7. Introduction
Pleural effusion a collection of fluid in the pleural space ,
is rarely a primary disease process but is usually
secondary to other disease.
Normally, the pleural space contains a small amount of
fluid (5 to 15ml), which acts as a lubricant that allows the
pleural surface to move without friction.
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8. Cont….
Pleural fluid normally seeps continually into the pleural
space from the capillaries lining the parietal pleura and is
reabsorbed by the visceral pleural capillaries and
lymphatic system.
Any condition that interferes with either secretion or
drainage of this fluid leads to pleural effusion.
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9. Definition
Pleural effusion is an abnormal, excessive collection of
fluid in the pleural spaces.
Too much fluid impairs the ability of the lung to expand and
move.
It may be a complication of heart failure, TB, pneumonia,
pulmonary infection, nephrotic syndrome
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12. Epidemiology
The incidence in U.S is estimated to be atleast 1.5 million
cases annually. Most cases are caused by CHF, bacterial
pneumonia.
In industralized countries the prevalence rate is 320 cases
per 1lakh people.
The incidence is equal between the sexes.Nearly two
thirds of malignant pleural effusion occur in women
associated with breast malignancies.
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14. Transudative Effusion
Transudative effusion is also known as hydrothorax, occur
primarily in non inflammatory conditions; is an
accumulation of low protein , low cell count fluid.It is
caused by fluid leaking into the pleural space.
It has a clear fluid similar to blood serum.
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15. Causes of transudative effusion
Increase hydrostatic pressure in heart failure (most
common cause of pleural effusion )
Decrease oncotic pressure (from hypoalbuminemia )
found in cirrhosis of liver and renal disease
Atelectasis
Nephrotic syndrome
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16. 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<3g100ml.
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17. Exudative effusion
Exudative effusion contain a fluid rich in protein and
cellular elements that oozes out of blood vessels due to
inflammation.
An exudates effusion result from increased capillary
permeability characteristic of inflammatory reaction.
A fluid is cloudy containing cells and much protein.
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18. Cont…
This types of effusion occurs secondary to condition such
as:
Tuberculosis
malignancies , pulmonary infection
pulmonary embolism
Empyema
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19. Characteristics of Exudate effusion
Often turbid, bloody or purulrnt.
pH<7.30
Specific gravity <1.016.
Protein content<3g100ml
High protein fluid
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22. Etiology contd..
Viral infection : Other condition sarcoidosis , systemic
lupus erythematosus (SLE)
Peritoneal dialysis
(Excessive fluid may accumulate because the body does not
handle fluid properly (such as in congestive heart failure, or
kidney and liver disease). The fluid in pleural effusions also may
result from inflammation, such as in pneumonia, autoimmune
disease, and many other conditions).
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23. Pathophysiology
Transudative effusion
Due to different etiological factors.
Increase hydrostatic pressure ,decrease oncotic pressure
Unable to remain the fluid with in a intravascular space
Fluid shift interstitial space (effusion)
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24. exudative effusion
(pathophysiology)
Invasion of microbes
Initiation of inflammatory reaction
Vasodilation increase capillary permeability
Leak of plasma protein decrease oncotic pressure
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26. Mechanism
Altered permeability (e.g.inflammation.
Reduction in intravascular oncotic pressure
(e.g.hypoalbuminemia)
Increased capillary hydrostatic pressure
(e.g.congestive heart failure)
Decreased lymphatic drainage.
Increased fluid in peritoneal cavity, with migration
across the diaphragm via the lymphatics (e.g. hepatic
cirrhosis, peritoneal dialysis).
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27. Clinical Manifestation
The clinical presentation of pleural effusion depends on
the amount of fluid present and the underlying causes. If
the effusion is small (250ml) ,it’s presence may be
discovered only on chest x-ray
Many patient have no symptoms at the time a pleural
effusion is discovered .
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28. Clinical Manifestation contd..
Fever with chills
Cough
Dyspnea
Dullness and flatness on chest percussion
Decreased or absent breathe sound
Shortness of breathe.
