76: PULMONARY EDEMA

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.