PLEURAL EFFUSION

PLEURAL EFFUSION – Etiology, Signs and Symptoms, Diagnostic Evaluation and Management

  • Pleural effusion is a collection of fluid in the pleural space, is rarely a primary disease process but is usually occur secondary to other disease
  • Normally small amount of fluid is present in the pleural space (5-15 ml) which acts as lubricant that allows the pleural surfaces to move without friction
  • Pleural effusion may be a complication of heart failure, TB, pneumonia, pulmonary infection, connective tissue disease, pulmonary embolus, neoplastic tumors
  • A pleural effusion is an abnormal amount of fluid around the lungs. A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity

ETIOLOGY

  • Some of the more common causes are:

Congestive heart failure

Pneumonia

Liver disease (cirrhosis)

End-stage renal disease

SIGNS AND SYMPTOMS

  • Shortness of breath
  • Chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain)
  • Fever
  • Cough

DIAGNOSTIC EVALUATION

  • Physical examination
  • Chest X-ray film
  • CT scan
  • Kidney and liver function blood tests
  • Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancer cells)
  • Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs)
  • Ultrasound of the chest and heart

MANAGEMENT

Assessment

  • Obtain history of previous pulmonary conditions
  • Assess patient for dyspnea and tachypnea
  • Auscultation and percussion for lung abnormalities

Medical and Surgical Management

  • Thoracocentesis is done to remove the fluid, collect a specimen, relieve dyspnea
  • Drug therapy: analgesics, antibiotic, corticosteroid therapy

For malignant effusion

  • Chest tube drainage, radiation and chemotherapy, surgical pleuralectomy, pleuroperitoneal shunt
  • Pleurodesis: production of adhesions between the parietal and visceral pleura accomplished by tube thoracostomy

NURSING MANAGEMENT

Nursing Diagnosis

  • Ineffective airway breathing pattern related to collection of fluid after space
  • Pain related to pleuritic fluid in lungs
  • Disturbed sleep pattern related to the pain and dyspnea
  • Anxiety related to the disease process

Nursing Interventions

  1. Ineffective airway breathing pattern related to collection of fluid after space

Interventions

  • Institute treatment to solve the underlying cause ordered
  • Assist with thoracocentesis if indicated
  • Maintain chest diseases
  • Provide care after pleurodesis:

Monitor for excessive pain from the sclerosing agent, which may cause hypoventilation

Administer prescribed analgesic

Administer oxygen to prevent hypoxemia and dyspnea

Observe patient’s breathing pattern

  • Pain related to pleuritic fluid in lungs

Interventions

  • Assess the pain intensity
  • Provide breathing exercises
  • Provide analgesics to relieve the pain
  • Disturbed sleep pattern related to the pain and dyspnea

Interventions

  • Asses the sleeping hours of the patient
  • Provide oxygen administration
  • Provide analgesics to patient
  • Provide cool and calm environment
  • Provide sideline position to the patient to increase the lung capacity

COMPLICATIONS

  • Infection that turns into an abscess, called an empyema, which will need to be drained with a chest tube
  • Pneumothorax (air in the chest cavity) after thoracentesis
  • Cancer
  • Pulmonary embolism
  • Lung damage
PLEURAL EFFUSION – Etiology, Signs and Symptoms, Diagnostic Evaluation and Management
PLEURAL EFFUSION – Etiology, Signs and Symptoms, Diagnostic Evaluation and Management

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