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CONDITION/DISORDER SYNONYM

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  • Oedema

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ICD-9-CM CODES

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  • 514 Pulmonary congestion and hypostasis

  • 518.4 Acute edema of lung, unspecified

  • PT diagnoses/treatment diagnoses that may be associated with respiratory disorders

    • 780.7 Malaise and fatigue

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

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ICD-10-CM CODES

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  • J81.0 Acute pulmonary edema

  • J81.1 Chronic pulmonary edema

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PREFERRED PRACTICE PATTERNS1

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  • 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders

  • 6B Impaired Aerobic Capacity/Endurance Associated with Deconditioning

  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction

  • 6F: Impaired Ventilation and Respiration/Gas Exchange Associated with Respiratory Failure

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PATIENT PRESENTATION

A 77-year-old male in a telemetry unit of an acute care facility for exacerbation of congestive heart failure (CHF) presents to the physical therapist during the second day of treatment with a sudden (new) onset of shortness of breath (respiration rate, 24; PO2 84% while on 2 L of O2 via nasal canula), crackles without wheezing heard upon auscultation, elevated blood pressure (177/109), anxiety, profuse diaphoresis, frothy pink sputum, and edema in both feet. The patient’s current relevant medications include furosemide as a diuretic, and enalapril for an angiotensin-converting enzyme (ACE) inhibitor. He is in some distress and is unable to respond to questions reliably or without further anxiety. The physical therapist notified the nurse and the physician who obtained the following STAT test results: a standard chest radiograph revealed fluid in the alveolar walls and upper lobe diversion; an echocardiogram confirmed impaired left ventricular function; a complete blood count (CBC) with differential revealed a mildly elevated white count (10,800 cells/µL/mm3); the blood urea nitrogen (BUN) was 30 mg/dL; creatinine was 1.5 mg/dL; B-type natriuretic peptide (BNP) was 600 pg/mL; and arterial blood gases revealed elevated carbon dioxide and low oxygen concentration.

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FIGURE 76-1

Radiographs of a 67-year-old man with dyspnea. A. Standard radiography demonstrates cardiomegaly and pulmonary edema (arrow). B. Dual-energy subtraction radiograph demonstrates extensive calcification within the left anterior descending artery (LAD) (arrows). C. Three-dimensional computed tomography reconstruction of the chest confirms extensive calcifications in the LAD territory (arrow). (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart. 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location Graphic Jump Location
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KEY FEATURES

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Description
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  • Fluid accumulation in the air sacs/spaces and parenchyma of the lungs

  • Respiratory failure

  • Impaired gas exchange

  • Peripheral edema

  • Shortness of breath/difficulty breathing

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Essentials of Diagnosis
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  • Sudden onset shortness of breath (dyspnea)

  • Cyanosis

  • Circulatory dysfunction

  • Coughing up blood

  • Pleural effusion

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General Considerations
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