SlideShare a Scribd company logo
Pleural effusion
Pleural effusion
 Pleural effusion, a collection of fluid in the pleural
space, is rarely a primary disease process but is usually
secondary to other diseases.
Causes
Pleural effusion may be a complication of :-
 Heart failure,
 Tuberculosis,
 Pneumonia,
 Pulmonary infections,
 Nephritic syndrome,
 Connective tissue disease,
 Pulmonary embolism, and
 Neoplasm (tumor).
Pathophysiology
The effusion can be composed of a relatively clear fluid, or it can
be bloody or purulent.
An effusion of clear fluid may be a transudate or an exudate.
(Transudate is fluid pushed through the capillary due to high
pressure within the capillary. Exudate is fluid that leaks
around the cells of the capillaries caused by inflammation.)
A transudate (filtrates of plasma that move across intact capillary
walls) occurs when factors influencing the formation and re-
absorption of pleural fluid are altered, usually by imbalances in
hydrostatic or oncotic pressures.
Continued..
The finding of a transudative effusion generally implies that
the pleural membranes are not diseased.
The most common cause of a transudative effusion is heart
failure.
An exudates (extravasation of fluid into tissues or a cavity)
usually results from inflammation by bacterial products
or tumors involving the pleural surfaces.
Clinical Manifestations
 Pneumonia causes fever, chills,
 Pleuritic chest pain,
 Malignant effusion may result in dyspnea
and coughing.
 A large pleural effusion causes shortness of
breath.
Assessment and Diagnostic
Findings
 Assessment of the area of the pleural effusion
reveals decreased or absent breath sounds,
decreased fremitus, and a dull, flat sound
when percussed.
 In an extremely large pleural effusion, the
assessment reveals a patient in acute
respiratory distress.
Continued..
 Tracheal deviation away from the affected side may
also be noted.
 Physical examination, chest x-ray, chest CT scan,
and thoracentesis confirm the presence of fluid.
 In some instances, a lateral decubitus x-ray is
obtained.
 A pleural effusion can be diagnosed because this
position allows for the “layering out” of the fluid,
and an air–fluid line is visible
Continued..
 Pleural fluid analysis by bacterial culture,
Gram stain, acid fast bacillus stain (for TB),
red and white blood cell counts, chemistry
studies (glucose, amylase, lactic
dehydrogenase, protein), cytologic analysis for
malignant cells, and pH.
Medical management
 The objectives of treatment :
 discover the underlying cause
 to prevent re accumulation of fluid, and to relieve
discomfort, dyspnea, and respiratory compromise.
 Specific treatment is directed at the underlying
cause (eg, heart failure, pneumonia, lung cancer,
cirrhosis).
 Thoracentesis is performed to remove fluid,
to obtain a specimen for analysis, and to
relieve dyspnea and respiratory
compromise.
CONTINUED..
 Repeated thoracenteses result in pain, depletion of
protein and electrolytes, and sometimes
pneumothorax.
 Once the pleural space is adequately drained, a
chemical pleurodesis may be performed to obliterate
the pleural space and prevent reaccumulation of fluid
Other treatments
 Surgical pleurectomy
 Insertion of a small catheter attached to a
drainage bottle for outpatient management
 Implantation of a Pleura peritoneal shunt
PP shunt
 A pleura peritoneal shunt consists of two catheters
connected by a pump chamber containing two one-
way valves. Fluid moves from the pleural space to
the pump chamber and then to the peritoneal cavity.
 The patient manually pumps on the reservoir daily
to move fluid from the pleural space to the
peritoneal space.
Atelectesis
 It refers to closure or collapse of alveoli and often is
described in relation to x-ray findings and clinical
signs and symptoms.
 May be acute or chronic and may cover a broad range
of pathophysiologic changes,
 Microatelectasis /Macroatelectasis
Continued..
 Excess secretions or mucus plugs may also cause
obstruction of airflow and result in atelectasis in an area
of the lung.
 Atelectasis also is observed in patients with a chronic
airway obstruction that impedes or blocks air flow to an
area of the lung
 Atelectasis resulting from bronchial obstruction by
secretions may occur in patients with impaired cough
mechanisms (eg, postoperative, musculoskeletal or
neurologic disorders) or in debilitated, bedridden patients.
 Atelectasis may also result from excessive pressure
on the lung tissue, which restricts normal lung
expansion on inspiration.
 Such pressure may be produced by fluid
accumulating within the pleural space (pleural
effusion), air in the pleural space (pneumothorax),
or blood in the pleural space (hemothorax).
Pathophysiology
 Following obstruction of bronchus the blood
circulating absorbs gas from alveoli
 Lead to retraction of lungs
 Blood perfuses unventillated lung
 Results in arterial hypoximea
 Uninvolved surrounding lung distends displacing
surrounding structures
 Mediastinal shift
Clinical manifestations
 Fever is universally cited as a clinical sign of
atelectasis,
 marked respiratory distress in In acute
atelectasis involving a large amount of lung
tissue (lobar atelectasis),
 Dyspnea, tachycardia, tachypnea, pleural pain,
and central cyanosis
Assessment and Diagnostic
Findings
 Decreased breath sounds and crackles are heard
over the affected area.
 In addition, chest x-ray findings may reveal patchy
