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PLEURAL EFFUSION
Conducted By: Mr. OMPRAKASH VERMA
M. Sc Nursing Lecturer
Medical Surgical Nursing
Reliance institute of nursing
Om pleural effusion
Om pleural effusion
Om pleural effusion
Om pleural effusion
Om pleural effusion
Om pleural effusion
Definition
The body produces pleural fluid in small
amounts to lubricate the surfaces of the
pleura, it lines the chest cavity and
surrounds the lungs. The pleural cavity
contains a relatively small amount of
fluid, approximately 10 ml on each side A
PLEURAL EFFUSION is an abnormal,
excessive collection of this fluid .
Excessive amounts of such fluid can
impair breathing by limiting the
expansion of the lungs during respiration
Con………………………………..
• Build up of excess fluid between
the layers of the pleura outside
the lungs.
• pleural effusion refers to a
collection of fluid in the pleural
space
TYPES
• TRANSUDATIVE PLEURAL
EFFUSIONS
• EXUDATIVE EFFUSIONS
Types of Effusions
a) TRANSUDATIVE PLEURAL EFFUSIONS
It caused by fluid leaking into the pleural
space. This is caused by increased
pressure in, or low protein content in,
the blood vessels . A transudate is a
clear fluid, similar to blood serum . It
reflect a systemic disturbance of body
Causes of Transudates
• Atelectasis
• Cirrhosis
• Congestive heart failure
• Hypoalbuminemia
• Nephrotic syndrome
• Peritoneal dialysis
• ATELECTASIS is the collapse or closure of a
lung resulting in reduced or absent gas
exchange.
• CIRROSIS = ascites can be present with
hepatic hydrothorax, ( usually greater than
500 mL) although right-sided pleural
effusion can develop in patients
with cirrhosis,
• Transudative pleural effusion is caused by
fluid leaking into the pleural space. This is
from increased pressure in the blood
vessels or a low blood protein count. Heart
failure is the most common cause.
• Hypoalbuminemia
is a medical sign in which the level of
albumin in the blood is abnormally
low.
Nephrotic syndrome
If there are too much protein losing
from patient’s blood vessel, he will
have more severe edema,
peritoneum, and a cleaning solution
called dialysate to clean your blood.
Dialysate absorbs waste and fluid from
your blood, using your peritoneum as a
filter.
Types Of Effusions
cont..
EXUDATIVE EFFUSIONS
A fluid rich in protein and cellular
elements that oozes ( leaking) out of
blood vessels due to inflammation . It is
caused by blocked blood vessels,
inflammation, lung injury, and drug
reactions. An exudate—which often is a
cloudy fluid, containing cells and much
protein .
Causes of Exudates:
• Asbestos exposure
• Atelectasis
• Hemothorax Infection (bacteria, viruses,
fungi, tuberculosis, or parasites)
• Pulmonary embolism
Uremia
• fluid, electrolyte, and hormone
imbalances and metabolic
abnormalities,
Asbestos exposure
• These diseases can lead to irritation,
swelling and inflammation, which in
causes the blood vessels in the pleurae
to leak extra fluid into the pleural space.
• Pulmonary embolism is a blockage in
one of the pulmonary arteries in your
lungs. In most cases, pulmonary
embolism is caused by blood clots that
travel to the lungs from the legs
Om pleural effusion
Pathophysiology
due to etiological factors
It is explained by increased pleural fluid
formation or decreased pleural fluid
absorption.
Increased pleural fluid formation can result from
elevation of hydrostatic pressure (increasing
weight of fluid ) & decreased osmotic
pressure.
It leads to increased capillary
permeability ( capacity of a
blood vessel wall to allow for the flow of
small molecules (drugs, nutrients, water,
ions) or even whole cells & passage of
fluid is through openings in the
diaphragm
Hence production increases &
absorption is decreases lymphatic
obstruction Pleural effusions produce a
restrictive ventilatory defect and also
decrease the total lung capacity and
CLINICAL MANIFESTATION
Pleuritic chest pain indicates
inflammation of the parietal pleura
Physical examination findings that can
reveal the presence of an effusion dull
or flat note on percussion
diminished or absent breath sounds on
auscultation. Chest pain, usually a
sharp pain that is worse with cough or
deep breaths, Cough, Fever, Rapid
breathing, Shortness of breath
DIAGNOSTIC EVALUATION
During a physical examination, the doctor
will listen to the sound of your breathing
with a stethoscope and may tap on your
chest to listen for dullness. The following
tests may help to confirm a diagnosis :
Chest CT scan Chest x-ray Pleural fluid
analysis (examining the fluid under a
microscope to look for bacteria, amount
of protein, and presence of cancer cells)
Thoracentesis (a sample of fluid is
removed with a needle inserted between
the ribs) Ultrasound of the chest
• Chest Radiography :The posteroanterior
and lateral chest radiographs are still the
most important initial tools in diagnosing
a pleural effusion.
