This document discusses pleural effusions, which are collections of fluid in the pleural space. Pleural effusions are usually secondary to other diseases rather than primary. There are two main types - transudative effusions which occur without inflammation from conditions like heart failure, and exudative effusions which occur with inflammation from things like infections or cancer. Diagnosis involves chest imaging and analyzing fluid obtained via thoracentesis. Treatment focuses on resolving the underlying cause as well as draining fluid to relieve symptoms. Nursing care centers around maintaining normal breathing patterns and monitoring for complications.

2. Introduction
Pleural effusion, a collection of fluid in
the pleural space, is rarely a primary
disease process but is usually secondary
to other diseases
The pleural space normally contains
only about 10-20 ml of serous fluid

3. Contd…
 Pleural fluid normally seeps continually
into the pleural space from the capillaries
lining the parietal pleura and is reabsorbed
by the visceral pleural capillaries and
lymphatic system
 Any condition that interferes with either
secretion or drainage of this fluid leads to
pleural effusion

4. Definition
Pleural effusion is a collection of
abnormal amount of fluid in the
pleural space

5. Classification
Transudative effusions
Exudative effusions

6. Transudative effusions
Transudative effusions also known as
hydrothoraces , occur primarily in
noninflammatory conditions; is an
accumulation of low-protein, low cell
count fluid

7. Cause of transudative effusion
Increase hydrostatic pressure found in heart
failure ( most common cause of pleural
effusion)
Decrease oncotic pressure ( From
hypoalbuminemia) found in cirrhosis of liver
or renal disease.
 In this condition, fluid movement is faciliated
out of the capillaries and into the pleural space

8. Exudative effusions
 Exudative effusions occur in an area of inflammation;
is an accumulation of high-protein fluid.
 An exudative effusion results from increased capillary
permeability characteristic of inflammatory reaction.
 This types of effusion occurs secondary to conditions
such as pulmonary malignancies, pulmonary
infections and pulmonary embolization.

9. Etiology
 Disseminated cancer (particularly lung and
breast), lymphoma
 Pleuro-pulmonary infections (pneumonia).
 Heart failure, cirrhosis, nephrotic syndrome
 Other conditions sarcoidosis, systemic lupus
erythematosus (SLE)
 Peritoneal dialysis

10. Pathophysiology
Transudative pleural effusions:
 hydrostatic pressure , oncotic pressure
 Unable to remain the fluid with in a intravascular space
 Fluid shift interstitial space
Effusion

11. Contd….
Exudative effusions
 Invasion of microbes
 Initiation of inflammatory reaction
 Vasodilation increase capillary permeability
 leak of plasma protein decrease oncotic pressure
fluid shift into interstitial space

12. Clinical Manifestations
 Usually the clinical manifestations are those caused
by the underlying disease and severity of effusion
 Pneumonia causes fever, chills, and pleuritic chest
pain,
 malignant effusion may result in dyspnea and
coughing

13. Contd…
 When a small to moderate pleural effusion is
present, dyspnea may be absent or only
minimal.
 Pleuritic chest pain,
 Dullness or flatness to percussion
 Decreased or absent breath sounds

14. Diagnostic Evaluation
Chest X-ray or ultrasound detects
presence of fluid.
Thoracentesis biochemical,
bacteriologic, and cytologic studies of
pleural fluid indicates cause.

16. Management
 The objectives of treatment are to discover the
underlying cause, to prevent reaccumulation of
fluid, and to relieve discomfort, dyspnea, and
respiratory compromise
General
 Treatment is aimed at underlying cause
(heart disease, infection).
 Thoracentesis is done to remove fluid,
collect a specimen, and relieve dyspnea

17. For Malignant Effusions
Chest tube drainage, radiation,
chemotherapy, surgical pleurectomy,
pleuroperitoneal shunt, or pleurodesis

18. Complications
Large effusion could lead to
respiratory failure

19. Nursing Assessment
Obtain history of previous pulmonary
condition
Assess patient for dyspnea and
tachypnea
Auscultate and percuss lungs for
abnormalities

20. Nursing Diagnosis
Ineffective Breathing Pattern related
to collection of fluid in pleural space

21. Nursing Interventions
Maintaining Normal Breathing Pattern
 Institute treatments to resolve the underlying cause as
ordered.
 Assist with thoracentesis if indicated
 Maintain chest drainage as needed
 Provide care after pleurodesis.
 Monitor for excessive pain from the sclerosing agent, which
may cause hypoventilation.
 Administer prescribed analgesic.
 Assist patient undergoing instillation of intrapleural lidocaine
if pain relief is not forthcoming.
 Administer oxygen as indicated by dyspnea and hypoxemia.
 Observe patient's breathing pattern, oxygen saturation

22. Evaluation: Expected Outcomes
 Reports absence of shortness of breath

23. THANK YOU

24. References
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Bucher. (2011). Lewis’s Medical Surgical Nursing:
Assessment and Management of Clinical Problems. (7th
Ed.). Mosby. P 595
 Black, J.M., Hawks, J.H., & Annabelle, M.K. (2005).
Medical-Surgical Nursing-clinical management for positive
outcomes.(6th ed.). P 1631
 Suzanne C. S., Brenda G. B., Janice L. H. , and Kerry H. C.
Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing.(11th ed). 540
 Lippincott Manual of Nursing Practice. (2010).William And
Wilkins.Nineth edition. 302