infiltrates or consolidated areas.
 Pulse oximetry (SpO2) may demonstrate a low
saturation of hemoglobin with oxygen (less than
90%) or a lower-than-normal partial pressure of
arterial oxygen (PaO2).
CONTINUED..
 Cough, Sputum Production, And Low-grade Fever.
 Dyspnea,
 Tachycardia,tachypnea
 Pleural Pain
 Central Cyanosis
Management
 First line measures:
 frequent turning, early ambulation, lung
volume expansion maneuvers (eg, deep-
breathing exercises, incentive spirometry),
and coughing
Other treatments such as positive expiratory
pressure or PEP therapy (a simple mask and one
way valve system that provides varying amounts of
expiratory resistance [usually 5 to 15 cm H2O])
Continuous or intermittent positive pressure-
breathing (IPPB)
 Bronchoscopy
Continued..
 Chest physical therapy to mobilize secretions.
 Nebulizer treatments with a bronchodilator medication or
sodium bicarbonate.
 Endotracheal intubation and mechanical ventilation
may be necessary.
 With a large pleural effusion that is compressing lung
tissue and causing alveolar collapse, treatment may
include thoracentesis,
 removal of the fluid by needle aspiration, or insertion of
a chest tube.
Continued..
 Management of chronic atelectasis focuses on
removing the cause of the obstruction of the
airways or the compression of the lung tissue.
 Bronchoscopy may be used to open an airway
obstructed by lung cancer or a nonmalignant
lesion, and the procedure may involve
cryotherapy or laser therapy.
Nursing management
 Nursing Assessment
 Obtain history of previous pulmonary
condition.
 Assess patient for dyspnea and tachypnea.
 Auscultate and percuss lungs for abnormalities
 Presence of respiratory secretions
Nursing diagnosis
1. Ineffective Breathing Pattern related to collection of fluid in
pleural space
2. Ineffective tissue perfusion related to decreased lung compliance
secondary to disease condition as evidenced by decreased SPO2.
3. Altered body temperature related to infection secondary to
disease condition as evidenced by patient’s body temperature
(38.6 degree Celsius).
4. Self care deficit related to critical condition of health and
mechanical ventilator secondary to sedation.
5. Anxiety related to unknown outcome.
Continued..
6. Knowledge deficient regarding condition, treatment
and self-care.
7. Risk for impaired skin integrity related to prolonged
immobility secondary to disease condition.
8. Risk for infection related to invasive procedures as
well as invasive and non invasive lines.
9. Anticipatory grieving related to perceived impending
death of the patient.
Maintaining Normal Breathing
Pattern
• Observe patient's breathing pattern, oxygen saturation,
and other vital signs, for evidence of improvement or
deterioration
• Administered oxygen as indicated by dyspnea and
hypoxemia.
• Mechanical ventilator parameters were monitored
• Patient was positioned in propped up position.
Maintain effective and patent airway
Interventions
 The patient’s respiratory status was assessed
 Auscultation of breath sounds done.
 Signs of cyanosis, dyspnea and hypoxia
observed.
 Patient’s ABG levels monitored regularly.
 Patient kept in a propped up or Fowler’s
position.
Continued..
 Humidification provided.
 Chest physiotherapy was provided to the
patient
 Suctioning was done under aseptic
techniques.
Maintaining effective tissue
perfusion
 The patient’s respiratory status was assessed.
 Auscultation of breath sounds was done.
 Signs of cyanosis, dyspnea and hypoxia observed.
 Patient’s ABG levels were monitored regularly.
 Vital signs monitored regularly.
 Patient kept in a propped up position.
 Ventilator circuits checked for any leakage.
 Adequate hyper-oxygenation done prior to and after
suctioning.
Reduce fever
 Vital signs monitored regularly.
 Blood investigations (TLC, Blood CS and ET
aspirate) were sent as prescribed.
 Sponging done.
 Cool environment was maintained
 Administered antipyretic and antibiotics as
prescribed.
Continued..
 I.V. tubing/lines were changed according
to hospital protocol.
 Hydration of the patient was maintained
via feed
 Temperature reassessed every 2 hourly.
To reduce anxiety
 Anxiety level along with previous coping mechanism of the
family was assessed
 Established trusting relationship with family
 Family encouraged to ask questions & clarify doubts
 Family provided explanation in simple words
 Importance and rationale for ventilation and ET insertion was
explained.
 Family members involved in plan of care.
 Diversional activities encouraged.
To maintain skin integrity
 Assessment of the patient’s skin was done
carefully for signs of infection, inflammation, and
breakdown.
 Patient’s position changed every 2 hours.
 Skin care and back care provided.
 Soiled linen and clothes were changed
accordingly
 Nutritional status of the patient was maintained
References
 Woods S.L.et al. Cardiac nursing . Lippincott Williams & Wilkins. 2000
 Lippincott Manual of Nursing Practice. 8th edition. Lippincott Williams &
Wilkins Publishers; 2010. p. 68, 328-332, 361.
 Smeltznner SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing. 11th edition. Lippincott Williams &
Wilkins Publishers; 2008. p. 789-805.
 Longo et al.Harrisons principles of internal medicine.18(2):2012
 Chintamoni Lewis LS et al.Lewis’s medical surgical nursing:assessment
and management of clinical problems.7. New delhi.ELSEVIER;2011

