Okay, so now we know this patient's
having pulmonary edema, what do we do?
Well, obvious one - oxygen.
Like what's the first thing we're gonna if we
determine they're really in pretty severe distress,
their pulse ox is dropping, we're going to try oxygen.
Now you know you have the extra fluid
on board, ahhh diuretics make sense, right?
So a diuretic is a medication that causes
the patient to pee out, get rid of more volume.
Things like furosemide,
you've heard those drugs before.
You may know it by the trade name called Lasix but a diuretic
is what helps you get rid of excess fluid on the body.
So we know if you're in pulmonary
edema, you got too much fluid with you.
So we're gonna give you oxygen.
You're gonna want to make more of it available
in your body than normally is from room air.
We're going to give you diuretics which are
medications so it will help pull that excess fluid off.
Just a note, diuretics are, if you're in distress, you give it.
But on a regular basis, you're gonna remind your
patient, "take these first thing in the morning"
because if they they take them in the evening,
they're gonna be up and down, up and down, up and down
all night because you're gonna
have increased urine output.
Now there's some blood pressure
medications that might be appropriate,
it will depend on what's going on with the patient
and how you figure out why are you in pulmonary edema.
With my friend at the camp, I knew that he was
inm pulmonary edema because we're in Colorado,
we're in a high altitude, he had that pulmonary
vasoconstriction because of the low oxygen
available in the air, and that's what caused it.
So we needed to take him from the
mountains to a hospital down much lower,
that was the first step to get into an ICU unit
Whatever the underlying caus is, just
like anything else, you want to address it.
See pulmonary edema is not a disease, it's telling
you woah, this is just something that's going on.
Something else has caused it - that's
the main problem, you got to address it.
It's an infection, it's a fluid-volume overload, it is a
renal failure, what is it part of a much bigger puzzle?
So elevating the head of the bed, the patient's gonna
tell you to do this whether you realize it or not
but that's really important because when a patient can't
breathe for any reason, you want them to sit up, right?
We have a lot of patients who struggle with being a bariatric
patient, they're carrying a lot of extra weight on their chest.
For them in particularly, it's good to have the head of
the bed elevated because they're in a more upright position,
they have more room to expand their lungs and they
don't have the weight of their body on the chest.
Bariatric patients are obese, morbidly obese,
extra weight, this is just gonna smother them.
So getting them as much as you can upright helps both the
bariatric patient and a patient whose of normal weight.
so keep that in mind.
Any respiratory distress elevate the head of the bed.
Now lastly, we're gonna look at limiting fluids.
That will be a decision in the discussion between you and the
healthcare provider and what's best for this particular patient.
Now, let's do something fun before we go on.
Take a look at all these.
If I had a select-all-that-apply-question",
well which of these would be appropriate?
Ah, everyone, right?
Because I told you, these are
the appropriate things that we do
and you know on NCLEX, on a select-all-that-apply
question, one answer or all the answers could be correct.
Now, let's make it a question that
says, let's say it was a multiple choice:
what is the first thing I would do and what is the most
important thing I would do, are two different concepts.
When I walk in the room, the first
thing I'm gonna do position them, right?
I'm gonna do that first but the
most important thing is oxygen.
That's the most important thing.
Then I'm gonna get one of
those diuretics pretty quickly.
See that's the frustrating part about test
questions, like great! all the answers are right,
you're asking me what I would
do first or what is most important.
Those are often two different answers and
you may be looking at a test question where
every single one of the four options are correct.
Get over it, that's how it rolls but you can do
You know first, I'm gonna do that as quickly as I can, I'm
gonna raise the head of the bed but most important, oxygen.
because raising the head of the bed will help the
patient but unless I increase the amount of oxygen
when they're pretty significant
distressed not really going to fix anything.
So that's just a little tip on
letting go like we say that Elsa that,
let it go when you see a test question
and all the answers are correct.
You want to ask yourself, are they asking me
what should I do first or what is most important.
That'll give you a different
prospective on the test question.