Arterial Pulse: Transmission, Method, Pulse Point, Rhythm Character, Volume, Pulse Deficit

  Pleural Effusion

Pleural effusion refers to a collection of fluid in the pleural space. It is almost always secondary to other diseases.

Pathophysiology and Causes of Pleural Effusion

 1. May be either transudative or exudative.

 2. Transudative effusions occur primarily in noninflammatory conditions; it is an accumulation of low-protein, low-cell-count fluid.

 3. Exudative effusions occur in an area of inflammation; it is an accumulation of high-protein fluid.

 4. Occurs as a complication of:

             a. Disseminated cancer (particularly lung and breast),  lymphoma.

             b. Pleuropulmonary infections (pneumonia).

             c. Heart failure, cirrhosis, nephrosis.

            d. Other conditions—sarcoidosis, SLE, peritoneal dialysis.

Clinical Manifestations of  Pleural Effusion

 1. Dyspnea, pleuritic chest pain, cough.

 2. Dullness or flatness to percussion (over areas of fluid) with decreased or absent breath sounds.

Diagnostic Study 

 1. Chest x-ray or ultrasound detects presence of fluid.

 2. Thoracentesis—biochemical, bacteriologic, and cytologic studies of pleural fluid indicate the cause.

Arterial Pulse: Transmission, Method, Pulse Point, Rhythm Character, Volume, Pulse Deficit 

Management of Pleural Effusion

General

 1. Treatment is aimed at underlying cause (heart disease, infection, cancer).

 2. Thoracentesis is done to remove fluid, collect a specimen, and relieve dyspnea.

For Malignant Effusions

 1. Video-assisted thoracoscopy, chest tube drainage, radiation, and/or chemotherapy.

 2. In malignant conditions, pleurodesis may be required. Thoracentesis may provide only transient benefits because effusion may reaccumulate within a few days.

 3. Pleurodesis—production of adhesions between the parietal and visceral pleura accomplished by tube thoracostomy, pleural space drainage, and intrapleural instillation of a sclerosing agent (tetracycline, doxycycline, or minocycline).

                a. Drug introduced through tube into pleural space; tube clamped.

                 b. Patient is assisted into various positions for 3 to 5 minutes each to allow drug to spread to all pleural surfaces.

               c. Tube is unclamped, as prescribed.

              d. Chest drainage continued for 24 hours or longer.

              e. Resulting pleural irritation, inflammation, and fibrosis cause adhesion of the visceral and parietal surfaces when they are brought together by the negative pressure caused by chest suction.

Complications of  Pleural Effusion

 1. Large effusion could lead to respiratory failure.

Nursing Assessment for   Pleural Effusion

           1. Obtain history of previous pulmonary condition.

           2. Assess patient for dyspnea and tachypnea.

           3. Auscultate and percuss lungs for abnormalities.

Nursing Diagnosis for   Pleural Effusion

￾ Ineffective Breathing Pattern related to collection of fluid in pleural space.

Nursing Interventions of   Pleural Effusion

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Maintaining Normal Breathing Pattern

 1. Institute treatments to resolve the underlying cause, as ordered.

 2. Assist with thoracentesis, if indicated.

 3. Maintain chest drainage, as needed.

 4. Provide care after pleurodesis.

a. Monitor for excessive pain from the sclerosing agent, which may cause hypoventilation.

b. Administer prescribed analgesic.

c. Assist patient undergoing instillation of intrapleural lidocaine if pain relief is not forthcoming.

d. Administer oxygen as indicated by dyspnea and hypoxemia.

e. Observe patient’s breathing pattern, oxygen saturation, and other vital signs for evidence of improvement or deterioration.

Patient Education and Health Maintenance

 1. Instruct patient to seek early intervention for unusual shortness of breath, especially if he or she has underlying  chronic lung disease.

Evaluation: Expected Outcomes

￾ Reports absence of shortness of breath.