More Related Content

What's hot

Lungs abscess
Lungs abscessLungs abscess
Lungs abscess
Abhay Rajpoot
 
Empyema
EmpyemaEmpyema
Empyema
salman habeeb
 
Pleural effusion
Pleural effusionPleural effusion
Pleural effusion
education4227
 
Bronchiectasis
Bronchiectasis Bronchiectasis
Bronchiectasis
ANILKUMAR BR
 
5.Bronchiectasis
5.Bronchiectasis5.Bronchiectasis
5.Bronchiectasis
ghalan
 
Emphyisema
EmphyisemaEmphyisema
Emphyisema
Abhay Rajpoot
 
Acute respiratory distress syndrome
Acute respiratory distress syndromeAcute respiratory distress syndrome
Acute respiratory distress syndrome
Pinky Rathee
 
Management of Pleural effusion
 Management of Pleural effusion  Management of Pleural effusion
Management of Pleural effusion
PROFESSOR DR. MD. TOUFIQUR RAHMAN
 
Lung abscess
Lung abscessLung abscess
Lung abscess
coolboy101pk
 
Pulmonary embolism
Pulmonary embolism Pulmonary embolism
Emphysema
EmphysemaEmphysema
Emphysema
Ramzee Small
 
Cor pulmonale
Cor pulmonaleCor pulmonale
Cor pulmonale
Ratheeshkrishnakripa
 
Respiratory failure
Respiratory failureRespiratory failure
Respiratory failure
Vijay Sal
 
Pulmonary embolism ppt
Pulmonary embolism pptPulmonary embolism ppt
Pulmonary embolism ppt
resmigs
 
Acute respiratory failure ppt
Acute respiratory failure pptAcute respiratory failure ppt
Acute respiratory failure ppt
Mahesh Chand
 
Asthma
AsthmaAsthma
Aspiration pneumonia
Aspiration pneumoniaAspiration pneumonia
Aspiration pneumonia
Ankit Gajjar
 
Pulmonary Embolism
Pulmonary EmbolismPulmonary Embolism
Pulmonary Embolism
meducationdotnet
 
Pneumothorax & Haemothorax
Pneumothorax & HaemothoraxPneumothorax & Haemothorax
Pneumothorax & Haemothorax
Abhay Rajpoot
 
Atelectasis
Atelectasis   Atelectasis
Atelectasis
OM VERMA
 

What's hot (20)

Lungs abscess
Lungs abscessLungs abscess
Lungs abscess
 
Empyema
EmpyemaEmpyema
Empyema
 
Pleural effusion
Pleural effusionPleural effusion
Pleural effusion
 
Bronchiectasis
Bronchiectasis Bronchiectasis
Bronchiectasis
 
5.Bronchiectasis
5.Bronchiectasis5.Bronchiectasis
5.Bronchiectasis
 
Emphyisema
EmphyisemaEmphyisema
Emphyisema
 
Acute respiratory distress syndrome
Acute respiratory distress syndromeAcute respiratory distress syndrome
Acute respiratory distress syndrome
 
Management of Pleural effusion
 Management of Pleural effusion  Management of Pleural effusion
Management of Pleural effusion
 
Lung abscess
Lung abscessLung abscess
Lung abscess
 
Pulmonary embolism
Pulmonary embolism Pulmonary embolism
Pulmonary embolism
 
Emphysema
EmphysemaEmphysema
Emphysema
 
Cor pulmonale
Cor pulmonaleCor pulmonale
Cor pulmonale
 
Respiratory failure
Respiratory failureRespiratory failure
Respiratory failure
 
Pulmonary embolism ppt
Pulmonary embolism pptPulmonary embolism ppt
Pulmonary embolism ppt
 
Acute respiratory failure ppt
Acute respiratory failure pptAcute respiratory failure ppt
Acute respiratory failure ppt
 
Asthma
AsthmaAsthma
Asthma
 
Aspiration pneumonia
Aspiration pneumoniaAspiration pneumonia
Aspiration pneumonia
 
Pulmonary Embolism
Pulmonary EmbolismPulmonary Embolism
Pulmonary Embolism
 
Pneumothorax & Haemothorax
Pneumothorax & HaemothoraxPneumothorax & Haemothorax
Pneumothorax & Haemothorax
 
Atelectasis
Atelectasis   Atelectasis
Atelectasis
 

Similar to Pleural effusion

Lower Respiratory Tract Conditions.ppt
Lower Respiratory Tract Conditions.pptLower Respiratory Tract Conditions.ppt
Lower Respiratory Tract Conditions.ppt
ShadrackKoech7
 
Pleural effusion
Pleural effusionPleural effusion
Pleural effusion
UnaisThaikkat
 
pleural_efusion.pdf
pleural_efusion.pdfpleural_efusion.pdf
pleural_efusion.pdf
sajjadAbd2
 
LCP Pleural Effusion Group Report March 12 2014
LCP Pleural Effusion Group Report March 12 2014LCP Pleural Effusion Group Report March 12 2014
LCP Pleural Effusion Group Report March 12 2014
Josephine Ann Necor
 
Acute pulmonary embolism and its management.
Acute pulmonary embolism and its management.Acute pulmonary embolism and its management.
Acute pulmonary embolism and its management.
Puja Gupta
 
pleuraleffusion-160424141916 (1) (2)-1.pdf
pleuraleffusion-160424141916 (1) (2)-1.pdfpleuraleffusion-160424141916 (1) (2)-1.pdf
pleuraleffusion-160424141916 (1) (2)-1.pdf
VanshikaGarg76
 
