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Pleural effusion

ANILKUMAR  BR
ANILKUMAR  BR
ANILKUMAR BRAssitant Professor at RGUHS

Normally, the pleural space contains a small amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction. But if fluid builds up from either increased production or inadequate removal pleural effusion results. Pleural effusion B/L or unilateral (parapneumonic process) Refers to any significant collection of fluid within pleural space. Any imbalance in formation, absorption lead accumulation of pleural fluid. Common condition: CHF Bacterial pneumonia Malignancy(chest tumor) Pulmonary embolism Pleura effusion is a condition refers to a collection of fluid in the pleural space. It is almost secondary to other conditions.

Pleural effusion

1 of 31
PLEURAL EFFUSION
BY
Mr. ANILKUMAR B R
Assit Professor
Medical-surgical Nursing
PLEURAL EFFUSION
PLEURAL EFFUSION
• Normally, the pleural space contains a small
amount of fluid (5 to 15 mL), which acts as a
lubricant that allows the pleural surfaces to
move without friction.
• But if fluid builds up from either increased
production or inadequate removal pleural
effusion results.
• Pleural effusion B/L or unilateral
(parapneumonic process)
PLEURAL EFFUSION
• Refers to any significant collection of
fluid within pleural space.
• Any imbalance in formation, absorption
lead accumulation of pleural fluid.
Common condition:
1.CHF
2.Bacterial pneumonia
3.Malignancy(chest tumor)
4.Pulmonary embolism
Definition
• A pleural effusion describes an
excess of fluid in the pleural cavity,
usually resulting from an imbalance
in the normal rate of pleural fluid
production or absorption, or both.
What is Pleural effusion?
• Pleura effusion is
a condition refers
to a collection of
fluid in the pleural
space. It is almost
secondary to other
conditions.

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Pleural effusion

  • 1. PLEURAL EFFUSION BY Mr. ANILKUMAR B R Assit Professor Medical-surgical Nursing
  • 3. PLEURAL EFFUSION • Normally, the pleural space contains a small amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction. • But if fluid builds up from either increased production or inadequate removal pleural effusion results. • Pleural effusion B/L or unilateral (parapneumonic process)
  • 4. PLEURAL EFFUSION • Refers to any significant collection of fluid within pleural space. • Any imbalance in formation, absorption lead accumulation of pleural fluid. Common condition: 1.CHF 2.Bacterial pneumonia 3.Malignancy(chest tumor) 4.Pulmonary embolism
  • 5. Definition • A pleural effusion describes an excess of fluid in the pleural cavity, usually resulting from an imbalance in the normal rate of pleural fluid production or absorption, or both.
  • 6. What is Pleural effusion? • Pleura effusion is a condition refers to a collection of fluid in the pleural space. It is almost secondary to other conditions.
  • 7. Pleural effusion • This fluid excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during respiration.
  • 8. TYPES OF PLEURAL EFFUSION • TRANSUDATIVE EFFUSIONS • EXUDATIVE EFFUSIONS
  • 9. TRANSUDATIVE EFFUSIONS • Transudative effusions arise from more commonly: Congestive heart failure  Hepatic disease with ascites  Nephrotic syndrome  Peritoneal dialysis  Hypoalbuminemia and disorders of increase extra cellular volume.
  • 10. Characteristics of Tranudative effusion • Occurs primarily in non-inflammatory conditions. • low protein, low-cell-count fluid. • Clear to faint yellow tinge, no odor • pH 7.40 7.55‐ • Specific gravity < 1.015 • Protein content < 3g/100ml • Glucose level equal serum plasma
  • 11. EXUDATIVE EFFUSIONS • Exudative effusion result from several conditions such as: 1.Tuberculosis 2.Subphrenic abscess 3.Pancreatitis 4.Bacterial or fungal pneuomonia 5.Empyema
  • 12. 1. Cancer 2. Pulmonary embolism 3. SLE & rheumatoid arthritis 4. Intra abdominal abscess 5. Esophageal perforation and chest injuries
  • 13. Characteristics of Exudative effusion • Often turbid, bloody or purulent • pH < 7.30 • Specific gravity > 1.016 • Protein content > 3g/100ml • Glucose level < 60mg/dl. • High-protein fluid
  • 14. Types of fluids THERE ARE MAINLY Four types of fluids can accumulate in the pleural space: 1. Serous fluid (hydrothorax) : A hydrothorax is a condition that results from serous fluid accumulating in the pleural cavity. 2.Blood (haemothorax): is a condition that results from blood accumulating in the pleural cavity.
  • 15. Types of fluids 3. Pus (pyothorax or empyema) : is an accumulation of pus in the pleural cavity.
  • 16. 2. Chyle (chylothorax): chyle is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs) and it is formed in the small intestine during digestion of fatty foods .It is a type of pleural effusion . it results from lymphatic fluid (chyle) accumulating in the pleural cavity.
  • 17. Complications • Large effusions could lead to reparatory failure.
  • 18. Clinical Manifestations The clinical presentation of pleural effusion depends on the amount of fluid present and the underlying cause. Many patients have no symptoms at the time a pleural effusion is discovered.
  • 19. Clinical Manifestations 1. Pleuritic chest pain 2. Dyspnea 3. Nonproductive cough. • The chest pain is usually sharp and is exacerbated by movement of the pleural surfaces, as with deep inspiration, coughing, and sneezing.
  • 20. Assessment & Diagnosis • History collection (A history of pneumonia, chest tumor cardiac, renal, or liver impairment and cancer related treatment) • Physical examination (decreased or absent breath sounds, decreased fremitus, and a dull, flat sound when percussed)
  • 22. Ultrasonography thorax • Even small amounts of pleural effusion can be detected accurately by ultrasonography. • CT-Scan thorax
  • 24. Medical Management • The objectives of treatment are to discover the underlying cause, to prevent reaccumulation of fluid, and to relieve discomfort, dyspnea, and respiratory compromise mainating oxygenation & facilating drainage)
  • 25. Medical Management • Thoracentesis is performed to remove fluid, to obtain a specimen for analysis, and to relieve dyspnea and respiratory compromise. • Thoracentesis may be performed under ultrasound guidance.
  • 26. Nursing Management • The nurse’s role in the care of the patient with a pleural effusion includes implementing the medical regimen.
  • 27. • The nurse prepares and positions the patient for thoracentesis and offers support throughout the procedure. • Pain management is a priority, and the nurse assists the patient to assume positions that are the least painful.
  • 28. Nursing diagnosis • Risk for infection related to introduction of foreign object ( thoracentesis needle, chest tube) in to chest cavity. • Impaired gas exchange related to ineffective breathing pattern. • Anxiety related to diagnosis and therapeutic procedure ( thoracentesis, chest drainage).
  • 29. Nursing Interventions • Administer oxygen and in empyema antibiotics, as ordered. Record the client response to these treatments. • Encourage to perform to perform pulmonary exercise such as deep breathing, effective coughing and use of spirometry etc.
  • 30. Nursing Interventions • Prepare the client for thoracentesis procedure and assist to physician during procedure and monitor complications associated with thoracentesis ( bleeding, pain, dyspena and cyanosis). • Monitor client respiratory status frequently. Obtain ABGs if necessary.
  • 31. Nursing Interventions • Ensure chest tube patency by observing for fluctuations in the tubing. Record the amount, color, and consistency of any tube drainage.