Nursing

1. NMT06207: Care of Patients
with Medical Conditions
Session 3: Care of a Patient with
Pleural Effusion
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2. Learning tasks
At the end of this session, students are expected to be
able to:
• Define pleural effusion
• Identify causes of pleural effusion
• Outline diagnostics measures of pleural
effusion
• Explain Pathophysiology of pleural effusion
• State signs and symptoms of pleural effusion
• Give care to patient with pleural effusion
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3. Activity: Brainstorming
• What is pleural effusion?
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4. Definition
• Pleural effusion refers to a build-up of fluid
in the pleura between the visceral and
parietal surfaces between a lung and the
chest wall
• Can be classified as
o Transudates
o Exudates
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5. Definition Cont..
• Transudates: occur primarily in non-
inflammatory conditions and is an
accumulation of protein-poor, cell-poor
fluid. It is clear, pale, yellow and caused by
imbalance in oncotic and hydrostatic
pressures
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6. Definition Cont..
• Exudates: result from an increased
capillary permeability characteristic of the
inflammatory process, it is commonly
associated with infections and malignancy
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7. Causes of pleural effusion
• Diseases of the pleura, the lung
parenchyma, or vasculature, or to extra-
pulmonary disorders
• Heart failure, malignancy, and pulmonary
embolism
• Congestive heart failure,
hypoalbuminemia, (liver disease, such as
cirrhosis; renal disease, such as nephrotic
syndrome)
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8. Causes Cont..
• Infection: bacterial pneumonia (Para
pneumonic effusions), tuberculous pleural
effusion or empyema which is a common
cause in developing countries
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9. Activity: Brainstorming
• What are the diagnostic Measures of
Pleural Effusion ?
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10. Diagnostic Measures of Pleural
Effusion
• Physical examination
o A stethoscope is important to check for
abnormal chest sounds, such as a friction rub
• History taking
• Laboratory analysis of the effusion as a
transudate (serous) or an exudate
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11. Diagnostic Measures of Pleural
Effusion Cont..
• Chest x-ray or ultrasound to detect
presence of fluid
• Blood test
• Computed tomography scan (CT scan)
• Fluid analysis after thoracentesis
• Biopsy of the pleura with video-associated
thoracic surgery (VATS)
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12. Pathophysiology of Pleural
Effusion
• A balance between hydrostatic pressure,
oncotic pressure, and membrane
permeability governs movement of fluid in
and out of the pleural space.
• Fluid accumulation can be a result of
increased pulmonary capillary pressure,
decreased oncotic pressure, increased
pleural membrane permeability, or
obstruction of lymphatic flow.
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13. Signs and Symptoms of pleural
effusion
• Symptoms of include;
o Sharp, stabbing pain towards the side and
lower part of the chest especially when lying
down, with relief by sitting up
o Pain along the shoulders, neck, and abdomen
o Aggravation of pain during any movement of
the chest, such as breathing and coughing
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14. Symptoms of pleural effusion
Cont…
o Dry coughing
o Weakness
o Headaches
o Loss of appetite
o Chills
o Dyspnea
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15. Signs of pleural effusion
• Fever
• Rapid pulse
• Rapid and shallow breathing
• Pleural rub in which the parietal and
visceral pleurae rub together and cause
friction.
• reduced breath sounds, wheezing.
• Productive cough with sputum
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16. Care of a Patient with pleural
effusion
• Pain Management
o Analgesics and anti-inflammatory
medicines.
o Some patients can reduce their pain by
lying on the painful side, holding a pillow
tightly, or wrapping chest with elastic
bandages.
o Administer prescribe codeine-based cough
syrup to treat a painful cough.
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17. Care of a Patient with pleural
effusion Cont..
• Administer prescribed antibiotics and
anti-inflammatory drugs to treat the
Source of Infection or Inflammation
• If it is the result of a viral infection,
treatment is simply letting it run its
course.
• Assist in removal of fluid to facilitate re-
expansion of the lung by chest
thoroacentesis or thoracotomy tubes
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18. Key Points
• Pleural effusion is an abnormal
accumulation of fluid within the pleural
space.
• Treatment and prognosis of a pleural
effusion depends on the underlying
pathology
.
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19. References
• References
• Black, J. M., & Hawks, J. H. (2009). Medical
surgical nursing (8th ed.). Philadelphia: W. B.
Saunders.
• Bunker Rosdahl, C. (1999). Textbook of basic
nursing (7th ed.). Philadelphia: Lippincott.
• Colmer, M. R. (2005). Moroney’s surgery for
nurses (16th ed.). London: Churchill
Livingstone.
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20. References Cont….
• Monahan, F. D., Sands, J. K., Marek, J. F., &
Phipps, M. (1999). Medical-surgical nursing:
Health and illness perspectives (7th ed.). St.
Louis: Mosby
• Nettina, S. M. (2001). Lippincott manual of
nursing practice (7th ed.). United States:
Lippincott Williams and Wilkins
• Scherer, J. K. & Timby, B. K. (1995).
Introductory medical surgical nursing (6th
ed.). Philadephia: Lippin
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21. Review questions
• What is the difference between
exudative from transudate pleural
effusion?
• What are the diagnostic measures of
pleural effusion?
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