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PLEURISY & PLEURAL
EFFUSION
By
Logman Mohammed
MS - MSN

2. PLEURISY
 Pleurisy is a clinical term to describe
pleuritis (inflammation of the pleura, both
parietal and visceral).
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3. Pathophysiology and Etiology
 Inflammation of the pleura stimulates nerve
endings (parietal pleura), causing pain.
 May occur in the course of many pulmonary
diseases:
a. Pneumonia (bacterial, viral).
b. TB.
c. Pulmonary infarction, embolism.
d. Pulmonary abscess.
e. Upper respiratory tract infection.
f. Pulmonary neoplasm.
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pleuritis

5. Clinical Manifestations
 Chest pain—becomes severe, sharp, and
knifelike on inspiration (pleuritic pain)
 Occurs on one side
 Minimal or absent when the breath is held.
 May be localized or radiate to the shoulder or abdomen
 Intercostal tenderness on palpation
 Pleural friction rub
 Evidence of infection; fever, malaise,
increased white blood cell count
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6. Diagnostic Evaluation
 1. Chest X-ray may show pleural thickening.
 2. Sputum examination may indicate
infectious organism.
 3. Examination of pleural fluid obtained by
thoracentesis for smear and culture.
 4. Pleural biopsy may be necessary to rule
out other conditions.
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7. Management
 Treatment for the underlying primary
disease (pneumonia, infarction)
inflammation usually resolves when the
primary disease subsides.
 Pain relief, using pharmacologic and non
pharmacologic methods.
 Intercostal nerve block may be necessary
when pain causes hypoventilation.
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8. Complications
1. Severe pleural effusion
2. Atelectasis due to shallow breathing to
avoid pain
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9. PLEURAL EFFUSION
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10. PLEURAL EFFUSION
 Pleural effusion is a collection of fluid in
the pleural space. It is always 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.
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11.  The effusion can be a relatively clear fluid, or
it can be bloody or purulent.
 An effusion of clear fluid may be a transudate
or an exudate.
 Atransudate (filtrate of plasma that moves
across intact capillary walls) occurs when
imbalances in hydrostatic or oncotic
pressures.
 Atransudative effusion most commonly
results from heart failure 11
Pathophysiology and Etiology

12.  An exudate (extravasation of fluid into tissues
or a cavity) usually results from inflammation
by bacterial products or tumors involving the
pleural surfaces.
 Is an accumulation of high-protein fluid
 Occurs as a complication of:
a. Disseminated cancer (lung and breast).
b. Pulmonary infections (pneumonia).
c. Cirrhosis , nephrosis.
d. Other conditions peritoneal dialysis
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Pleural effusion

14. Clinical Manifestations
 Dyspnea, pleuritic chest pain, cough
 Dullness or flatness to percussion (over areas
of fluid) with decreased or absent breath
sounds.
 Clinical manifestations caused by underlying
disease.
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15. Diagnostic Evaluation
 Chest X-ray or ultrasound detects presence
of fluid.
 Chest CT- to confirm the diagnoses
 Thoracentesis
 Biochemical (protein – glucose)
 Bacteriologic –to detect TB
 Cytologic studies of pleural fluid for
malignant cells..
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16. Management
The objectives of treatment are
 To discover the underlying cause of the pleural
effusion(heart disease ,infection , cancer).
 To prevent reaccumulation of fluid
 To relieve discomfort, dyspnea, and
respiratory compromise.
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17.  Thoracentesis is done to remove fluid,
collect a specimen, and relieve dyspnea.
For Malignant Effusions
 Chest tube drainage, radiation, chemotherapy,
surgical pleuroperitoneal shunt, or
pleurodesis
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Thoracentesis

19. Complications
 Large effusion could lead to respiratory
failure.
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20. Empyema
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21. Empyema
An empyema is an accumulation of thick,
purulent fluid within the pleural space, often
with fibrin development and a loculated in
area where infection is located.
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22. Pathophysiology
 Most empyema's occur as complications of
bacterial pneumonia or lung abscess. They
also result from penetrating chest trauma,
hematogenous infection of the pleural space.
 Occur after thoracic surgery or thoracentesis.
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Empyema

24. Clinical Manifestations
 The patient is acutely ill and has signs and
symptoms similar to those of an acute
respiratory infection or pneumonia (fever,
night sweats, pleural pain, cough, dyspnea,
anorexia, weight loss)
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25. Medical Management
 Drained fluid by Needle aspiration
(thoracentesis) or Open chest drainage
 large doses of antibiotics 4 to 6 weeks
 In long-standing inflammation the exudate
must be removed surgically
 The complete obliteration of the pleural space
is monitored by serial chest x-rays
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26. Nursing Assessment
 Obtain history of previous pulmonary condition.
 Assess patient’s level of pain.
 Observe for signs and symptoms of pleural
effusion (dyspnea, pain, decreased diaphragmatic
excursion on affected side).
 Auscultate lungs for pleural friction rub.
 percuss lungs for abnormalities.
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27. Nursing Diagnosis
Ineffective Breathing Pattern related to
stabbing chest pain(pleuritis) and collection
of fluid in pleural space (Pleural effusion ).
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28. Nursing Interventions
Easing Painful Respiration
 1. Assist patient to find comfortable position lying
on affected side decreases stretching of the pleura
 2. Instruct patient in splinting chest while taking a
deep breath or coughing.
 3. Assist with intercostal nerve block .or teach
self-administration of pain medications as ordered.
 Apply non pharmacologic interventions for pain
relief, such as application of heat, muscle
relaxation,
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29. To Maintaining Normal Breathing Pattern
 Resolve the underlying cause as prescribe.
 Assist with thoracentesis if indicated .
 Maintain chest drainage as needed
 Administer oxygen as indicated .
 Observe patient’s breathing pattern, oxygen
saturation, ABG and other vital signs, for evidence
of improvement or deterioration.
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Any Questions?