6. HOW DOES PLEURA WORKS?
The pleura is composed of two layers of thin lining tissue. the layer
covering the lung (visceral pleura) and the parietal pleura that covers
the inner wall of the chest are lubricated by pleural fluid.
Normally, there is about 10-20 ml of clear liquid that acts as a
lubricant between these layers..
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7. DEFINITION
Pleurisy is a medical condition affecting the two layers of the tissue
called “pleura”, which acts as a separator between the lungs and the
chest wall.
Pleurisy is defined as inflammation of the tissue layers (pleura)
lining the lungs and inner chest wall
These conditions manifest as a sharp chest pain called “pleuritic
chest pain”, and can be worse during respirations.
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9. DEFINITION
Pleurisy is inflammation of the pleura often associated with the
accumulation of fluid between the two layers of pleura, known as
pleural effusion. Pleurisy causes roughening of the surfaces of the
pleura.
Pleurisy is a symptom rather than a disease.
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10. DEFINITION
It may develop in conjunction with:
• Pneumonia ; an upper respiratory tract infection,
• TB, or collagen disease( a component of the connective tissue)
• Trauma to the chest,
• Pulmonary embolism;
• Primary and metastatic cancer; and
• After thoracotomy
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12. TYPES
1. Dry Pleurisy
• The amount of pleural fluid does not increase.
• Associated with:
tuberculosis
rheumatic fever
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13. TYPES
acute bacterial or viral pulmonary infections
acute upper respiratory tract illness.
• The process is usually limited to the visceral pleura, with small
amounts of yellow serous fluid .
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14. TYPES
• Adhesion between pleural surfaces
• Pleural thickening
• Fibrothorax due to fibrin deposition and severe adhesions
Note: fibrothorax is defined as fibrosis within the pleural space, and
occurs secondary to the inflammatory response.
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15. TYPES
2. Wet Pleurisy
• It is accompanied by abnormal increase in pleural fluids and divided
into transudate and exudate.
• Generally, inflammatory disease and tissue destruction produce
exudates with specific gravity of above 1.017 and high concentration
of proteins and LDH(lactic acids dehydrogenase)
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16. TYPES
• If the effusion contains purulent materials, it is called empyma.
• If the empyma ultimately leads to fibrous fusing of the lungs and
chest wall, it is then called fibro thorax.
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17. TYPES
• Transudates which are produced by diseases such as CCF show
lower values for these components with protein below 3.5 gm/dl and
LDH below 200 units.
• The accumulation of pleural transudate is sometimes referred to as
hydrothorax or pleural effusion
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20. ETIOLOGY
• Pleurisy can be caused by any of the following conditions:
1. INFECTIONS
The most common cause of pleurisy is infection.
Several viruses that cause pleurisy include influenza or flu virus,
cytomegalovirus(CMV) , parainflenza virus, and Epstein-Barr
virus.
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21. ETIOLOGY
Bacterial infections resulting to pleurisy are less common and can be
caused by streptococcus. More specifically, bacterial pneumonia, a
respiratory infection that can result in inflammation of the air sacs in
the lungs, and tuberculosis, a serious bacterial disease that typically
infects the lungs can prompt pleurisy
Fungal infection can also cause pleurisy.
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22. ETIOLOGY
2. INHALED CHEMICALS OR TOXIC SUBSTANCES:
Asbestosis.
3. AUTOIMMUNE DISORDERS:
Illnesses such as lupus or rheumatoid arthritis involve the immune
system abnormally attacking healthy tissues.
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23. ETIOLOGY
4. TRAUMA
Mechanical injury can result to pleurisy. The pleurisy can have
swelling and inflammation when there is bruising or fracture of the
ribs.
Rib fractures or irritation from chest tubes used to drain air or fluid
from the pleural cavity in the chest
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24. ETIOLOGY
5. PULMONARY EMBOLISM:
Blood clot inside the blood vessels to the lungs. These blood clots
blocks the lungs and causes reduced blood and oxygen to portions
of the lung and can result in death to that portion of lung tissue
(termed lung infarction). This can cause pleurisy.
6. PNEUMOTHORAX
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25. ETIOLOGY
7. CANCER
When a tumor grows in the pleural cavity, fluid buildup occurs,
causing pleurisy and pleural effusion. For example, the spread of lung
cancer to the pleura.
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26. ETIOLOGY(8/9)
8. CERTAIN DRUGS
Certain medications can produce pleurisy as a side effect.
