1. Running Head: ACUTE PLEURAL EFFUSIONS Lofgran 1
Acute Pleural Effusions Secondary to Pneumonia
Mariah Anne Lofgran
California Baptist University

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Acute Pleural Effusions Secondary to Pneumonia
Breathing is an act necessary to sustain life for many creatures, from humans to pets,
such as dogs and cats. In order for breathing to occur, it requires the use of the whole respiratory
system, especially the lungs. Inside the lungs, there is space known as pleural space in which
small amounts of fluid help to reduce friction during breathing. Pleural effusion is “a collection
of fluid in the pleural space, which is rarely a primary disease process but one that is secondary
to another” (Smeltzer, Bare, Hinkle, & Cheever, 2010). “Pleural effusion, a complication of
community acquired pneumonia, is usually attributed to a bacterial infection” (Nascimento-
Carvalho, Oliveira, Cardoso, Araújo-Neto, Barral, Saukkoriipi, & Ruuskanen, 2013).
Pathophysiology
According to Morton and Fontaine, pleural effusions are caused by the buildup of pleural
fluid occurring because of increased production of fluid, a decrease in fluid removal, or
sometimes both (2012). There are a variety of mechanisms that cause pleural effusions, such as
“increased pressure in pulmonary capillaries including heart failure, increased capillary
permeability including pneumonia, decreased plasma osmotic pressure including cirrhosis,
increased intrapleural negative pressure including atelectasis, and impaired lymphatic drainage
of pleural space including pleural malignancy” (Morton & Fontaine, 2012). The primary
diagnosis that causes pleural effusions is pneumonia, which is an “inflammatory response to
inhaled or aspirated foreign material or uncontrolled multiplication of microorganisms invading
the lower respiratory tract” (Morton & Fontaine, 2012).
Diagnostic studies

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To diagnosis the underlying cause, pneumonia can be done using chest radiography
which also assesses pleural effusions. According to Morton and Fontaine, a lateral decubitus
radiograph gives the best image of the free pleural fluid with as little as 20mL of fluid being
visible in the image (2012). Along with the chest radiograph, “pleural fluid is analyzed by
bacterial culture, Gram stain, AFB stain, red and white blood cell counts, chemistry studies, and
pH” (Smeltzer, Bare, Hinkle, & Cheever, 2010). According to Morton and Fontaine, evaluation
of pleural fluid is needed in order to distinguish exudative from transudative pleural effusion, but
the risk of pneumothorax must be weighed against the benefit of the thoracentesis (2012).
Physical Assessment
Pleural effusion can be suspected with self-reported subjective symptoms include
shortness of breath and pleuritic chest pain along with objective symptoms like deceased breath
sounds, dullness upon percussion, tachypnea, and hypoxemia (Morton & Fontaine, 2012).
According to Morton and Fontaine, a complete respiratory and cardiovascular assessment must
be completed including monitoring for signs of hypoxemia, dyspnea, cough, sputum production,
fever, and chills which can help diagnosis the underlying cause of pneumonia (2012).
Treatment
According to Morton and Fontaine, the course of treatment is dependent upon the
underlying cause of the effusions. “Removal of the pleural effusions by thoracentesis, chest tube
placement, or surgery may be indicated depending on etiology and size of effusion” (Morton &
Fontaine, 2012). Oxygen therapy is also vital in maintaining oxygen levels at an acceptable
value over 95% saturation in order to reduce the use of accessory muscles that can cause fatigue
over time (Porat, Bhatia, & Barnett, 2002).

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Medication
Antibiotic therapy is needed to treat pneumonia; the recommendation is for the patient to
receive antibiotic therapy within the first eight hours of arriving to the hospital to improve the
patient’s outcome (Morton & Fontaine, 2012). Usual medications for this patient include
ibuprofen 600mg every four hours as needed for pain and inflammation, azithromycin to treat the
bacterial pneumonia 500mg the first day and 250mg the following days, along with an influenza
vaccination and pneumococcal conjugate (Deglin, Vallerand, & Sanoski, 2011).
Nursing Diagnosis
Nursing diagnoses for a patient experiencing pleural effusion could include monitoring
for acute pain, monitoring for changes and signs of impaired gas exchange, and anxiety.
Interventions combatting the impaired gas exchange include performing bronchial hygiene
therapy through percussion, cough and deep breathing, postural drainage, and suctioning. Also, it
is important for the patient to have the head of the bed elevated 30 to 45 degrees and have
frequent position changes at least every two hours. To intervene with the pain that the patient is
feeling, it is important to assess the pain level of the patient and administer analgesics
appropriately along with teaching and promoting relaxation and deep breathing. Lastly it is very
important to reduce the anxiety that the patient is feeling due to the hospitalization along with
having trouble breathing. It is important to listen closely to what the patient has to say and is
feeling to create a good rapport which can help to reduce some anxiety as well as taking the time
to fully explain to the patient what is happening, all procedures, and medications in order to
reduce fear and anxiety that can come from the unknown in the hospital (Ralph & Taylor, 2011).