• Ultrasound is useful both as a diagnostic
tool and as an aid in performing
thoracentesis. It assist in identifying
pleural fluid loculations.
• Computed Tomography: Cross-sectional
computed tomography (CT) It helps
distinguish anatomic compartments more
clearly This modality is useful as well in
distinguishing empyema
Normal Pleural effusion
CRG CRG
• Treatment depends on the cause of
your pleural effusion and how bad
your symptoms are. You may need
any of the following:
• Diuretics laxis may help you lose
extra fluid caused by heart failure or
other problems.
• Antibiotics help prevent or treat an
infection caused by bacteria.
• Prescription pain medicine may be
given. Ask your healthcare provider
how to take this medicine safely.
• NSAIDs help decrease swelling and
pain or fever..
• Steroids or other types of medicines
may be given to decrease swelling.
• Drainage of extra pleural fluid may be
done using thoracentesis or a chest
tube. A chest tube may stay in your
chest for days or weeks. This allows the
extra fluid around your lungs to drain
over time. You may need medicines put
directly into your chest if the fluid does
not drain out easily.
Treatment
Treatment aims to: Remove the fluid
Prevent fluid from building up again
Treating the cause of the fluid buildup
• Therapeutic thoracentesis may be
done if the fluid collection is large and
causing chest pressure, shortness of
breath, or other breathing problems,
such as low oxygen levels. Removing
the fluid allows the lung to expand,
making breathing easier.
pleural effusions caused by congestive
heart failure are treated with diuretics
(water pills) and other medications that
treat heart failure. Pleural effusions
caused by infection are treated with
appropriate antibiotics. In people with
cancer or infections. the effusion is often
treated by using a chest tube for several
days to drain the fluid. small tubes can
be left in the pleural cavity for a long
time to drain the fluid.
In some cases, the following may be done:
Surgery
• Thoracentasis Pleural fluid is drawn out of
the pleural space in a process called
thoracentesis. A needle is inserted through
the back of the chest wall in the sixth,
seventh, or eighth intercostal space into
the pleural space. The fluid may then be
evaluated.
• Gram stain and culture to identify possible
bacterial infections Cytopathology to
identify cancer cells, but may also identify
some infective organisms
Nursing Diagnosis
&
Nursing Intervention
• 1. Ineffective breathing pattern related to
decreased lung expansion(accumulation
of liquid), as evidenced by dyspnea,
changes in depth of breathing, accessory
muscle use.
Interventions
• Maintain a comfortable position is
usually elevated headboard
• Given oxygen through a cannula (8mls)
2. Acute Pain related to accumulation of
fluid in the pleural space and rubbing of
thoracostomy tube to the lungs
• Interventions
• -The presence of pain, the scale and
intensity of pain was well assessed
• -The client taught about pain
management and relaxation with
distraction
• -Chest tube secured to restrict
movement and avoid irritation
• -Given prescribed analgesics i.e
diclofenac 75mg.
3. Risk for nutrition impariment, less than
body requirement related to inability to
ingest adequate nutrients
Interventions
• -Patient relative i.e his father encouraged
to give him energy reaching food stuff
together with energy supplement so that
he can get enough energy.
• -Administer DNS as prescribed to the
patient to increase energy lost.
4. Risk for fluid volume deficit related to
chest tube drainage.
• Interventions
• -encourage the patient to drink
enough water to supplement the one
lost by chest tube drainage
• -IV fluids & DNS to replace fluid lost in
drainage system monitored in
24hours.
5. Risk for infection related to the
presence of fluid in the pleural space
and the incision site.
• Interventions
• -The patient dressed at the incision
site when it is wetted, probably after 2
to 3 days
• -Given antibiotics as prescribed i.e IV
metronidazole 500mg 8 hourly, IV
ceftiaxone 1gm.
Possible Complications
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.
References
• A. Putnam JB. Malignant pleural effusions. Surg Clin N
Am.2002;38;375-383.
• B. Villena V, López Encuentra E, García-Luján R,
Clinicalimplications of appearance of pleural fluid at
thoracentesis.Chest.2004;125:156-9.
