2. • Pleural effusion is excess fluid that accumulates
in the pleural cavity, the fluid-filled space that
surrounds the lungs. This excess can impair
breathing by limiting the expansion of the lungs
3. Introduction
Accumulation of fluid
within the visceral and
parietal layers of the pleura
when there is an imbalance
between formation and
absorption in various disease
states.
5. Pleural Effusion: Signs & Symptoms
Shortness of breath
Chest pain: Pleuritic Pain, defined as a sharp pain, worsening with a
deep breath. It may be localized to the chest, but if the effusion causes
inflammation of the diaphragm, the pain may be referred to the
shoulder or the upper abdomen
Cough
Fever
Hiccups
Rapid Breathing
6. Pleural Effusion: Diagnosis
Percussion Dullness to tapping on one side of the chest when compared to the
other side.
Chest X-ray Confirm presence of fluid
Chest ultrasound Confirm presence and location of fluid. Helps decide whether the fluid
is free flowing within the pleural space or whether it is contained in a
specific area (loculated).
CT scans To image the chest and reveal not only the lung but other potential
causes of the effusion.
Thoracentesis Used to sample the fluid from the pleural effusion to sent it for
chemical analysis.
Chemical analysis To differentiate between transudate and exudate pleural fluid.
(glucose, amylase, lactic dehydrogenase, protein)
Cell count To look for infection and cultures for infection.
Cell analysis For tumor cells
7. Pleural Effusion: Management
Goals:
To discover the underlying cause
To prevent re-accumulation of fluid
To relieve discomfort, dyspnea, and respiratory
compromise
8. Pleural Effusion: Management
Therapeutic Procedures Description
Thoracentesis To remove fluid
To obtain a specimen for analysis
To relieve dyspnea and respiratory compromise
Insertion of chest
drainage tube
To evacuate the pleural space and re-expand the lung.
Chemical Pleurodesis To obliterate the pleural space and prevent
reaccumulation of fluid.
Chemically irritating agents (eg., bleomycin or talc)
are instilled in the pleural space
Surgical Pleurectomy Prevent the formation of pleural fluid
Implantation of a
pleuroperitoneal shunt
Fluid moves from the pleural space to the pump
chamber and then to the peritoneal cavity
9. Pleural Effusion: Nurse’s Role
Implementing the medical regimen
Assisting in therapeutic procedures
Assisting patient in measures to enhance drainage through
drainage system
Monitoring the drainage system’s function
Recording the amount of drainage at prescribed intervals
Educating the patient and family regarding management
and care of the catheter and drainage system.
11. • Pleurisy (also known as pleuritis) is
an inflammation of the pleura, the lining
surrounding the lungs.
• Causes :
• Viral infections.
• Aortic dissections
• Autoimmune disorders
• Bacterial infections associated with pneumonia and tuberculosis
• Chest injuries (blunt or penetrating)
12. Signs and symptoms
• sudden sharp, stabbing, burning or dull pain in the right or left side of the chest during
breathing, especially when one inhales and exhales.
• It feels worse with deep breathing, coughing, sneezing, or laughing.
• The pain may stay in one place, or it may spread to the shoulder or back.
• Depending on its cause, Pleuritic chest pain may be accompanied by other symptoms:
• Dry cough
• Fever and chills
• Rapid, shallow breathing
• Shortness of breath
• Tachycardia
• Sore throat followed by pain and swelling in the joints
14. TREATMENT
• Thoracentesis : During thoracentesis, a needle or a thin, hollow, plastic tube is inserted
through the ribs in the back of the chest into the chest wall. A syringe is attached to draw
fluid out of the chest. This procedure can remove more than 6 cups (1.5 litres) of fluid at
a time.
• Paracetamol (acetaminophen) or anti-inflammatory agents to control pain and decrease
inflammation.
• Codeine-based cough syrups to control the cough
• antibiotics or antifungal medicines.