Swati pal ppt
Swati pal pptSwati pal ppt
Swati pal ppt
swatipalnehabharti
 
PLEURAL EFFUSION.pptx
PLEURAL EFFUSION.pptxPLEURAL EFFUSION.pptx
PLEURAL EFFUSION.pptx
rajendra gopal
 
Pleural effusion icd niv
Pleural effusion icd niv  Pleural effusion icd niv
Pleural effusion icd niv
prabuganesan3
 
Pulmonary-Failure-.pptx
Pulmonary-Failure-.pptxPulmonary-Failure-.pptx
Pulmonary-Failure-.pptx
WengelRedkiss
 
Pleural Effusion
Pleural EffusionPleural Effusion
Pleural effusion by nurse peter
Pleural effusion by nurse peterPleural effusion by nurse peter
Pleural effusion by nurse peter
Peter Shirima
 
Om pleural effusion
Om pleural effusionOm pleural effusion
Om pleural effusion
OM VERMA
 
Approaches to pleural effusion
Approaches to pleural effusionApproaches to pleural effusion
Approaches to pleural effusion
Dr Slayer
 
Pleural Effusion
Pleural EffusionPleural Effusion
Pulmonary edema.pptx
Pulmonary edema.pptxPulmonary edema.pptx
Pulmonary edema.pptx
Sapana Shrestha
 
Paediatric empyema case presentation
Paediatric empyema case presentationPaediatric empyema case presentation
Paediatric empyema case presentation
Asia Noureen
 
Reexpansion pulmonary edema
Reexpansion pulmonary edemaReexpansion pulmonary edema
Reexpansion pulmonary edema
Vijay Anand
 
EMPYEMA THORACIS.pdf
EMPYEMA THORACIS.pdfEMPYEMA THORACIS.pdf
EMPYEMA THORACIS.pdf
Shapi. MD
 
Respiratory system 1
Respiratory system 1Respiratory system 1
Respiratory system 1
Cindrella Zinnia Burge
 

Similar to Pleural effusion (20)

Lower Respiratory Tract Conditions.ppt
Lower Respiratory Tract Conditions.pptLower Respiratory Tract Conditions.ppt
Lower Respiratory Tract Conditions.ppt
 
Pleural effusion
Pleural effusionPleural effusion
Pleural effusion
 
pleural_efusion.pdf
pleural_efusion.pdfpleural_efusion.pdf
pleural_efusion.pdf
 
LCP Pleural Effusion Group Report March 12 2014
LCP Pleural Effusion Group Report March 12 2014LCP Pleural Effusion Group Report March 12 2014
LCP Pleural Effusion Group Report March 12 2014
 
Acute pulmonary embolism and its management.
Acute pulmonary embolism and its management.Acute pulmonary embolism and its management.
Acute pulmonary embolism and its management.
 
pleuraleffusion-160424141916 (1) (2)-1.pdf
pleuraleffusion-160424141916 (1) (2)-1.pdfpleuraleffusion-160424141916 (1) (2)-1.pdf
pleuraleffusion-160424141916 (1) (2)-1.pdf
 
Swati pal ppt
Swati pal pptSwati pal ppt
Swati pal ppt
 
PLEURAL EFFUSION.pptx
PLEURAL EFFUSION.pptxPLEURAL EFFUSION.pptx
PLEURAL EFFUSION.pptx
 
Pleural effusion icd niv
Pleural effusion icd niv  Pleural effusion icd niv
Pleural effusion icd niv
 
Pulmonary-Failure-.pptx
Pulmonary-Failure-.pptxPulmonary-Failure-.pptx
Pulmonary-Failure-.pptx
 
Pleural Effusion
Pleural EffusionPleural Effusion
Pleural Effusion
 
Pleural effusion by nurse peter
Pleural effusion by nurse peterPleural effusion by nurse peter
Pleural effusion by nurse peter
 
Om pleural effusion
Om pleural effusionOm pleural effusion
Om pleural effusion
 
Approaches to pleural effusion
Approaches to pleural effusionApproaches to pleural effusion
Approaches to pleural effusion
 
Pleural Effusion
Pleural EffusionPleural Effusion
Pleural Effusion
 
Pulmonary edema.pptx
Pulmonary edema.pptxPulmonary edema.pptx
Pulmonary edema.pptx
 
Paediatric empyema case presentation
Paediatric empyema case presentationPaediatric empyema case presentation
Paediatric empyema case presentation
 
Reexpansion pulmonary edema
Reexpansion pulmonary edemaReexpansion pulmonary edema
Reexpansion pulmonary edema
 
EMPYEMA THORACIS.pdf
EMPYEMA THORACIS.pdfEMPYEMA THORACIS.pdf
EMPYEMA THORACIS.pdf
 
Respiratory system 1
Respiratory system 1Respiratory system 1
Respiratory system 1
 

More from GAMANDEEP

Parathyroid disorders
Parathyroid disordersParathyroid disorders
Parathyroid disorders
GAMANDEEP
 
