pleural effusion.

1. PLEURAL EFFUSION
CYSTS AND TUMOURS,CHEST
INJURIES
PRESENTED BY
DEEPIKA.R
M.SC(N) IYEAR
COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE

2. PLEURAL EFFUSION

3. REVIEW OF ANATOMY AND PHYSIOLOGY

4. DEFINITION:
A collection of fluid in the pleural space, is
Rarely a primary disease process; it is usually
secondary to other Diseases.
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

7.  ETIOLOGY
 Complication of heart failure, TB,
 Pneumonia, pulmonary infections (particularly viral
infections),
 Nephrotic syndrome, connective tissue disease,
pulmonary
 Embolus, and neoplastic tumors. The most common
 Malignancy associated with a pleural effusion is
bronchogenic
 Carcinoma.

9.  Due to causes
 Accumulation of fluid in the pleural space
 It can be bloody or purulent
 It may be transudate or an exudate
 A transudate (filtration of plasma that moves across
intact capillary walls)

10.  Formation and reabsorption of fluid are altered
 Due to imbalance in hydrostatic or oncotic pressure
 Transudate results from heart failure
 An exudate-due to inflammatory process (bacterial
products)or tumors involved pleural spaces
 Results in pleural effusion

12.  Clinical manifestation
 Pneumonia causes fever,
 chills, and pleuritic
 chest pain,
 whereas a malignant effusion may result in dyspnea,
 difficulty lying flat, and coughing

13.  DIAGNOSTIC EVALUATION
 Decreased or absent breath sounds with an
intermittent
 Pleural friction rub (grating or rubbing
sound)
 On auscultation. Crackles may be present.
 Confirmation of The diagnosis is made by
chest x-ray,
 sputum culture, and, in
 fiberoptic bronchoscopy.

14.  CONT…..
 The chest x-ray reveals
 An infiltrate with an air–fluid level. A
computed tomography
 (CT) scan of the chest may be required
to provide more detailed
 Images of different cross-sectional areas
of the lung.

15.  CONT…..
 chest x-ray, chest CT, and
 Thoracentesis confirm the presence of fluid.
 In some instances, a lateral decubitus x-ray is
obtained. For this x-ray
 lies on the affected side in a side-lying position.
 A pleural effusion can be diagnosed because this
position allows for the
 “layering out” of the fluid, and an air–fluid line is
visible.

16. Medical Management
 Objectives of treatment are to discover the
underlying
 Cause of the pleural effusion; to prevent re
accumulation of Fluid; and
 to relieve discomfort, dyspnea, and respiratory
 Compromise. Specific treatment is directed at the
underlying
 Cause (eg, heart failure, pneumonia, cirrhosis).

17. CONT……
1. Thoracentesis
1. Pleurodesis
2. Implantation of a pleuroperitoneal shunt.
3. Surgical pleurectomy
• Nursing management
 The nurse is responsible for making sure the
thoracentesis fluid amount
 Is recorded and sent for appropriate laboratory
testing. If a chest tube drainage and water-seal
system is used,

18. CONT…
 The nurse is responsible for monitoring the
system’s function and
 Recording the amount of drainage at prescribed
intervals.
 Nursing care related to the underlying cause of
the pleural
 Effusion is specific to the underlying condition

19. PLEUREDESIS

22. CHEST TRAUMA
 Chest trauma may occur alone or in
combination
 With multiple other injuries.
 Chest trauma is classified as either
 Blunt or penetrating.

23. Blunt chest
 Blunt chest trauma results from
 sudden compression or positive
pressure inflicted to the
 chest wall.
 Penetrating trauma
 Penetrating trauma occurs when a
foreign object
 penetrates the chest wall.

24. BLUNT TRAUMA
 Common penetrating trauma
 It is often difficult to identify the extent of the
damage
 Because symptoms may be generalized and vaque

25. PATHOPHYSIOLOGY
 Due to causes
 Injury to lung parenchyma
 , rib cage and respiratory musculature
 Massive heamorrhage

26.  Collapsed lungs
 Pneumothorax/hypoxemia
 Hypovolemia
 Cardiac failure from cardiac tamponade
 Cardiac contusion
 Increased intrathoracic pressure

27.  ETIOLOGY
 Motor vehicles accident
 Acceleration
 Deceleration
 Shearing forces
 compression

28. STERNAL AND RIBS FRACTURES
 Common in motor
vehicles accident
direct blow to
sternum via the
shearing wheel.
 Clinical
manifestation
 Sternal fractures
 Ribs fractures

29. Diagnostic evaluation
 X –rays
 Ecg
 Continuous
monitoring
 ABG

30. Flail chest
 Two or more ribs
affected Are
fractured .

This Photo by Unknown Author is licensed under CC BY

31. pneumothorax

32. Tension pneumothorax

33. PNEUMOTHORAX

36. Cardiac tamponade

37. Tumors of lungs

41. lobectomy

44. Cystic lung disease
 Cysts that occur in the lungs are
called pulmonary cysts. Instead
of containing fluid, they usually
contain gas. They can develop as
a person ages. However, they
may also indicate an underlying
medical condition.