These include certain chemotherapy medications(e.g, methotrexate
and bleomycin), antiarrhythmic medications (e.g amiodarone and
procainamide), tuberculosis medication (e.g. ionazid) , and high
blood pressure medications(e.g, hydralazine)
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27. ETIOLOGY
9. TUMORS OF THE PLEURA
Mesothelioma or sarcoma
10. CARDIAC CONDITIONS
Heart failure
Heart attack(Myocardial infarction)
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29. PATHOPHYSIOLOGY
Now , when the inflamed pleural membrane rubs together during
inspiration, the result is severe, sharp and knife like pain
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30. SIGN AND SYMPTOMS
1. Pleuritic Chest Pain 2.Shortness of breath
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31. SIGN AND SYMPTOMS
3. Fever ,Chills, 4. Cough
Malaise and increased WBC count
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32. SIGN AND SYMPTOMS
6. Unexplained weight loss 7. Sore Throat
.
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33. SIGN AND SYMPTOMS
8. Dyspnea
9.Purulent sputum
10. Limited chest movement on affected site
11. Tenderness of intercostal space on affected site.
12. Dull sound on percussion on affected site
13.Diminished breath sounds.
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34. DIAGNOSTIC EVALUATION
The diagnosis of pleurisy is made by the characteristic of chest pain
and physical findings on examination of the chest.
Analysis of pleural fluid aspirated from the chest can help determine
the cause of the pleurisy.
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42. TREATMENT
Treatment for pleurisy focuses primarily on underlying cause
The objectives of treatment are :
• To discover the underlying cause and to relieve the pain.
• To remove the fluid, air or blood from pleural spaces
• To relieve symptoms
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43. TREATMENT
1. BACTERIA (BACTERIAL PNEUMONIA)
Antibiotics that are specific for bacteria- caused pleurisy to manage
the infection.
2. FUNGAL
Antifungal for fungal- caused pleurisy.
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44. TREATMENT
3. VIRAL
If pleurisy is caused by a virus- antiviral may not be required as it
can resolve on its own.
The doctor may ask the patient to rest for a few days, with close
monitoring.
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45. TREATMENT
4. PAIN AND INFLAMMATION
Non-steroidal anti-inflammatory drugs(NSAIDs), such as;
Indomethacin are effective to relieve pleuritic pain.
Indomethacin, in dosages of 50 to 100 mg orally up to three times
per day with food, has been found to be effective in relieving pleural
pain
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46. TREATMENT
In case, when NSAIDs are not helpful , paracetamol or codeine can
be administered . Codeine can also help suppress cough.
Removal of fluid from the chest cavity (thoracentesis) can relieve the
pain and shortness of breath.
Take deep breaths every 1-2 hours while awake
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47. TREATMENT
5. DRUG-INDUCED
If a patient has suspected drug-induced pleuritis or drug-induced
lupus pleuritis, the causal agent should be discontinued.
6.TOXIN SUBSTANCE
Smoking cessation should be advised for patients with pleurisy
caused by asbestosis
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48. TREATMENT
7. LUPUS OR TUBERCULOSIS
corticosteroids such as prednisolone, dexamethasone, or
methylprednisolone to reduce swelling.
8. CHEST DRAIN
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49. TREATMENT
9. CHEST PHYSIOTHERAPY-- DEEP BREATHING AND
COUGHING.
10. BLOOD CLOTS
If pleurisy is caused by blood clots in the arteries of the lungs,
medications that prevent further blood clots such as heparin may be
prescribed.
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50. TREATMENT
10. OXYGEN ADMINISTRATION
If the condition is severe, particularly if it is accompanied by
pneumonia, oxygen may be required.
12. RADIATION TREATMENT OR CHEMOTHERAPY
In some cases, doctor use cancer treatments to shrink tumors that
cause pleurisy.
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51. LIFESTYLE AND HOME
REMEDIES
1. Take prescribed medication
2. Get plenty of rest
3.Do not smoke
4.Breath deeply
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53. NURSING MANAGEMENT
1. NURSING ASSESSMENT
Obtain history of previous pulmonary condition
Take history with emphasis on onset and nature of chest pain.
Obtain history of illness such as systemic lupus erythematous,
tuberculosis infection, etc.
History of cigarette, alcohol and tobacco use
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54. NURSING MANAGEMENT
Obtain history of drugs used
Assess patient for dyspnea and shortness of breath
Assess breath sounds and monitor respiratory rate
Percussion for dullness sound.
Ascultate for pleural friction rub.
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55. NURSING DIAGNOSIS
1. Acute pain (pleuritic) related to inflammatory process as evidenced
by chest pain.
2. Ineffective breathing pattern related to bacteria-caused pleurisy as
evidenced by shortness of breath and cough.
3. Impaired gas exchange related to decreased function of lung tissue.
4. Anxiety related to pain, dyspnea and prognosis of disease.
5. Risk for infection related to pooling of fluid in lung space
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56. NURSING MANAGEMENT
1. REDUCING PAIN
Assess the patient by using pain rating scale for intensity,
characteristics and location of pain.