Pheochromocytoma
PheochromocytomaPheochromocytoma
Pheochromocytoma
GAMANDEEP
 
Disorders of adrenal gland
Disorders of adrenal glandDisorders of adrenal gland
Disorders of adrenal gland
GAMANDEEP
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
GAMANDEEP
 
Special respiratory therapies
Special respiratory therapiesSpecial respiratory therapies
Special respiratory therapies
GAMANDEEP
 
Respiratory failure
Respiratory failureRespiratory failure
Respiratory failure
GAMANDEEP
 
Pulmonary embolism1
Pulmonary embolism1Pulmonary embolism1
Pulmonary embolism1
GAMANDEEP
 
Lung cancer
Lung cancerLung cancer
Lung cancer
GAMANDEEP
 
Pneumonia seminar presentaation
Pneumonia seminar presentaationPneumonia seminar presentaation
Pneumonia seminar presentaation
GAMANDEEP
 
Chest physiotherapy
Chest physiotherapyChest physiotherapy
Chest physiotherapy
GAMANDEEP
 
Tuberculosis
TuberculosisTuberculosis
Tuberculosis
GAMANDEEP
 
Asthma ppt
Asthma pptAsthma ppt
Asthma ppt
GAMANDEEP
 
Infection control and safety measures
Infection control and safety measuresInfection control and safety measures
Infection control and safety measures
GAMANDEEP
 
The evolution of nursing
The evolution of nursingThe evolution of nursing
The evolution of nursing
GAMANDEEP
 
International classification of disease
International classification of diseaseInternational classification of disease
International classification of disease
GAMANDEEP
 
Concept of disease causation
Concept of disease causationConcept of disease causation
Concept of disease causation
GAMANDEEP
 
Chest injury
Chest injuryChest injury
Chest injury
GAMANDEEP
 
Intracranial pressure measurement
Intracranial pressure measurementIntracranial pressure measurement
Intracranial pressure measurement
GAMANDEEP
 
Immunosuppressants final drug ppt
Immunosuppressants  final drug pptImmunosuppressants  final drug ppt
Immunosuppressants final drug ppt
GAMANDEEP
 
Polio myelitis
Polio myelitisPolio myelitis
Polio myelitis
GAMANDEEP
 

More from GAMANDEEP (20)

Parathyroid disorders
Parathyroid disordersParathyroid disorders
Parathyroid disorders
 
Pheochromocytoma
PheochromocytomaPheochromocytoma
Pheochromocytoma
 
Disorders of adrenal gland
Disorders of adrenal glandDisorders of adrenal gland
Disorders of adrenal gland
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Special respiratory therapies
Special respiratory therapiesSpecial respiratory therapies
Special respiratory therapies
 
Respiratory failure
Respiratory failureRespiratory failure
Respiratory failure
 
Pulmonary embolism1
Pulmonary embolism1Pulmonary embolism1
Pulmonary embolism1
 
Lung cancer
Lung cancerLung cancer
Lung cancer
 
Pneumonia seminar presentaation
Pneumonia seminar presentaationPneumonia seminar presentaation
Pneumonia seminar presentaation
 
Chest physiotherapy
Chest physiotherapyChest physiotherapy
Chest physiotherapy
 
Tuberculosis
TuberculosisTuberculosis
Tuberculosis
 
Asthma ppt
Asthma pptAsthma ppt
Asthma ppt
 
Infection control and safety measures
Infection control and safety measuresInfection control and safety measures
Infection control and safety measures
 
The evolution of nursing
The evolution of nursingThe evolution of nursing
The evolution of nursing
 
International classification of disease
International classification of diseaseInternational classification of disease
International classification of disease
 
Concept of disease causation
Concept of disease causationConcept of disease causation
Concept of disease causation
 
Chest injury
Chest injuryChest injury
Chest injury
 
Intracranial pressure measurement
Intracranial pressure measurementIntracranial pressure measurement
Intracranial pressure measurement
 
Immunosuppressants final drug ppt
Immunosuppressants  final drug pptImmunosuppressants  final drug ppt
Immunosuppressants final drug ppt
 
Polio myelitis
Polio myelitisPolio myelitis
Polio myelitis
 

Recently uploaded

Girls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in CityGirls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in City
snehamittal#G05
 
MGI DNBSEQ Sequencing Technology short.pptx
MGI DNBSEQ Sequencing Technology short.pptxMGI DNBSEQ Sequencing Technology short.pptx
MGI DNBSEQ Sequencing Technology short.pptx
tnglml2
 
RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.
RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.
RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.
BinduBandheBarman
 
chapter 1- changing trends in physical education.pptx
chapter 1- changing trends in physical education.pptxchapter 1- changing trends in physical education.pptx
chapter 1- changing trends in physical education.pptx
divijsinghrenu10
 
Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...
Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...
Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...
grandmotherprocess99
 
Girls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in CityGirls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in City
snehamittal#G05
 
�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf
�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf
�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf
د حاتم البيطار
 
Respectful Care _Special Patient Care for health science students
Respectful Care _Special Patient Care for health science studentsRespectful Care _Special Patient Care for health science students
Respectful Care _Special Patient Care for health science students
Debre Berhan University
 
arm balance asana - Comprehensive understanding of arm balancing asana
arm balance asana - Comprehensive understanding of arm balancing asanaarm balance asana - Comprehensive understanding of arm balancing asana
arm balance asana - Comprehensive understanding of arm balancing asana
Karuna Yoga Vidya Peetham
 
