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
- 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