45. Types of cysts
 Blebs and bullae:
 These are small collections of gas
that usually occur between the
lung and the outer surface of the
lung
 Blebs are under 1 centimeter (cm)
in diameter, and bullae are over 1
cm in diameter. Bullae can
become substantial in size and can
sometimes take up an entire lobe
of the lung.

47.  Cont
 Honeycombing:
 This occurs when there are multiple cysts of
different sizes and thicknesses in multiple
layers. It results in a pattern resembling a
honeycomb.
 Pneumatocele: this term refers to bullae that
form after trauma to the lung due to conditions
such as pneumonia or inhaling certain gases.
 Symptoms
 Difficulty breathing

48.  Cont,….
 Pain while breathing
 Wheezing
 Shortness of breath
 Frequently developing pneumonia
 Causes
 ey may also occur due to cystic lung disease. Cystic lung disease includes a group
of conditions wherein multiple cysts have developed.

49.  C

50.  Birt-Hogg-Dubé syndrome
 Birt-Hogg-Dubé (BHD) syndrome is a rare
hereditary condition that develops due to
mutations of certain genes.
 Treatment
 To treat the cysts, a healthcare professional may
recommend a blebectomy or a bullectomy. These
are surgical procedures to remove the cysts.
 Lymphangioleiomyomatosis

51.  Lymphangioleiomyomatosis (LAM) is a rare
condition that occurs almost only in females. It
mostly affects the lungs, but it can also affect
the kidneys and lymphatic system.
 symptoms
 chest pain when inhaling
 fatigue
 collapsed lung, or pneumothorax
 swollen lymph nodes
 shortness of breath
 wheezing
 frequent cough

52. Treatment
 Mtor inhibitors, to regulate the growth of LAM
cells
 Bronchodilators, to help improve breathing
 Oxygen therapy

53.  Pulmonary Langerhans cell histiocytosis
 Pulmonary Langerhans cell histiocytosis (PLCH) causes cysts to
appear in the lungs. The cysts typically measure up to 10 mm in
diameter. However, they can become as large as 20 mm.
 Symptoms may include:
 breathlessness
 fever
 night sweats
 weight loss
 dry coughing

54.  Treatment
 A person with PLCH should try to quit smoking.
This can result in complete remission.
 Other than quitting smoking, research suggests
that there is no effective treatment.

55.  Lymphocytic interstitial pneumonia
 Lymphocytic interstitial pneumonia (LIP) is a group of
symptoms that includes the development of lung cysts and:
 shortness of breath
 weight loss
 fever
 cough
 Some research suggests that the cysts appear
in approximately 80% of cases. Typically, only a few cysts
appear, and they develop in both lungs.
 They tend to measure up to 3 cm in diameter and vary in
shape.

56.  Other causes
 Other conditions that may cause lung cysts include:
 centrilobular and para septal emphysema, which are forms of
chronic obstructive pulmonary disease
 amyloidosis, which is a group of conditions that occur when a
protein called amyloid builds up in the organs
 pneumonia
 some types of cancer, including
metastatic cancer
squamous carcinoma
adenocarcinoma

57.  Diagnosis
 A healthcare professional may ask about a person’s medical
history and perform the following tests to diagnose the
underlying condition causing lung cysts:
 physical examinations
 blood tests
 imaging tests, such as CT scans
 Complications
 Lung cysts can cause pneumothorax, or collapsed lung.

58.  Prevention
 Smoking has associations with a variety of lung
conditions, including lung cysts.
 As a result, those who smoke may have a higher
chance of developing cysts in their lungs.
 Summary
 Lung cysts may be a part of aging. However, they
may indicate some serious underlying conditions.

59.  Cont…
 Detection usually only occurs when a person is
having a scan for other reasons. However, if a
person is experiencing breathlessness or other
symptoms that may be cause for concern, they
should seek medical advice.