• C. cleveland clinic journal of medicine volume 72 • number
10 october 2005
• D. villena garrido v et al. diagnosis and treatment of
pleural effusion(2005)
• E. Jeffrey Rubins, MD; Chief Editor: Zab Mosenifar, MD.
Pleural Effusion Clinical Presentation.
• F. Sarah Avery, RGN Insertion and management of chest
drains vol: 96, issue: 37, page no: 3 (2000).
• G.Burrows CM, Mathews WC, Colt HG. Predicting
survival in patientswith recurrent symptomatic
malignant pleural effusions: an assessment of the
prognostic values of physiologic, morphologic, and
quality of life measures of extent of disease. Chest.
2000;117(1):73-78. [PubMed]
• H.Anderson CB, Philpott GW, Gerguson TB. The
treatment of malignant pleural effusion.
Cancer.1974;33(4):916–922.
Om pleural effusion

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Om pleural effusion

  • 1. PLEURAL EFFUSION Conducted By: Mr. OMPRAKASH VERMA M. Sc Nursing Lecturer Medical Surgical Nursing Reliance institute of nursing
  • 8. Definition The body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, it lines the chest cavity and surrounds the lungs. The pleural cavity contains a relatively small amount of fluid, approximately 10 ml on each side A PLEURAL EFFUSION is an abnormal, excessive collection of this fluid . Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during respiration
  • 9. Con……………………………….. • Build up of excess fluid between the layers of the pleura outside the lungs. • pleural effusion refers to a collection of fluid in the pleural space
  • 11. Types of Effusions a) TRANSUDATIVE PLEURAL EFFUSIONS It caused by fluid leaking into the pleural space. This is caused by increased pressure in, or low protein content in, the blood vessels . A transudate is a clear fluid, similar to blood serum . It reflect a systemic disturbance of body
  • 12. Causes of Transudates • Atelectasis • Cirrhosis • Congestive heart failure • Hypoalbuminemia • Nephrotic syndrome • Peritoneal dialysis
  • 13. • ATELECTASIS is the collapse or closure of a lung resulting in reduced or absent gas exchange. • CIRROSIS = ascites can be present with hepatic hydrothorax, ( usually greater than 500 mL) although right-sided pleural effusion can develop in patients with cirrhosis, • Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause.
  • 14. • Hypoalbuminemia is a medical sign in which the level of albumin in the blood is abnormally low. Nephrotic syndrome If there are too much protein losing from patient’s blood vessel, he will have more severe edema, peritoneum, and a cleaning solution called dialysate to clean your blood. Dialysate absorbs waste and fluid from your blood, using your peritoneum as a filter.
  • 15. Types Of Effusions cont.. EXUDATIVE EFFUSIONS A fluid rich in protein and cellular elements that oozes ( leaking) out of blood vessels due to inflammation . It is caused by blocked blood vessels, inflammation, lung injury, and drug reactions. An exudate—which often is a cloudy fluid, containing cells and much protein .
  • 16. Causes of Exudates: • Asbestos exposure • Atelectasis • Hemothorax Infection (bacteria, viruses, fungi, tuberculosis, or parasites) • Pulmonary embolism Uremia • fluid, electrolyte, and hormone imbalances and metabolic abnormalities,
  • 17. Asbestos exposure • These diseases can lead to irritation, swelling and inflammation, which in causes the blood vessels in the pleurae to leak extra fluid into the pleural space. • Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs
  • 19. Pathophysiology due to etiological factors It is explained by increased pleural fluid formation or decreased pleural fluid absorption. Increased pleural fluid formation can result from elevation of hydrostatic pressure (increasing weight of fluid ) & decreased osmotic pressure.
  • 20. It leads to increased capillary permeability ( capacity of a blood vessel wall to allow for the flow of small molecules (drugs, nutrients, water, ions) or even whole cells & passage of fluid is through openings in the diaphragm Hence production increases & absorption is decreases lymphatic obstruction Pleural effusions produce a restrictive ventilatory defect and also decrease the total lung capacity and
  • 21. CLINICAL MANIFESTATION Pleuritic chest pain indicates inflammation of the parietal pleura Physical examination findings that can reveal the presence of an effusion dull or flat note on percussion diminished or absent breath sounds on auscultation. Chest pain, usually a sharp pain that is worse with cough or deep breaths, Cough, Fever, Rapid breathing, Shortness of breath
  • 22. DIAGNOSTIC EVALUATION During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness. The following tests may help to confirm a diagnosis : Chest CT scan Chest x-ray Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancer cells) Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs) Ultrasound of the chest
  • 23. • Chest Radiography :The posteroanterior and lateral chest radiographs are still the most important initial tools in diagnosing a pleural effusion. • Ultrasound is useful both as a diagnostic tool and as an aid in performing thoracentesis. It assist in identifying pleural fluid loculations. • Computed Tomography: Cross-sectional computed tomography (CT) It helps distinguish anatomic compartments more clearly This modality is useful as well in distinguishing empyema
  • 25. • Treatment depends on the cause of your pleural effusion and how bad your symptoms are. You may need any of the following: • Diuretics laxis may help you lose extra fluid caused by heart failure or other problems. • Antibiotics help prevent or treat an infection caused by bacteria. • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely.