Cardiac_Disease-1.ppt in canine & feline
Cardiac_Disease-1.ppt in canine & felineCardiac_Disease-1.ppt in canine & feline
Cardiac_Disease-1.ppt in canine & feline
MadhudarshiKumar2
 
Girls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in CityGirls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in City
snehamittal#G05
 
Asthma CPD.pptx.Based on new GINA guidelines
Asthma CPD.pptx.Based on new GINA guidelinesAsthma CPD.pptx.Based on new GINA guidelines
Asthma CPD.pptx.Based on new GINA guidelines
RanaTareq1
 
Diagnosis and treatment planning in complete denture.pptx
Diagnosis and treatment planning in complete denture.pptxDiagnosis and treatment planning in complete denture.pptx
Diagnosis and treatment planning in complete denture.pptx
SatvikaPrasad
 
High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...
High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...
High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...
jealousviolet
 
Welco to PowerPointhihhlljjjllasfafafkkk
Welco to PowerPointhihhlljjjllasfafafkkkWelco to PowerPointhihhlljjjllasfafafkkk
Welco to PowerPointhihhlljjjllasfafafkkk
TngHunh31
 
How Virtual Medical Assistants Improve Patient Engagement.pdf
How Virtual Medical Assistants Improve Patient Engagement.pdfHow Virtual Medical Assistants Improve Patient Engagement.pdf
How Virtual Medical Assistants Improve Patient Engagement.pdf
johnmark49490
 
Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...
Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...
Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...
bellared2
 
ppt on National health mission copy - pptx
ppt on National health mission copy - pptxppt on National health mission copy - pptx
ppt on National health mission copy - pptx
AbinanthanLekhashree
 
Multiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - PlexusMultiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - Plexus
Albert840788
 
RNA AND DNA VIRUSES morphology,chemical composition
RNA AND DNA VIRUSES morphology,chemical compositionRNA AND DNA VIRUSES morphology,chemical composition
RNA AND DNA VIRUSES morphology,chemical composition
BenjaminMutisyaMuimi
 

Recently uploaded (20)

Girls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in CityGirls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Mumbai 000XX00000 Provide Best And Top Girl Service And No1 in City
 
MGI DNBSEQ Sequencing Technology short.pptx
MGI DNBSEQ Sequencing Technology short.pptxMGI DNBSEQ Sequencing Technology short.pptx
MGI DNBSEQ Sequencing Technology short.pptx
 
RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.
RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.
RTI STD TORCH UTI ,HIV/AIDS BY BINDU PRE.
 
chapter 1- changing trends in physical education.pptx
chapter 1- changing trends in physical education.pptxchapter 1- changing trends in physical education.pptx
chapter 1- changing trends in physical education.pptx
 
Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...
Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...
Procaine powder cas 51-05-8 safe Transport safety to Europe Netherlands Facto...
 
Girls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in CityGirls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Thane 000XX00000 Provide Best And Top Girl Service And No1 in City
 
�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf
�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf
�� د حاتم البيطار القمةاسينمنت فاضية لطلاب القمة كورس مساعد طبيب الاسنان 2�.pdf
 
Respectful Care _Special Patient Care for health science students
Respectful Care _Special Patient Care for health science studentsRespectful Care _Special Patient Care for health science students
Respectful Care _Special Patient Care for health science students
 
arm balance asana - Comprehensive understanding of arm balancing asana
arm balance asana - Comprehensive understanding of arm balancing asanaarm balance asana - Comprehensive understanding of arm balancing asana
arm balance asana - Comprehensive understanding of arm balancing asana
 
Cardiac_Disease-1.ppt in canine & feline
Cardiac_Disease-1.ppt in canine & felineCardiac_Disease-1.ppt in canine & feline
Cardiac_Disease-1.ppt in canine & feline
 
Girls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in CityGirls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in City
Girls Call Delhi 000XX00000 Provide Best And Top Girl Service And No1 in City
 
Asthma CPD.pptx.Based on new GINA guidelines
Asthma CPD.pptx.Based on new GINA guidelinesAsthma CPD.pptx.Based on new GINA guidelines
Asthma CPD.pptx.Based on new GINA guidelines
 
Diagnosis and treatment planning in complete denture.pptx
Diagnosis and treatment planning in complete denture.pptxDiagnosis and treatment planning in complete denture.pptx
Diagnosis and treatment planning in complete denture.pptx
 
High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...
High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...
High Class Girls Call Mumbai 9910780858 Provide Best And Top Girl Service And...
 
