Pleural effusion MSN AHN NURSING

1. Unit: IV
Topic: Pleural effusion
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Hezil Reema Barboza
Prepared by, Reviewed by,
Mrs. Hezil Reema Barboza Mr Gireesh
Assistant Professor-II HOD
Dept. of Medical Surgical Dept. of Medical Surgical
Nursing Nursing
Yenepoya Nursing College Yenepoya Nursing College

2. Learning objectives
At the end of class learner will be able to
• define pleural effusion
• explain the causes and pathophysiology of pleural
effusion
• list the clinical features and diagnosis of pleural
effusion
• describe the management of pleural effusion
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3. Introduction
• 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
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4. Meaning
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
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5. Causes:
• Increase hydrostatic pressure
• Decrease oncotic pressure
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7. Types of Effusions
a) Transudative pleural effusions
• It caused by fluid leaking out of capillaries and into
the pleural space .
• This is caused by non inflammatory conditions
• A transudate is a clear fluid, poor protein, cell poor
fluid
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8. Causes of Transudates
• Atelectasis
• (early)Cirrhosis
• Congestive heart failure
• Hypoalbuminemia
• Nephrotic syndrome
• Peritoneal dialysis
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9. 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 .
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10. Causes of Exudates:
• Asbestos exposure
• Atelectasis
• Hemothorax Infection (bacteria, viruses, fungi,
tuberculosis, or parasites)
• Pulmonary embolism
• Uremia
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11. 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
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12. Cont..
• Blood (haemothorax): is a condition that results
from blood accumulating in the pleural cavity
• Chyle (chylothorax): 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.
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13. Cont..
• 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
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14. Pathophysiology
Causes
Elevation of hydrostatic pressure & decreased osmotic
pressure.
Increased pleural fluid formation or decreased pleural
fluid absorption
It leads to increased capillary permeability
Hence production increases & absorption is decreases
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15. Cont..
Pleural effusions produce a restrictive ventilatory
defect
Decrease the total lung capacity and vital capacity
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16. Clinical features
• Pleuritic chest
• Physical examination findings 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
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17. Diagnosis
• History and Physical examination
• Chest CT scan
• Chest x-ray
• Pleural fluid analysis
• Thoracentesis
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18. Cont..
• 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.
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19. Cont..
• Computed Tomography: Cross-sectional computed
tomography (CT) It helps distinguish anatomic
compartments more clearly This modality is useful as
well in distinguishing empyema
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20. Management
Aim :
• Remove the fluid
• Prevent fluid from building up again
• Treating the cause of the fluid buildup
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21. Cont..
Therapeutic thoracentesis:
• 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.
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22. Thoracentesis
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23. Cont..
• Pleural effusions caused by congestive heart failure
are treated with diuretics
• Pleural effusions caused by infection are treated with
appropriate antibiotics.
• 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.
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24. Cont..
• Sodium restriction
• Chemical pleurodesis: used to sclerose the plueral
space and prevent re accumulation of effusion fluid
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25. Surgical management
• Thoracentesis: 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.
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27. Cont..
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28. Conclusion
• Most people recover within a few days or weeks.
Minor complications from more invasive treatments
can include slight pain and discomfort, which often
go away with time.
• Some cases of pleural effusion can have more serious
complications, depending on the severity of the
condition, cause, and treatment used.
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29. Recapitulation
1. What is pleural effusion?
2. What are the causes of pleural effusion?
3. What are the clinical features of pleural effusion?
4. What is the management of pleural effusion?
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30. References
• Smeltzer C, Bare Brenda. Brunner and Suddarth’s
textbook of medical surgical nursing, 10th ed.
Philadelphia: Lippincott Williams and Wilkins; 2004.
• Black MJ, Jacobs EM. Luckmann & Sorensen’s
Medical Surgical Nursing, 4th ed. Philadelphia:
Saunders;1993.
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