  • 26. • NSAIDs help decrease swelling and pain or fever.. • Steroids or other types of medicines may be given to decrease swelling. • Drainage of extra pleural fluid may be done using thoracentesis or a chest tube. A chest tube may stay in your chest for days or weeks. This allows the extra fluid around your lungs to drain over time. You may need medicines put directly into your chest if the fluid does not drain out easily.
  • 27. Treatment Treatment aims to: Remove the fluid Prevent fluid from building up again Treating the cause of the fluid buildup • Therapeutic thoracentesis may be done if the fluid collection is large and causing chest pressure, shortness of breath, or other breathing problems, such as low oxygen levels. Removing the fluid allows the lung to expand, making breathing easier.
  • 28. pleural effusions caused by congestive heart failure are treated with diuretics (water pills) and other medications that treat heart failure. Pleural effusions caused by infection are treated with appropriate antibiotics. In people with cancer or infections. the effusion is often treated by using a chest tube for several days to drain the fluid. small tubes can be left in the pleural cavity for a long time to drain the fluid.
  • 29. In some cases, the following may be done: Surgery • Thoracentasis Pleural fluid is drawn out of the pleural space in a process called thoracentesis. A needle is inserted through the back of the chest wall in the sixth, seventh, or eighth intercostal space into the pleural space. The fluid may then be evaluated. • Gram stain and culture to identify possible bacterial infections Cytopathology to identify cancer cells, but may also identify some infective organisms
  • 30. Nursing Diagnosis & Nursing Intervention • 1. Ineffective breathing pattern related to decreased lung expansion(accumulation of liquid), as evidenced by dyspnea, changes in depth of breathing, accessory muscle use. Interventions • Maintain a comfortable position is usually elevated headboard • Given oxygen through a cannula (8mls)
  • 31. 2. Acute Pain related to accumulation of fluid in the pleural space and rubbing of thoracostomy tube to the lungs • Interventions • -The presence of pain, the scale and intensity of pain was well assessed • -The client taught about pain management and relaxation with distraction • -Chest tube secured to restrict movement and avoid irritation • -Given prescribed analgesics i.e diclofenac 75mg.
  • 32. 3. Risk for nutrition impariment, less than body requirement related to inability to ingest adequate nutrients Interventions • -Patient relative i.e his father encouraged to give him energy reaching food stuff together with energy supplement so that he can get enough energy. • -Administer DNS as prescribed to the patient to increase energy lost.
  • 33. 4. Risk for fluid volume deficit related to chest tube drainage. • Interventions • -encourage the patient to drink enough water to supplement the one lost by chest tube drainage • -IV fluids & DNS to replace fluid lost in drainage system monitored in 24hours.
  • 34. 5. Risk for infection related to the presence of fluid in the pleural space and the incision site. • Interventions • -The patient dressed at the incision site when it is wetted, probably after 2 to 3 days • -Given antibiotics as prescribed i.e IV metronidazole 500mg 8 hourly, IV ceftiaxone 1gm.
  • 35. Possible Complications 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.
  • 36. References • A. Putnam JB. Malignant pleural effusions. Surg Clin N Am.2002;38;375-383. • B. Villena V, López Encuentra E, García-Luján R, Clinicalimplications of appearance of pleural fluid at thoracentesis.Chest.2004;125:156-9. • C. cleveland clinic journal of medicine volume 72 • number 10 october 2005 • D. villena garrido v et al. diagnosis and treatment of pleural effusion(2005) • E. Jeffrey Rubins, MD; Chief Editor: Zab Mosenifar, MD. Pleural Effusion Clinical Presentation. • F. Sarah Avery, RGN Insertion and management of chest drains vol: 96, issue: 37, page no: 3 (2000).
  • 37. • G.Burrows CM, Mathews WC, Colt HG. Predicting survival in patientswith recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest. 2000;117(1):73-78. [PubMed] • H.Anderson CB, Philpott GW, Gerguson TB. The treatment of malignant pleural effusion. Cancer.1974;33(4):916–922.