Welco to PowerPointhihhlljjjllasfafafkkk
Welco to PowerPointhihhlljjjllasfafafkkkWelco to PowerPointhihhlljjjllasfafafkkk
Welco to PowerPointhihhlljjjllasfafafkkk
 
How Virtual Medical Assistants Improve Patient Engagement.pdf
How Virtual Medical Assistants Improve Patient Engagement.pdfHow Virtual Medical Assistants Improve Patient Engagement.pdf
How Virtual Medical Assistants Improve Patient Engagement.pdf
 
Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...
Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...
Female Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Serv...
 
ppt on National health mission copy - pptx
ppt on National health mission copy - pptxppt on National health mission copy - pptx
ppt on National health mission copy - pptx
 
Multiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - PlexusMultiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - Plexus
 
RNA AND DNA VIRUSES morphology,chemical composition
RNA AND DNA VIRUSES morphology,chemical compositionRNA AND DNA VIRUSES morphology,chemical composition
RNA AND DNA VIRUSES morphology,chemical composition
 

Pleural effusion

  • 2. Pleural effusion  Pleural effusion, a collection of fluid in the pleural space, is rarely a primary disease process but is usually secondary to other diseases.
  • 3. Causes Pleural effusion may be a complication of :-  Heart failure,  Tuberculosis,  Pneumonia,  Pulmonary infections,  Nephritic syndrome,  Connective tissue disease,  Pulmonary embolism, and  Neoplasm (tumor).
  • 4. Pathophysiology The effusion can be composed of a relatively clear fluid, or it can be bloody or purulent. An effusion of clear fluid may be a transudate or an exudate. (Transudate is fluid pushed through the capillary due to high pressure within the capillary. Exudate is fluid that leaks around the cells of the capillaries caused by inflammation.) A transudate (filtrates of plasma that move across intact capillary walls) occurs when factors influencing the formation and re- absorption of pleural fluid are altered, usually by imbalances in hydrostatic or oncotic pressures.
  • 5. Continued.. The finding of a transudative effusion generally implies that the pleural membranes are not diseased. The most common cause of a transudative effusion is heart failure. An exudates (extravasation of fluid into tissues or a cavity) usually results from inflammation by bacterial products or tumors involving the pleural surfaces.
  • 6. Clinical Manifestations  Pneumonia causes fever, chills,  Pleuritic chest pain,  Malignant effusion may result in dyspnea and coughing.  A large pleural effusion causes shortness of breath.
  • 7. Assessment and Diagnostic Findings  Assessment of the area of the pleural effusion reveals decreased or absent breath sounds, decreased fremitus, and a dull, flat sound when percussed.  In an extremely large pleural effusion, the assessment reveals a patient in acute respiratory distress.
  • 8. Continued..  Tracheal deviation away from the affected side may also be noted.  Physical examination, chest x-ray, chest CT scan, and thoracentesis confirm the presence of fluid.  In some instances, a lateral decubitus x-ray is obtained.  A pleural effusion can be diagnosed because this position allows for the “layering out” of the fluid, and an air–fluid line is visible
  • 9. Continued..  Pleural fluid analysis by bacterial culture, Gram stain, acid fast bacillus stain (for TB), red and white blood cell counts, chemistry studies (glucose, amylase, lactic dehydrogenase, protein), cytologic analysis for malignant cells, and pH.
  • 10. Medical management  The objectives of treatment :  discover the underlying cause  to prevent re accumulation of fluid, and to relieve discomfort, dyspnea, and respiratory compromise.  Specific treatment is directed at the underlying cause (eg, heart failure, pneumonia, lung cancer, cirrhosis).
  • 11.  Thoracentesis is performed to remove fluid, to obtain a specimen for analysis, and to relieve dyspnea and respiratory compromise.
  • 12. CONTINUED..  Repeated thoracenteses result in pain, depletion of protein and electrolytes, and sometimes pneumothorax.  Once the pleural space is adequately drained, a chemical pleurodesis may be performed to obliterate the pleural space and prevent reaccumulation of fluid
  • 13. Other treatments  Surgical pleurectomy  Insertion of a small catheter attached to a drainage bottle for outpatient management  Implantation of a Pleura peritoneal shunt
  • 14. PP shunt  A pleura peritoneal shunt consists of two catheters connected by a pump chamber containing two one- way valves. Fluid moves from the pleural space to the pump chamber and then to the peritoneal cavity.  The patient manually pumps on the reservoir daily to move fluid from the pleural space to the peritoneal space.
  • 15. Atelectesis  It refers to closure or collapse of alveoli and often is described in relation to x-ray findings and clinical signs and symptoms.  May be acute or chronic and may cover a broad range of pathophysiologic changes,  Microatelectasis /Macroatelectasis
  • 16. Continued..  Excess secretions or mucus plugs may also cause obstruction of airflow and result in atelectasis in an area of the lung.  Atelectasis also is observed in patients with a chronic airway obstruction that impedes or blocks air flow to an area of the lung  Atelectasis resulting from bronchial obstruction by secretions may occur in patients with impaired cough mechanisms (eg, postoperative, musculoskeletal or neurologic disorders) or in debilitated, bedridden patients.
  • 17.  Atelectasis may also result from excessive pressure on the lung tissue, which restricts normal lung expansion on inspiration.  Such pressure may be produced by fluid accumulating within the pleural space (pleural effusion), air in the pleural space (pneumothorax), or blood in the pleural space (hemothorax).
  • 18. Pathophysiology  Following obstruction of bronchus the blood circulating absorbs gas from alveoli  Lead to retraction of lungs  Blood perfuses unventillated lung  Results in arterial hypoximea  Uninvolved surrounding lung distends displacing surrounding structures  Mediastinal shift
