This document provides information on pleural effusions including the physiology of normal lungs, definition of pleural effusion, types of effusions, causes, pathophysiology, clinical manifestations, diagnostic evaluations, treatment, nursing diagnosis and interventions, and possible complications. A pleural effusion is an abnormal collection of fluid in the pleural space between the lungs and chest wall. Effusions can be transudative or exudative depending on the fluid characteristics and underlying cause. Diagnosis involves imaging and fluid analysis. Treatment focuses on removing fluid and treating the underlying cause. Nursing care centers around pain management, breathing exercises, and preventing infections.
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.
But if fluid builds up from either increased production or inadequate removal pleural effusion results.
Pleural effusion B/L or unilateral (parapneumonic process)
Refers to any significant collection of fluid within pleural space.
Any imbalance in formation, absorption lead accumulation of pleural fluid. Common condition:
CHF
Bacterial pneumonia
Malignancy(chest tumor)
Pulmonary embolism
Pleura effusion is a condition refers to a collection of fluid in the pleural space. It is almost secondary to other conditions.
Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing.
Cor pulmonale is alteration in the structure and function of the right ventricle (RV) of the heart. The overall five-year survival rate for cor pulmonale complicating COPD is approximately 50%.
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.
But if fluid builds up from either increased production or inadequate removal pleural effusion results.
Pleural effusion B/L or unilateral (parapneumonic process)
Refers to any significant collection of fluid within pleural space.
Any imbalance in formation, absorption lead accumulation of pleural fluid. Common condition:
CHF
Bacterial pneumonia
Malignancy(chest tumor)
Pulmonary embolism
Pleura effusion is a condition refers to a collection of fluid in the pleural space. It is almost secondary to other conditions.
Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing.
Cor pulmonale is alteration in the structure and function of the right ventricle (RV) of the heart. The overall five-year survival rate for cor pulmonale complicating COPD is approximately 50%.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
Atelectasis is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid.
Urinary Tract Infection with Nursing ManagementSwatilekha Das
Urinary Tract Infection introduction, definition, common microorganisms, classification, predisposing factors, clinical manifestations, pathophysiology, diagnostic studies, medical management and nursing management along with assessment, nursing diagnosis, goal, nursing interventions and expected outcome after the intervention.
Atelectasis is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid.
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This 𝐏𝐥𝐞𝐮𝐫𝐚𝐥 𝐞𝐟𝐟𝐮𝐬𝐢𝐨𝐧animated template is designed by RxSlides, a medical professional team covering the following topics about 𝐏𝐥𝐞𝐮𝐫𝐚𝐥 𝐞𝐟𝐟𝐮𝐬𝐢𝐨𝐧
𝐃𝐞𝐟𝐢𝐧𝐢𝐭𝐢𝐨𝐧:
• Respiratory illness caused by the buildup of fluid between lung and chest cavity tissue layers.
𝐀𝐧𝐚𝐭𝐨𝐦𝐲 𝐨𝐟 𝐭𝐡𝐞 𝐋𝐮𝐧𝐠
• The lung is a vital organ responsible for gas exchange.
• It is surrounded by two thin membranes called the pleurae.
• The visceral pleura covers the lung surface.
• The parietal pleura lines the inner chest wall.
𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞:
• 𝐏𝐥𝐞𝐮𝐫𝐚𝐥 𝐞𝐟𝐟𝐮𝐬𝐢𝐨𝐧 is a common condition, affecting millions of people worldwide.
• The prevalence varies by region, with higher rates in developing countries
𝐏𝐚𝐭𝐡𝐨𝐩𝐡𝐲𝐬𝐢𝐨𝐥𝐨𝐠𝐲:
• Illustrated anatomy of the respiratory system included.
• Animated illustrations demonstrate fluid formation and maintenance.
• Parietal and visceral pleura form the pleural space.
• Fluid produced by filtration from systemic capillaries.
• Fluid accumulation in the pleural cavity causes Pleural Effusion.
𝐑𝐢𝐬𝐤 𝐅𝐚𝐜𝐭𝐨𝐫𝐬
• Smoking
• Heart disease
• Liver disease
• Alcohol
• Lung disease
• Asbestos exposure
𝐜𝐚𝐮𝐬𝐞𝐬:
𝐓𝐫𝐚𝐧𝐬𝐮𝐝𝐚𝐭𝐢𝐯𝐞
o Increased systemic/pulmonary capillary pressure and decreased osmotic pressure.
o Major causes: cirrhosis, heart failure, nephrotic syndrome, protein-losing enteropathy.
