This academic paper requires students to write up the patient presented at their Clinical Case Conference (CCC) as a detailed report. There must be analysis of the patient's medical condition(s) demonstrating the ability to apply theoretical concepts  including (but not limited to) pharmacology; pathophysiology; anatomy and physiology. Ensure to discuss a system based  approach (e.g. head to toe) when discussing the assessment of your patient. There must be discussion and evaluation of nursing and medical management of the patient. Sound clinical rationales must be provided that support the care given to the patient. Appropriate evidence based literature sources must be used and Harvard referencing used throughout. You must follow Academic Standards and policy in writing, with the report to be written in third person. Students are encouraged to write up this report prior to undertaking their CCC presentations. The CCC Report must be uploaded with the CCC Declaration cover sheet otherwise the report will not be marked until a copy is received by the tutor allocated to mark the report. Please refer to the marking guide below for the specific requirements of the assignment, you may use the marking guide headings throughout your paper however please note the section on Evaluation of nursing and medical management should not be a heading but should be integrated throughout your entire paper supporting your knowledge and understanding of the patient case. 

Introduction

Pulmonary edema is one of the most common cause for mortality in critically ill patients. The condition is a result of various prior diseases and co-morbidities (Tilman 2015, p.1). Currently, cardiogenic pulmonary edema is the leading cause for emergency department presentations. The current case scenario involves an 80-year-old woman who is presented to the emergency department with complains of shortness of breath and chest tightness. She reports increase in shortness of breath after admission with exacerbation of CCF. Patient assessment revealed the diagnosis of Acute Pulmonary Oedema (APO) as the reason for present admission to the ED. Her past medical diagnosis included presence of congestive cardiac failure and Benign hypertensive heart disease. Furthermore, her medical history includes presence of coronary artery disease, coronary artery bypass grafting (CABG) which is performed for improving blood flow towards the heart, angioplasty for opening the blocked blood vessel, chronic renal failure, and MIBI where none of the areas showed reversible ischaemia. The current report focuses on understanding the pathophysiology of the condition, effects of co-morbidities, evaluates the diagnostic tests, medical and nursing management of the condition and further implications for the patient.

Pathophysiology of patient condition

The 80-year-old woman lived at home with her elderly husband and the cleaner comes to the house for chores. The cleaner noted her struggling for breath in the morning and called for the ambulance. She does not report nausea, diaphoresis, cough, sputum production, chills or fever. She was diagnosed with acute pulmonary edema based on her current symptoms. Pulmonary edema is caused by abnormal accumulation of fluids in the lungs extravascular compartments. The pathophysiology of pulmonary edema involve increment in the hydrostatic pressure of the capillary walls resulting in enhanced capillary permeability (Sureka, Bansal & Arora 2015). The complications that follow as a cascade from pulmonary vasculature obstruction are both chemical and mechanical in nature. Accumulation of fluid in the alveoli results in impediment of oxygen movement and gas exchange. The most commonly caused due to heart failure which results in increased pressure build in the veins going to the lungs. The cardiogenic pulmonary edema is often observed due to increment in the hydrostatic pressure after increased pulmonary venous pressure. The various factors of cardiogenic edema include congestive heart failure, atrial outflow obstruction, left ventricular volume overload, left ventricular diastolic dysfunction, left ventricle outflow obstruction, cardiomyopathies, myocardial infraction or dysrhythmias (Sureka et al 2015). Patients undergoing dialysis due to chronic renal failure is also associated with cardiac risk factors and makes the patient vulnerable to acute pulmonary edema. The progression of pulmonary edema consists of two stages. The first stage is characterised by interstitial edema, increased lymphatic flow and inflammation of the peribronchial and perivascular spaces. The later stage involves alveolar edema which results in movement of fluid into the alveoli form the interstitial spaces (Urden, Stacy, & Lough 2017). Patients with cardiogenic acute pulmonary edema experience extreme breathlessness and have a feeling of suffocation as observed in this case scenario. The primary diagnostic workup and management for acute pulmonary edema involves physical examination, review of past medical history, laboratory tests like blood counts, creatinine measures, troponin measurements, imaging, ECG, and pulse oximetry.

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