  • 19. Clinical manifestations  Fever is universally cited as a clinical sign of atelectasis,  marked respiratory distress in In acute atelectasis involving a large amount of lung tissue (lobar atelectasis),  Dyspnea, tachycardia, tachypnea, pleural pain, and central cyanosis
  • 20. Assessment and Diagnostic Findings  Decreased breath sounds and crackles are heard over the affected area.  In addition, chest x-ray findings may reveal patchy infiltrates or consolidated areas.  Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen (less than 90%) or a lower-than-normal partial pressure of arterial oxygen (PaO2).
  • 21. CONTINUED..  Cough, Sputum Production, And Low-grade Fever.  Dyspnea,  Tachycardia,tachypnea  Pleural Pain  Central Cyanosis
  • 22. Management  First line measures:  frequent turning, early ambulation, lung volume expansion maneuvers (eg, deep- breathing exercises, incentive spirometry), and coughing
  • 23. Other treatments such as positive expiratory pressure or PEP therapy (a simple mask and one way valve system that provides varying amounts of expiratory resistance [usually 5 to 15 cm H2O]) Continuous or intermittent positive pressure- breathing (IPPB)
  • 25. Continued..  Chest physical therapy to mobilize secretions.  Nebulizer treatments with a bronchodilator medication or sodium bicarbonate.  Endotracheal intubation and mechanical ventilation may be necessary.  With a large pleural effusion that is compressing lung tissue and causing alveolar collapse, treatment may include thoracentesis,  removal of the fluid by needle aspiration, or insertion of a chest tube.
  • 26. Continued..  Management of chronic atelectasis focuses on removing the cause of the obstruction of the airways or the compression of the lung tissue.  Bronchoscopy may be used to open an airway obstructed by lung cancer or a nonmalignant lesion, and the procedure may involve cryotherapy or laser therapy.
  • 27. Nursing management  Nursing Assessment  Obtain history of previous pulmonary condition.  Assess patient for dyspnea and tachypnea.  Auscultate and percuss lungs for abnormalities  Presence of respiratory secretions
  • 28. Nursing diagnosis 1. Ineffective Breathing Pattern related to collection of fluid in pleural space 2. Ineffective tissue perfusion related to decreased lung compliance secondary to disease condition as evidenced by decreased SPO2. 3. Altered body temperature related to infection secondary to disease condition as evidenced by patient’s body temperature (38.6 degree Celsius). 4. Self care deficit related to critical condition of health and mechanical ventilator secondary to sedation. 5. Anxiety related to unknown outcome.
  • 29. Continued.. 6. Knowledge deficient regarding condition, treatment and self-care. 7. Risk for impaired skin integrity related to prolonged immobility secondary to disease condition. 8. Risk for infection related to invasive procedures as well as invasive and non invasive lines. 9. Anticipatory grieving related to perceived impending death of the patient.
  • 30. Maintaining Normal Breathing Pattern • Observe patient's breathing pattern, oxygen saturation, and other vital signs, for evidence of improvement or deterioration • Administered oxygen as indicated by dyspnea and hypoxemia. • Mechanical ventilator parameters were monitored • Patient was positioned in propped up position.
  • 31. Maintain effective and patent airway Interventions  The patient’s respiratory status was assessed  Auscultation of breath sounds done.  Signs of cyanosis, dyspnea and hypoxia observed.  Patient’s ABG levels monitored regularly.  Patient kept in a propped up or Fowler’s position.
  • 32. Continued..  Humidification provided.  Chest physiotherapy was provided to the patient  Suctioning was done under aseptic techniques.
  • 33. Maintaining effective tissue perfusion  The patient’s respiratory status was assessed.  Auscultation of breath sounds was done.  Signs of cyanosis, dyspnea and hypoxia observed.  Patient’s ABG levels were monitored regularly.  Vital signs monitored regularly.  Patient kept in a propped up position.  Ventilator circuits checked for any leakage.  Adequate hyper-oxygenation done prior to and after suctioning.
  • 34. Reduce fever  Vital signs monitored regularly.  Blood investigations (TLC, Blood CS and ET aspirate) were sent as prescribed.  Sponging done.  Cool environment was maintained  Administered antipyretic and antibiotics as prescribed.
  • 35. Continued..  I.V. tubing/lines were changed according to hospital protocol.  Hydration of the patient was maintained via feed  Temperature reassessed every 2 hourly.
  • 36. To reduce anxiety  Anxiety level along with previous coping mechanism of the family was assessed  Established trusting relationship with family  Family encouraged to ask questions & clarify doubts  Family provided explanation in simple words  Importance and rationale for ventilation and ET insertion was explained.  Family members involved in plan of care.  Diversional activities encouraged.
  • 37. To maintain skin integrity  Assessment of the patient’s skin was done carefully for signs of infection, inflammation, and breakdown.  Patient’s position changed every 2 hours.  Skin care and back care provided.  Soiled linen and clothes were changed accordingly  Nutritional status of the patient was maintained
  • 38. References  Woods S.L.et al. Cardiac nursing . Lippincott Williams & Wilkins. 2000  Lippincott Manual of Nursing Practice. 8th edition. Lippincott Williams & Wilkins Publishers; 2010. p. 68, 328-332, 361.  Smeltznner SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 11th edition. Lippincott Williams & Wilkins Publishers; 2008. p. 789-805.  Longo et al.Harrisons principles of internal medicine.18(2):2012  Chintamoni Lewis LS et al.Lewis’s medical surgical nursing:assessment and management of clinical problems.7. New delhi.ELSEVIER;2011

Editor's Notes

  1. For this x-ray, the patient lies on the affected side in a side-lying position.