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.

1. PLEURAL EFFUSION
BY
Mr. ANILKUMAR B R
Assit Professor
Medical-surgical Nursing

2. PLEURAL EFFUSION

3. PLEURAL EFFUSION
• 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)

4. PLEURAL EFFUSION
• Refers to any significant collection of
fluid within pleural space.
• Any imbalance in formation, absorption
lead accumulation of pleural fluid.
Common condition:
1.CHF
2.Bacterial pneumonia
3.Malignancy(chest tumor)
4.Pulmonary embolism

5. Definition
• A pleural effusion describes an
excess of fluid in the pleural cavity,
usually resulting from an imbalance
in the normal rate of pleural fluid
production or absorption, or both.

6. What is Pleural effusion?
• Pleura effusion is
a condition refers
to a collection of
fluid in the pleural
space. It is almost
secondary to other
conditions.

7. Pleural effusion
• This fluid excessive amounts of such
fluid can impair breathing by limiting
the expansion of the lungs during
respiration.

8. TYPES OF PLEURAL EFFUSION
• TRANSUDATIVE EFFUSIONS
• EXUDATIVE EFFUSIONS

9. TRANSUDATIVE EFFUSIONS
• Transudative effusions arise from more
commonly:
Congestive heart failure
 Hepatic disease with ascites
 Nephrotic syndrome
 Peritoneal dialysis
 Hypoalbuminemia and disorders of increase
extra cellular volume.

10. Characteristics of Tranudative effusion
• Occurs primarily in non-inflammatory
conditions.
• low protein, low-cell-count fluid.
• Clear to faint yellow tinge, no odor
• pH 7.40 7.55‐
• Specific gravity < 1.015
• Protein content < 3g/100ml
• Glucose level equal serum plasma

11. EXUDATIVE EFFUSIONS
• Exudative effusion result from several
conditions such as:
1.Tuberculosis
2.Subphrenic abscess
3.Pancreatitis
4.Bacterial or fungal pneuomonia
5.Empyema

12. 1. Cancer
2. Pulmonary embolism
3. SLE & rheumatoid arthritis
4. Intra abdominal abscess
5. Esophageal perforation and chest
injuries

13. Characteristics of Exudative effusion
• Often turbid, bloody or purulent
• pH < 7.30
• Specific gravity > 1.016
• Protein content > 3g/100ml
• Glucose level < 60mg/dl.
• High-protein fluid

14. Types of fluids
THERE ARE MAINLY Four types of fluids can
accumulate in the pleural space:
1. Serous fluid (hydrothorax) : A
hydrothorax is a condition that results from
serous fluid accumulating in the pleural cavity.
2.Blood (haemothorax): is a condition that
results from blood accumulating in the pleural
cavity.

15. Types of fluids
3. Pus (pyothorax or empyema) : is
an accumulation of pus in the pleural
cavity.

16. 2. Chyle (chylothorax): chyle is a milky
bodily fluid consisting of lymph and
emulsified fats, or free fatty acids (FFAs)
and 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.

17. Complications
• Large effusions could lead to
reparatory failure.

18. Clinical Manifestations
The clinical presentation of pleural effusion
depends on the amount of fluid present and
the underlying cause.
Many patients have no symptoms at the
time a pleural effusion is discovered.

19. Clinical Manifestations
1. Pleuritic chest pain
2. Dyspnea
3. Nonproductive cough.
• The chest pain is usually sharp and is
exacerbated by movement of the pleural
surfaces, as with deep inspiration,
coughing, and sneezing.

20. Assessment & Diagnosis
• History collection (A history of
pneumonia, chest tumor cardiac, renal, or
liver impairment and cancer related
treatment)
• Physical examination (decreased or
absent breath sounds, decreased fremitus,
and a dull, flat sound when percussed)

21. Imaging studies
Chest radiography

22. Ultrasonography thorax
• Even small amounts of pleural effusion can be
detected accurately by ultrasonography.
• CT-Scan thorax

23. Thoracocentesis

24. Medical Management
• The objectives of treatment are to
discover the underlying cause, to prevent
reaccumulation of fluid, and to relieve
discomfort, dyspnea, and respiratory
compromise mainating oxygenation &
facilating drainage)

25. Medical Management
• Thoracentesis is performed to remove
fluid, to obtain a specimen for analysis,
and to relieve dyspnea and respiratory
compromise.
• Thoracentesis may be performed under
ultrasound guidance.

26. Nursing Management
• The nurse’s role in the care of the patient
with a pleural effusion includes
implementing the medical regimen.

27. • The nurse prepares and positions the
patient for thoracentesis and offers
support throughout the procedure.
• Pain management is a priority, and the
nurse assists the patient to assume
positions that are the least painful.

28. Nursing diagnosis
• Risk for infection related to introduction of
foreign object ( thoracentesis needle, chest
tube) in to chest cavity.
• Impaired gas exchange related to
ineffective breathing pattern.
• Anxiety related to diagnosis and
therapeutic procedure ( thoracentesis, chest
drainage).

29. Nursing Interventions
• Administer oxygen and in empyema
antibiotics, as ordered. Record the client
response to these treatments.
• Encourage to perform to perform
pulmonary exercise such as deep
breathing, effective coughing and use of
spirometry etc.

30. Nursing Interventions
• Prepare the client for thoracentesis
procedure and assist to physician during
procedure and monitor complications
associated with thoracentesis ( bleeding,
pain, dyspena and cyanosis).
• Monitor client respiratory status
frequently. Obtain ABGs if necessary.

31. Nursing Interventions
• Ensure chest tube patency by observing
for fluctuations in the tubing. Record the
amount, color, and consistency of any
tube drainage.