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Pleural effusions caused by pneumonia can be diagnosed and treated with a strong focus
on the pneumonia disease process. This disease can be diagnosed using a chest radiograph and
treated using antibiotics and reducing the accumulation of fluid using thoracentesis or a chest
tube if indicated. These patients should be monitored closely for breathing changes and anxiety
from changes in life and hospitalization.
Personal Reflection
At this point in my life as a 21-year-old nursing student, to be diagnosed with pleural
effusions due to pneumonia would be painful and difficult, forcing me to rethink not only how
well I am taking care of myself, but also if I will be able to continue with nursing school.
As a full-time student, to get sick is already very difficult, but to get so sick that I must be
hospitalized and treated is even worse. Since I am so busy with school, I unfortunately waited a
long time to get seen by my doctor and get diagnosed. By that point, the pleural effusions were
very large in my lungs, and I was told I will be needing a chest tube to drain the fluid along with
extensive antibiotic treatment to combat the pneumonia that was the cause of my pleural
effusions. This is really scary, because even though I have had many patients with chest tubes
and invasive lines, getting one myself is very frightening and very painful. This is very
frustrating because not only will I get behind in school work due to the pain and fatigue from
being hospitalized along with the recovery following my chest tube, but I will also miss more
than an allotted amount of clinical and I will have to consider taking the semester off and going
back the following semester. This is very unfortunate because it will set back my graduation
another semester, which is very strenuous for me due to the fact that I pay to put myself through

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college. I will also have to rely heavily on the help of family and friends since I will have
hospital bills to pay and will be unable to work for at least a few weeks if not more.
This diagnosis is going to make me have to rely heavily on not only my family, but also
on my relationship with God. It is very hard to be accepting when such a big change comes into
your life that causes a lot of fear and anxiety. However, I know I will have to rely on God and
know that he can and will get me through this diagnosis, as well as having to leave this semester
and getting set back in school. A verse that I can look to and rely on to remind me that even in
such a dark time that God will be there for me is “I can do all things through him who gives me
strength” (Philippians 4: 13, New International Version). Through this diagnosis I will have to
overcome many obstacles and accept the ever-changing momentum of life, and as Parse states,
“Cotranscending with possibles is the powering and originating of transforming” (2014).
I will need to cotranscend through this difficult time relying heavily on my faith in Christ
and know that I can transcend from where God has me now to where he has planned for me,
doing as he says in his Word to “Trust in the Lord with all your heart and lean not on your own
understanding; in all your ways submit to him, and he will make your paths straight” (Proverbs
3: 5-6 New International Version).

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References
Deglin, J. H., Vallerand, A. H., & Sanoski, C. A. (2011). Davis's drug guide for nurses.
Philadelphia: F.A. Davis.
Morton, P. G. & Fontaine, D. K., (2012) Critical Care Nursing: A Holistic Approach (10th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Nascimento-Carvalho, C. M., Oliveira, J. R., Cardoso, M. A., Araújo-Neto, C., Barral, A.,
Saukkoriipi, A., & ... Ruuskanen, O. (2013). Respiratory viral infections among children
with community-acquired pneumonia and pleural effusion. Scandinavian Journal Of
Infectious Diseases, 45(6), 478-483. doi:10.3109/00365548.2012.754106
Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview.
Porat, S., Bhatia, N., & Barnett, D. W. (2002). A child with severe pneumonia, pleural effusion
and acute hypoalbuminemia. Clinical Pediatrics, 41(3), 199-200.
Ralph, S. S., & Taylor, C. M. (2011). Sparks & Taylor's nursing diagnosis reference manual.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Brunner and Suddarth’s textbook of
medical-surgical nursing (13th ed.). New York, NY: Lippincott.