Original Article

Analysis of Systematic Nursing Intervention on

High-altitude Pulmonary Edema
Xiaofeng Wang*
Litang County Peoples Hospital, Ganzi, Sichuan 627550, China
ABSTRACT Objective: To analyze the effect of a nursing intervention program in patients with high altitude pulmonary edema, and to provide a guideline for clinical nursing work. Methods: A total of 52 cases of patients suffering from high-altitude pulmonary edema were divided into two groups. The control group was given routine nursing
intervention, while the experimental group was given a systematic nursing intervention.
The disappearance of cyanosis and pulmonary rales in both groups of patients over time
were compared and the Results were statistically analyzed. Results: In the experimental group, both cyanosis and pulmonary rales disappeared faster compared the routine
group. The comparison between patients in both groups was significantly different (p <
0.05). The level of anxiety among patients of the experimental group is also significantly
lower than the patients in the control group (p < 0.05). In both groups, the difference
was not significant (p > 0.05) before treatment and the clinical symptom score of the
experimental group was significantly lower than that in the control group (p < 0.05).
Conclusion: It is effective to implement a systematic nursing intervention program in
caring for patients with high-altitude pulmonary edema and it is suitable for clinical application.
1. Introduction1
High altitude pulmonary edema is a condition that affects
people who rapidly climb to an altitude of 3000 m above
the sea level. It is a common cause of fatality in highaltitude region owing to hypoxia and other closely related
conditions. An effective early response is the key to treat
patients with high-altitude pulmonary edema, and nursing
intervention is an indispensable part of the early rehabilitation of patients. Although conventional nursing methods
can improve the symptoms of patients, the long-term effect
can be severe and patient prognosis is poor [1]. Therefore,
it is important to study the proactive and effective nursing
methods in patients with high altitude pulmonary edema.
In order to analyze the effect of nursing intervention in
patients with high altitude pulmonary edema, the effect
Copyright 2015 Xiaofeng Wang
doi: 10.18686/jn.v4i3.3
Received: July 2, 2015; Accepted: August 3, 2015; Published online: August 14, 2015
This is an open-access article distributed under the terms of the Creative
Commons Attribution Unported License (http://creativecommons.org/
licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
*Corresponding author: Litang Litang County Peoples Hospital, Ganzi,
Sichuan 627550, China. E-mail: 001wangxiaofeng@sina.com

Journal of Nursing

KEYWORDS
High altitude
Pulmonary edema
Systematic nursing

of nursing intervention is presented and discussed. In our

hospital, the implementation of nursing intervention system in patients with high altitude pulmonary edema had
achieved good results.
2. Materials and methods
2.1. General information
A total of 52 cases of patients with high altitude pulmonary edema (admitted to our hospital from August 2013
to November 2014) form the basis of this study. The patients were randomly divided into two groups. In the control group, there were 26 patients including 19 males and
7 females (aged between 1155 years), with the average age
being 37.95 6.85 years old. The duration between the
manifestation of symptoms to hospitalization was between
8h and 7 days, averaging at 3.62 1.02 days. Meanwhile,
in the experimental group, there were 26 patients including 20 males and 6 females (aged between 1156 years),
with the average age being 37.24 6.97 years. The duration
between the manifestation of symptoms to hospitalization
was between 6h and 7 days, averaging at 3.71 1.26 days.
Patients and their families are fully aware of the treatment
methods and nursing measures taken, and voluntarily
signed the consent form. The differences in age and gender
Volume 4 Issue 3 | September 2015 | 7

of the patients were not significant (p > 0.05) and the data
are thus comparable.
2.2. Method
The control group received routine nursing intervention
from the point of admission. Nurses regularly checked the
oxygen level of patients, followed doctors advice on drug
prescription and dosage, observed patients vital signs and
implemented psychological care. According to the needs of
patients, they were informed of the planned treatment process and given appropriate attention to improve the treatment compliance of patients [2].
In the experimental group, the patients were treated
with systematic nursing intervention. According to our
clinical experience, the quality of nursing service was improved with the implementation of a systematic nursing
intervention program. Patient monitoring: The vital signs
of the patients were closely monitored, paying attention to
whether the hypoxia affects the central nervous system of
the patients, such as coma, pupil dilation, etc. Oxygen: Patients used a closed-mask oxygen inhalation system (with
the humidification bottle containing 20% alcohol); inhaling a large quantity of oxygen while the changes in their
SPO2 level were observed [3]. Medication: Patients were
given their prescription drugs according to their doctors
advice. The infusion speed was carefully controlled (i.e.,
it should neither be too fast nor contain too much liquid)
to avoid cardiac load. Obtaining patients statistics within
24 hours post-treatment will help doctor to better evaluate
the correct drug dosage. Psychology: Psychological care
intervention was provided according to the requirement
of each patient to hasten the process of recovery. Physical
care: Patients were provided with a warm and comfortable ward. In addition, they were kept warm and patients
with impaired mobility were given extra support such as
meal-feeding and cleaning. Guidance: Patients were advised to rest, gradually increase the amount of physical
activity, avoid strenuous exercise, consume low salt and
high protein food, and choose food that is easy to digest.
They were also informed of the potential reasons for the
manifestation of their illness [4]. Other factors: While
in recovery, patients were given guidance on appropriate
physical exercise to improve the patient's lung function in
order to stimulate a faster recovery. In addition, patients
were given post-hospitalization guidance on important
matters to ensure they receive the same quality of care after discharge [5].
2.3. Observation index
Both groups of patients (i.e., with nursing intervention vs.
control) were observed and their recovery progress compared (based on the disappearance of symptoms such as
cyanosis and pulmonary rales). Using a scoring method
(taken 3 days after admission), patients with anxiety was
evaluated using 0-10 scale to indicate their state of anxiety.
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2.4. Data processing