𝐄𝐱𝐮𝐝𝐚𝐭𝐢𝐯𝐞:
o Local processes leading to increased capillary permeability.
o Fluid, protein, cells, and serum constituents exude.
o Major causes: inflammation, infection, lung injury, tumors, lung cancer, rheumatoid arthritis, pneumonia, tuberculosis, surgical damage, lymphatic fluid accumulation.
𝐒𝐲𝐦𝐩𝐭𝐨𝐦𝐬:
• Dyspnea (shortness of breath)
• Labored breathing
• Non-productive cough
• Chest tightness
• Orthopnea (difficulty breathing lying down)
𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐭𝐢𝐜 𝐦𝐞𝐭𝐡𝐨𝐝𝐬
• Physical examination
• Chest radiographs
• Imaging
𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐎𝐩𝐭𝐢𝐨𝐧𝐬:
Thoracentesis (fluid removal)
Catheter drainage
Pleurodesis (scarring of pleural space)
Pleuroperitoneal shunt (fluid drainage to abdomen)
Pleurectomy (surgical removal of pleura)
Thoracoscopy (visual examination of pleural space)
Thoracostomy (surgical opening of chest cavity)
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. PLEURAL EFFUSION
Conducted By: Mr. Atul Lawrence
M. Sc Nursing 1st Year
Medical Surgical Nursing
Rattan Professional College of Nursing
2. Physiology of the Normal
Lungs
• The lungs are soft, spongy, coneshaped organs located in the chest
cavity.
• They are separated by the
mediastinum and the heart. There
are 3 lobes on the right lung and 2
lobes on the left lung.
3.
4. Physiology of the
normal lungs cont..
• The lungs are supplied with blood via
the pulmonary and bronchial
circulations.
• Pulmonary circulation: supplied from
the pulmonary artery and provides for
gas exchange function of the lungs.
• Bronchial circulation: distributes blood
to the conducting airways and
supporting structures of the lung.
5. Physiology of the
normal lungs cont..
Layers of the lung
• Parietal Pleura -Lines the thoracic
cavity, including the thoracic cage,
mediastinum, and diaphragm.
• Pleural space- thin, transparent,
serous membrane which lines the
thoracic cavity a potential space
between the parietal pleura and
visceral pleura
• Visceral pleura- Lines the entire
surface of the lung.
6.
7.
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. Types of Effusions
a) TRANSUDATIVE PLEURAL EFFUSIONS
a fluid substance that has passed through
a membrane or has been extruded from
a tissue it is of high fluidity and has a
low content of protein, cells, or solid
materials derived from cells. 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
11. Types Of Effusions
cont..
EXUDATIVE EFFUSIONS
A fluid rich in protein and cellular
elements that oozes 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 .
signify underlying local
(pleuropulmonary) disease.
14. Types of fluids
Four types of fluids can accumulate in the
pleural space:
Serous fluid (hydrothorax) : A hydrothorax
is a condition that results from serous
fluid accumulating in the pleural cavity.
This specific condition can be related to
cirrhosis with ascites in which ascitic fluid
leaks into the pleural cavity
Blood (haemothorax): is a condition that
results from blood accumulating in the
pleural cavity
15. Chyle (chylothorax): chyle is a milky
bodily fluid consisting of lymph and
emulsified fats, or free fatty acids
(FFAs). It is formed in the small
intestine during digestion of fatty
foods .It is a type of pleural effusion .
It results from lymphatic fluid (chyle)
accumulating in the pleural cavity.
Pus (pyothorax or empyema) : is an
accumulation of pus in the pleural
cavity
16. Pathophysiology
It is explained by increased pleural fluid
formation or decreased pleural fluid
absorption. Increased pleural fluid formation
can result from elevation of hydrostatic
pressure & decreased osmotic pressure. It
leads to increased capillary permeability &
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 vital capacity
17. 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
18. 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
19. • 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
23. 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.
24. 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.
25. 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
26. 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)
27. 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.
28. 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.
29. 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.
30. 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.
31. 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.
32. 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).
33. • 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.