Johan Maulana
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed
Mrs. M/64 yo/
Subjective
- Shortness of breath 2 days before
admission in hospital
- DOE(-), PND(-), Orthopneu(-), Sleep using 1 pillow, Leg edema (+)
- History of
uncontrolled HT and DM for the past 2 years
Objective - GCS: 325
- TD: 150/108 mmHg - N: 98 x/menit
- RR: 28x/menit - tAx: 36,7℃
- SpO2: 99-100% on 10 lpm nrbm
- Pulmo: SN vvv menurun/vvv, rh -+
+/-++, wh ---/---
Shortness of breath+Desatu ration+Ronkhi
Acute Lung
Oedem - EKG Non
Pharmacology:
- Bed rest semifowler position
- O₂ 8-10 lpm NRBM Pharmacology:
- Inj. Furosemide 0- 0-40 mg
Pmo:
- S, VS, Balance cairan, UOP, GCS, EKG serial, BGA serial
Ed:
- Educate family of the pation
about diagnosis, planning, and treatment
Johan Maulana
POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&E
d
Laboratory
- DL
13,2/10.360/41,3/3 05.000
- DC
3,4/0,4/60/29,3/6,9 - GDS 597
- UR/Cr
89,1/2,88(eGFR 16,5591)
- CRP 0,17 - Procal 0,15
- BGA
7,27/49,2/211,4/22, 5/-4,6/98,8
(Uncompensated Respiratoric
Acidosis) Radiology
- Pneumonia dengan edema pulmonum - Cardiomegaly
dengan
aortasklerosis - Efusi pleura kanan
Johan Maulana
Acute Lung Oedema
DEFINISI
• Edema paru akut adalah ekstravasasi cairan yang berasal dari vaskular paru masuk ke dalam interstitium dan alveoli paru sehingga
mengganggu proses pertukaran gas dan menurunkan
compliance paru
3
Johan Maulana
4
Disrup,mngacauknhjy
Johan Maulana
5
Cardiogenic Fluid Overload
A rapid increase in hydrostatic pressure in the pulmonary capillaries leading to increased
transvascular fluid filtration is the hallmark of acute
cardiogenic or volume-overload edema. Increased hydrostatic
pressure in the pulmonary capillaries is usually due to elevated pulmonary venous pressure from increased left
ventricular end-diastolic pressure and left atrial
pressure.
LAP 18 ~ 25mmHg
LAP > 25mmHg
LAP:Left Atrial Pr.
Johan Maulana
6
Noncardiogenic pulmonary edema has a high protein content because the vascular membrane is more permeable to
the outward movement of plasma proteins. The net
quantity of
accumulated pulmonary edema is determined by the balance between the rate at which fluid is filtered into the lung and the
rate at which fluid
is removed from the air spaces and lung interstitium.
Non-cardiogenic
IMPAIRED
Impire mnggujhy
Johan Maulana
• Dyspnea on exertion
• Paroxysmal nocturnal dyspnea
• Orthopnea
• Noisy, labored breathing
• Restlessness, anxiety
• Productive cough (frothy sputum)/berbusa
• Rales, wheezing
• Tachypnea
• Tachycardia
Pulmonary Edema: Signs & Symptoms
7
Johan Maulana
8
In patients with an uncertain cause or possible multiple causes of edema, insertion of a pulmonary artery catheter may be necessary
THE END