The experimental data of our hospital were analyzed using
the SPSS 18.0 software package for statistical analysis. The
test value was set at 0.05. When p < 0.05, the difference was
statistically significant.
The disappearance of symptoms of the two groups of
patients over time and their state of anxiety were used to
compare the mean standard difference using t-test for
between groups comparison.
3. Results
Patients in the experimental group showed a faster disappearance of cyanosis along with an improvement in pulmonary rales compared with patients in the control group,
and these results are significantly different with p < 0.05.
Patients in the experimental group were also less anxious
than patients in the control group (p < 0.05) and the difference was statistically significant. The detailed results are
shown in Table 1.
Table 1. Comparison of symptoms and anxiety level in the two
patient groups.
Cyanosis disap- Pulmonary
Anxiety state
pearance
rales disap(minute)
time (h)
pearance (h)

Group

Case
number

Experimental group

26

6.88 1.24

8.51 1.01

3.02 1.55

Control
group

26

12.85 2.01

13.24 2.54

5.11 0.84

In this study, the results were not significantly different (p

> 0.05) before the treatment of both patient groups. However, the clinical symptoms of the experimental group were
significantly less severe than the control group (p < 0.05)
post treatment (see Table 2).
Table 2. Comparison between the two patient groups before
and after treatment.
Group

Case
number

Before
treatment

After treatment

Difference
value

Experimental
group

26

5.14 1.40

1.74 1.12

2.80 0.22

Control group

26

5.40 1.22

3.53 1.38

1.49 0.15

1.02

23.53

35.99

p value

>0.05

<0.05

<0.05

4. Discussion
Patients experiencing pulmonary edema have physical symptoms such as headache, chest pain, cough and
cyanosis, accompanied by a difficulty in breathing and
other conditions. The cause of the illness is not clear and
may be associated with pulmonary hypertension. When
combined with hypoxia induced pulmonary artery contraction, this results in reduced blood flow and increased
pulmonary blood flow, hence causing pulmonary edema
Xiaofeng Wang

[6]. At present, there is a lack of ideal clinical treatment

for high-altitude pulmonary edema but conventional
methods can improve the symptoms. However, the longterm efficacy of existing treatment is poor. Additionally,
the prognosis is poor among patients who do not receive
adequate nursing care. In our hospital, the implementation of a systematic nursing intervention program involves the centralization of resources and integrating all
effective nursing measures. By using a properly defined
system, nurses have a better understanding of the clinical
work flow and could avoid erroneous practices (e.g., delayed response or omission of procedures). This is especially true for young nurses owing to the lack of nursing
experience. Patients who received nursing intervention
showed a rapid disappearance of symptoms. In the experimental group, the disappearance times for cyanosis and
pulmonary rales are 6.88 + 1.24 h and 8.51 + 1.01 h, respectively. They are both lower than those of the control
group and the group comparison also has a significant
difference (p < 0.05) [7].
In addition, the nursing intervention system is in line
with the needs of the whole nursing program, taking into
consideration psychological nursing, overall care quality
and physical health guidance. It is important for nurses to
realize that nursing work is not only to follow the doctors
advice, but also includes making the patients feel comfortable and meeting their healthcare expectations. Using this method, patients received a more comprehensive
care and their level of anxiety is significantly lower (3.02
1.55 points lower than the control group, p < 0.05). In
conclusion, this study showed that the conditions of two
groups of pulmonary edema patients were comparable
before treatment (p > 0.05). Nonetheless, after the introduction of a nursing intervention program, the clinical
symptoms of the experimental group were significantly
lower than the control group (p < 0.05). The implementation of an effective nursing practice model is relatively

Journal of Nursing

important in developing the professional skills of nurses.

Therefore, nurses should continuously learn and master
more skills, implement targeted care for each patient, improve clinical treatment work flow and the overall quality
of service [8].
In short, the implementation of a systematic nursing intervention program in dealing with patients suffering from
high-altitude pulmonary edema is effective and should be
promoted as a clinical strategy.
Reference
111 Zheng F, Yuan H. Nifedipine in the treatment of high-altitude pulmonary edema: clinical observation of 63 cases.
West Med. 2010;22(2):272273.
222 Gao H, Wang Y, Liu W, et al. Nursing experience of 12 patients with high-altitude pulmonary edema. J Clin Med.
2009;2(1):77.
333 Fang Y, Li J, Deng X, et al. Characteristics and nursing
measures of high-altitude Yushu earthquake relief workers. Nurs Res. 2011;25(11):10081009.
444 Lian J, He X. Emergency treatment and nursing of
acute pulmonary edema in the plateau. Chin Med Innov.
2010;7(13):155156.
555 Lu L, Zhang M, Zhang X. Analysis of maternal and infant
outcomes in 264 cases of hypertensive disease in pregnancy. Zhejiang Clin Med. 2010;12(6):583.
666 Wang L, Song W, An J. Effect of noninvasive positive
pressure ventilation in the treatment of severe community acquired pneumonia and respiratory failure. Clin
Misdiagnosis Error Treat. 2012;25(9):6667.
777 Imran K, Ismail A, Naing L, et al. Type 2 diabetes mellitus
patients with poor glycaemic control have lower quality
of life scores as measured by the short form-36. Singap
Med J. 2010;51(2):157162.
888 The Third National Symposium on High-Altitude Medicine.
The standard of nomenclature, classification and diagnostic criteria of plateau disease in China. Plateau Med J.
2010;20(1):911.

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