Watch patient for signs of discomfort and pain.
Assist patient on deep breathing exercise and relaxation technique.
Assist the patient to change position.
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57. NURSING MANAGEMENT
Maintain calm environment.
Administer the prescribed pain medications and assess response at
least 30 minutes after drug administration.
Assist patient to a position of comfort, possibly lying on affected
side, to decrease stretching of pleurae.
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58. NURSING MANAGEMENT
2. MAINTAIN EFFECTIVE PATTERN
Assess the patient’s vital signs and characteristics of respirations at
least every 4 hours.
Administer the prescribed antibiotic medications.
Elevate the head of the bed.
Assist the patient to change position as tolerated. Encourage the
patient to lie on the affected side if possible
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59. NURSING MANAGEMENT
Check out respiratory function, respiratory distress and changes in
vital function.
Position the patient in high fowler's position to maximize chest
expansion and ease the work of breathing.
Maintain calm environment.
Check drainage if inserted.
Administer oxygen, if ordered, based on oxygen saturation levels;
assess for signs and symptoms of hypoxia.
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60. NURSING MANAGEMENT
3. IMPROVE GAS EXCHANGE
Assess respiration; quality, rate ,rhythm, depth.
Auscultate lung sounds.
Observe color of skin, mucous membrane and nail beds for presence
of cyanosis.
Advice patient for complete bed rest.
Encourage use of relaxation technique such as deep breathing.
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61. NURSING MANAGEMENT
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Administer 02 by appropriate means: nasal prongs , mask , venture
mask.
Provide for frequent rest periods;
Assist with passive range-of-motion (ROM) exercises; encourage
active ROM exercises..
Assist with thoracentesis, if indicated.
62. NURSING MANAGEMENT
4. REDUCING ANXIETY
Correct dyspnea and relief physical discomfort.
Explain diagnostic procedures and the patients role: correct
misconception.
Speak calmly and slowly.
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63. NURSING MANAGEMENT
Listen to patient concerns; attentive listening relieves anxiety and
reduces emotional distress
Encourage the patient to verbalize feelings and concerns; provide
emotional support and guidance.
Assist the patient in using positive coping strategies and relaxation
techniques.
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64. NURSING MANAGEMENT
5. 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.
Administer antibiotic as prescribed.
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65. PATIENT TEACHING
Disorder, possible underlying cause, diagnosis, and treatment,
including medications to control pain and coughing need to take
ibuprofen or other NSAIDs with food or meals to minimize GI
distress possible sedative effects if codeine is prescribed, and the
need for safety measures
How to perform and deep-breathing exercises
Importance of regular rest periods energy conservation measures
anxiety reduction and coping strategies
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66. PATIENT TEACHING
Importance of seeking early intervention for pulmonary conditions
signs and symptoms of possible complications, such as increasing
respiratory distress, development of productive cough, and fever, and
the need to notify the practitioner immediately
Importance of adhering to recommended follow-up care to evaluate
the condition and the underlying cause.
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67. PREVENTION
There is a vaccine against one of the most common organism that
causes pneumonia.
It is recommended that people who are at risk of pneumonia be
immunized , including young children, older people over the age of
65, people with chronic medical conditions (such as diabetes) and
people with reduced immunity.
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68. PREVENTION
Apart from vaccination , treating any infection of the respiratory
tract promptly can also reduce the risk of developing pleurisy.
Quit smoking.
Early diagnosis and treatment of underlying cause of pleurisy.
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70. PROGNOSIS
Most people who receive prompt diagnosis and treatment for the
condition causing pleurisy recover fully
People treated with antibiotics for an infection causing pleurisy
usually feel better in about a week .
Very rarely, people who are not treated may have life-threatening
complications.
The outlook also depends on the underlying condition that causes the
pleurisy.
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72. REFERENCES
Smeltzer.S.G. Bare.B.G. Hinkle.J.G. Cheezer K.H.(2010) “Brunner
& Suddarth’s textbook of Medical- Surgical Nursing", Volume 1.
(12th edition). New Delhi, Kluwer India. Pvt. Ltd. 2078/04/10 at 1 pm
Mandal G.N (2016) “A Textbook Of Medical Surgical Nursing”. 5th
edition. Kathmandu. Makalu Publication House.2078/04/11at 3 pm.
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73. REFERENCE
2019. Mayo Foundation Of Medical Foundation And Research. Pleurisy
https://www.mayoclinic.org@2021/07/25at 3pm.
Nov4,2019,pleurisyhttps://www.slideshare.net/gamandeep@2021/06/25 at 5pm
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