Nursing care of patient with respiratory diseases.

1. PLEURAL EFFUSION
Mr. Veerabhadra .B B
Asst Professor.
Medical surgical Nsg.

2. PLEURAL EFFUSION
 Pleural effusion, an
excess collection of
fluid in the pleural
space.
 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

3. CAUSES
 Heart failure,
 Tuberculosis.
 Pneumonia
 Pulmonary infections (particularly viral infections)
 Nephrotic syndrome( Hypoalbuminemia)
 Connective tissue disease
 Pulmonary embolism
 Neoplastic tumors.(Bronchogenic carcinoma)

4. PATHOPHYSIOLOGY
Due to etiological causes
Excess production & accumulation of Fluid in the pleural
space.
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

5. CONTINUED…..
Pleural effusion may be categorized as
either Transudate (watery fluid )or exudate
(protein-rich fluid).
 Transudate is usually composed of ultrafiltrates
of plasma due to an imbalance in vascular
hydrostatic and oncotic forces in the chest (heart
failure, cirrhosis).
 Exudate is typically produced by inflammatory
conditions (lung infection, lung cancer). Exudative
pleural effusions are usually more serious and
difficult to treat.

6. Clinical manisfestation
 Fever with chills
 Pleuritic chest pain
 Dyspnea
 shortness of breath.
 Dry cough.
 Loss of appetite.
 Orthopnea
 Decreased chest wall movement.
 Decreased breath sounds

7. Diagnostic studies.
 Complete health history
 Physical examination: on auscultation
 Decreased or absent breath sounds,
 Decreased fremitus,
 a dull, flat sound when percussed
 Chest x-ray, chest CT scan
 A pleural biopsy also may be performed.

8. CONTINUED…..
 Pleural tapping (Thoracentesis) to check type of fluid
(exudate / transudate).
 Pleural fluid is analyzed by
 Chemistry studies (glucose, amylase, lactic
dehydrogenase (LDH) , Protein),
 Cytologic analysis for malignant cells
 pH.
 Culture (Gram stain, Acid fast bacillus stain (for TB),
 Blood test : Blood for LDH, glucose, protein,
pH, cholesterol

9. DIAGNOSTIC APPROACH TO PLEURAL EFFUSION IN ADULTS
An effusion is exudative if it meets any of the
following three criteria:
(1) the ratio of pleural fluid protein to serum protein is
greater than 0.5
(2) the pleural fluid lactate dehydrogenase (LDH) to
serum LDH ratio is greater than 0.6,
(3) pleural fluid LDH is greater than two thirds of the
upper limit of normal

10.  Chest X-rays showing white areas at the lung
base suggest of pleural effusions

11. CT SCAN SHOWING FLUID COLLECTION ON BOTH SIDE OF
PLEURAL CAVITY

12. PLEURAL BIOPSY

13. MANAGEMENT OF PLEURAL EFFUSION.
 Treatment of the underlying cause (eg, heart
failure, pneumonia, lung cancer, cirrhosis).
 Diuretics and other heart failure medications
 chemotherapy, radiation therapy for cancer.
 Inserting a chest tube connected to a water-seal
drainage system or suction to relieve pain and
reduce fluid in pleural space.

14. CHEST TUBE CONNECTED TO A WATER-
SEAL DRAINAGE SYSTEM

15. CONTINUED..
A chemical pleurodesis
Chemically irritating agents (eg. doxycycline, and
tetracycline bleomycin or talc) are instilled in the
pleural space by using a thoracoscopic approach
The chest tube is clamped for 60 to 90 minutes.
The tube is unclamped
Chest drainage may be continued several days
To promote the formation of adhesions between the
visceral and parietal pleurae.

16. SURGERY
 Pleurectomy- consists of
surgically stripping the
parietal pleura from the
visceral pleura.
 This produces and
inflammatory reaction that
causes adhesion formation
between the two layers as
they heal

17. THORACOTOMY
 A thoracotomy is
performed to remove all
of the fibrous tissue and
in evacuating the
infection from the pleural
space.
 Video-assisted
thoracoscopic surgery
(VATS)
Surgical management
continued..

18. NURSING DIAGNOSIS.
1. Ineffective Breathing Pattern RT Decreased Lung
Volume Capacity as evidenced by tachypnea
 Monitor and record vital signs
 Elevate head of the patient
 Encourage patient to perform deep breathing
exercises
 Assist client in the use of relaxation technique
 Administer supplemental oxygen as ordered

19. 2. Impaired Gas Exchange R/T Alveolar –Capillary
Membrane Changes and respiratory fatigue
Secondary to Pleural Effusion
 Monitor respiratory rate, depth and rhythm
Auscultate breath sounds,
 Encourage frequent position changes and deep-
breathing exercises
 Provide supplemental oxygen at lowest
concentration indicated
 Administer prescribed medications as ordered

20. CONTINUED….
 Activity Intolerance
 Acute Pain

21. NURSING MANAGEMENT
 Identify and treat the underlying cause
 Monitor breath sounds
 Place the client in a high Fowler’s position
 Encourage coughing and deep breathing
 Prepare the client for thoracentesis
 If pleural effusion is recurrent, prepare the client for
pleurectomy or pleurodesis as prescribed