pulmonary edema, the accumulation of extravascular fluid in lung tissues and alveoli, caused most commonly by congestive heart failure. Serous fluid is pushed through the pulmonary capillaries into alveoli and quickly enters bronchioles and bronchi. The condition also may occur in barbiturate and opiate poisoning, diffuse infections, hemorrhagic pancreatitis, and renal failure and after a stroke, skull fracture, near-drowning, inhalation of irritating gases, and rapid administration of whole blood, plasma, serum albumin, or IV fluids. See also pleural effusion. ▪ OBSERVATIONS: Signs and symptoms of pulmonary edema include tachypnea; labored, shallow respirations; restlessness; apprehensiveness; air hunger; cyanosis; and blood-tinged or frothy pink sputum. The peripheral and neck veins are usually engorged, blood pressure and heart rate are increased, and the pulse may be full and pounding or weak and thready. There may be edema of the extremities, adventitious breath sounds in the lungs, respiratory acidosis, and profuse diaphoresis. ▪ INTERVENTIONS: Acute pulmonary edema is an emergency condition requiring prompt treatment. The patient is given oxygen and placed in bed in a high Fowler’s position, and IV morphine sulfate is usually administered immediately to relieve pain, to quiet breathing, and to allay apprehension. Morphine also acts as a pulmonary vasodilator. A cardiotonic, such as digitalis or dobutamine, and a fast-acting diuretic, such as furosemide or bumetanide, may be given. Oxygen may be ordered. While the patient is acutely ill, the blood pressure, respiration, apical pulse, and breath sounds are checked frequently or continually monitored. Parenteral fluids, if indicated, are infused slowly in limited quantities. A low-sodium diet is served, and the patient’s intake and output of fluids are measured. The patient is weighed daily, and any sudden weight gain is noted and reported. ▪ PATIENT CARE CONSIDERATIONS: The nurse provides continued care and emotional support. The physical therapist and occupational therapist direct the patient to exercise to tolerance with frequent rest periods. All health care providers should educate the patient to report any symptoms, to avoid smoking, and to follow the regimen ordered for medication, diet, and return checkups.