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29. Cont …
Pleuritic chest pain
Dyspnea
- the chest pain is usually sharp and is exacerbated by
movement of the pleural surfaces ,as with deep inspiration ,
coughing and sneezing .
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37. Complication
Large effusion can lead to respiratory failure.
Disseminated cancer.
Pleuropulmonary infection.
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38. Management
General management:
Treatment is aim at underlying cause eg heart disease ,
tuberculosis infection ,cancer
Thoracocentesis is done to remove fluids. Collect a
specimen and relieve dyspnea.
Intrapleural instillation of medicine: tetrascycline,
doxycycline
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39. For malignant effusion
Chest tube drainage, radiation and chemotherapy ,surgical
pleumonectomy, pleuroperitoneal shunt or pleurodesis
thoracocentesis may be provided only transient benefits in
malignant because effusion may reaccumulate within few
days
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40. Surgical management
Surgical pleurectomy:
Pleurectomy is a type of surgery in which part of the
pleura is removed. This procedure helps to prevent
fluid from collecting in the affected area and is used
for the treatment of mesothelioma, a pleural
mesothelial cancer.
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41. Nursing Management
Assessment:
Obtain history of previous pulmonary condition
Assess patient for dyspnea and tachypnea
Auscultation and percussion of the lungs of abnormalities
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42. Nursing diagnosis
Impaired gas exchange related to decreased function of
lung tissue
Ineffective breathing pattern related to compromised lung
expansion
Acute pain related to inflammatory process
Anxiety related to inability to take deep breaths
Risk for infection r/t pooling of fluid in lung space
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43. Nursing intervention:
To improve gas exchange:
Assess respiration; quality, rate ,rhythm, depth.
Observe colour of skin, mucous membrane and nail beds
for presence of cyanosis.
Advice patient for compelte bed rest.
Encourage use of relaxation technique such as deep
breathing.
Administer 02 by appropriate means: nasal prongs , mask ,
venture mask.
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44. Maintain effective pattern:
Check ou respiratory function, resiratory distress and
changes in vital function.
Maintain a position of comfort, with a head of bed slightly
elevated.
Turn to affected site.
Administer oxygen therapy as prescribed to maintain
oxygen level.
Maintain calm environment.
Check drainage if inserted.
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45. To reduce pain:
Assess the patient by using pain rating scale for intensity,
characteristics and location of pain.
Assist patient on deep breathing exercise and relaxation
technique.
Assist the patient to change position.
Maintain calm environment.
Administer analgesic for pain as prescribed.
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46. To reduce risk of infection:
Demonstrate and encourage good hand washing
technique.
Limit visitors.
Promote adequate nutrition intake which facilitate healing
process.
Encourage adequate rest with moderate activity.
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47. Cont..
Patient education and health maintenance:
Provide care after pleurodesis
Monitor for excessive pain and give analgesic
Assist patient undergoing instillation of intrapleural
lignocaine if pain is not relief
Administer oxygen as indicated dyspnea and hypoxemia
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48. Cont….
Observed patient’s breathing pattern , oxygen saturation
and vital sign for assessment weather improvement or
deterioration
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49. Complication:
A lung that is surrounded by excess fluid for a long
time may be damaged.
Pleural fluid that becomes infected may turn into an
abscess, called an empyema, which will need to be
drained with a chest tube.
Pneumothorax (air in the chest cavity) can be a
complication of the thoracentesis procedure.
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50. Care of Chest Tube Drainage
Never lift drain above chest level
The unit and all tubing should be below patient ’s chest
level to facilitate drainage
Tubing should have no kinks or obstructions that may
inhibit drainage
Ensure all connections between chest tubes and drainage
unit are tight and secure
Connections should have cable ties in place
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51. Care of Chest Tube Drainage
contd
Tubing should be anchored to the patient ’s skin to prevent
pulling of the drain prevent accidental removal.
In PICU and NICU tubing should also be secured to patient bed
prevent accidental removal .
Ensure the unit is securely positioned on its stand or hanging on
the bed.
Ensure the water seal is maintained at 2cm at all times.
Measure the output of drainage.
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