and he became super fit and buff, very strong young man lived to healthy life.

08:16 But because of this HAPE and this pulmonary edema, if we wouldn't have got to him this story might have had a very, very different ending.

08:27 So remember, high altitude, low oxygen, increased vasoconstruction because hypoxic, low oxygen pulmonary vasoconstriction elevated pulmonary artery pressures, fluid leaks into the vessels, the alveoli makes some little water balloons like you see there and that's what almost had a very sad ending for my friend.

08:51 But luckily, that story has a happy ending.

08:55 Now let's look at role of the kidneys.

08:57 You know the kidneys play a major role in fluid-volume balance in the body.

09:01 Okay, so yes you knew that but remember that's great.

09:06 Celebrate the things you know because you're learning more than you realise everyday.

09:11 I know doesn't feel that way sometimes in school but you really are.

09:16 So you know the kidneys play a major role in fluid-volume balance.

09:21 Okay, so if the kidneys are failing, now we're gonna have fluid-volume overload Ooh, there you go, you already know that edema is fluid the leaking into the tissues and it's because you end up with pulmonary edema because there's more than the body can handle.

09:39 Well if the patient's in renal failure, a classic sign that you've got extra volume or fluid volume overload and that's why you can end up with it backing up and leading to pulmonary edema.

09:51 Also, we talked about lung damage.

09:53 You have a severe infection of the lungs or the lung tissue's impacted from its severe inflammatory response, that can cause fluid to leak into the alveoli Now sepsis, well we'll do separate presentations on sepsis but we want to put it in here to remind you So in sepsis, the capillaries become damaged and the body's in inflammatory response.

10:17 so sepsis is a really severe condition for a patient and the reason they have leaking, is because of this inflammatory response, the capillaries become damaged and then you end up with fluid leaking other vessels into the tissues.

10:32 Again, in sepsis it's not just in the lungs.

10:36 In sepsis, you can end up all your circulatory systems, so I've had some amazing stories not in a good way of patients that we knew they were septic, we kept putting fluid in them to try to bring the blood pressure up They're on all kinds of vasoactive drips but everything we put into their veins just went straight into their tissues.

10:57 The patient just blew up and we still didn't win that battle.

11:02 So sepsis, widespread, it's an infection in the bloodstream and ends up attacking all these capillaries.

11:08 They become damaged and so fluid will just fill up the tissues all over the body, including the lungs