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Unit III 3. Pleural Effusion.ppt

  2. GENERAL OBJECTIVE • At the end of the class students will gain in depth knowledge regarding pleural effusion, develops desirable attitude and able to apply this knowledge whenever necessary.
  3. Specific objective • Explain the causes of pleural effusion • Describe the pathophysiology of pleural effusion • Explain the signs and symptoms of pleural effusion • Describe the diagnostic investigations for pleural effusion • Summarize the medical and nursing management of pleural effusion PLEURAL EFFUSION
  4. PLEURAL EFFUSION Introduction: • Pleural effusions are accumulations of fluid within the pleural space. They are classified as transudates or exudates. • TRANSUDATES-fluid buildup caused by systemic conditions[ due to cardiac or renal problem] • EXUDATES-fluid buildup caused by tissue leakage due to inflammation or local cellular damage. 4
  5. Definition: • Pleural effusion is defined as abnormal accumulation of fluid in the pleural space. • Fluid can accumulate around the lungs due to poor pumping by the heart or by inflammation. • The excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during respiration. PLEURAL EFFUSION 5
  6. 5 PLEURAL FLUID FORMATION  Normally, 10 to 20 ml of pleural fluid is spread thinly over visceral and parietal pleurae, facilitating movement between the lungs and chest wall. The fluid enters the pleural space from systemic capillaries in the parietal pleurae and exits via parietal pleural stomas and lymphatic's.
  7. PLEURAL FLUID FORMATION Pleural fluid accumulates when too much fluid enters or too little exits the pleural space. The fluid will be clear or pale yellow.
  8. .Clear ultra filtrate of plasma •Volume - 0.3 ml/kg[eg.50kg=12ml] •Cells/ mm3 -1000 – 5000 •Mesothelial cells - 60% •Monocytes - 30% •Lymphocytes - 5% •Protein - 1-2 g/dl COMPOSITION OF PLEURAL FLUID
  9. CLASSIFICATION a)Based on site Apical Inter lobar Sub-pulmonic-base[btw pleura and diaphragm] Mediastinal-btw the lungs
  10. B)Based on mechanism and type of pleural fluid  Transudative  Exudative  Serous fluid[hydrothorax]-accumulation of serous fluid in pleural cavity  Blood[haemothorax]-blood accumulating in pleural cavity  Pus [pyothorax or empyema]- accumulation of pus in pleural cavity  Chyle[chylothorax]-milky body fluid contains fatty cells
  11. ETIOLOGY • A viral infection such as the flu[influenza] • A bacterial infection,such as pneumonia • A fungal infection • Autoimmune disorder eg.rheumatoid arthritis • Certain medications • Lung cancer near the pleural surface
  12. PATHOPHYSIOLOGY • Due to etiological factor • Increased pressure in pulmonary capillaries • Increased amount of fluid enter the interstitial spaces of lung • Increased interstitial pressure in interstitial spaces
  13. Fluid moves from the pulmonary interstitial spaces into pleural space Pleural effusion
  14. Dyspnea-breathlessness Pleuritic chest pain-a vague discomfort or sharp pain that worsens during inspiration Pain is usually felt over the inflamed site. Dull percussion over area of effusion Decreased breath sounds of area of effusion Pleural rub,crackles sounds on auscultation SYMPTOMS
  15. DIAGNOSIS • Chest x-ray
  16. Pleural fluid cytology •WBC count •Predominant cell type(neutrophil,Lymphocytes, •Eosinophils, red blood cells) •Gram stain •Acid fast for acid fast bacilli(AFB) •Pleural fluid culture •AFB culture •Polymerase chain reaction for TB DIAGNOSIS
  17. • CT scan of chest • Ultrasound of the chest • Thoracentesis- a needle is inserted between the ribs to remove a biopsy or to collect fluid] • Pleural fluid analysis-examination of the fluid removed from the pleural space. • Thoracoscopy- minimally invasive technique allows for a visual evaluation of the pleura - It is also known as video assisted thoracoscopic surgery[VATS] - It is performed under general anesthesia
  18. MANAGEMENT  Treatment of pleural effusion is based on the underlying condition and whether the effusion is causing severe respiratory symptoms such as shortness of breath or difficulty breathing. Congestive heart failure- treat with diuretics Thoracentesis [ tube thoracostomy ]- drained through a chest tube. Pleural sclerosis performed with sclerosing agents[such as doxycycline , tetracycline]
  19. SURGICAL MANAGEMENT : 1.VIDEO ASSISTED THORACOSCOPIC SURGERY • 1-3 small incision Is made to remove fluids • Very effective in managing effusion • Antibiotics are inserted at the time of surgery to prevent the recurrence of fluid build up. 2.THORACOTOMY-OPEN THORACIC SURGERY • Performed through 6-8 inch incision in the chest • Removes all the fibrous tissue- chest tube is maintained for 2 weeks after surgery for drain collection
  20. • Pleural shock • Air embolism • Introduction of infection • Pneumothorax-lung collapse • Pulmonary embolism • Air embolism • Acute pulmonary edema • Injury to vascular bundles • Hydropneumothorax-presence of air and fluids COMPLICATION
  21. 1.Impaired gas exchange related to fluid collection in pleural spaces evidenced by dullness on percussion, pleural friction rub on auscultation. Goal :demonstrates full lung expansion with normal oxygen saturation intervention: • Monitor respiratory rate and oxygenation status • Initiate and maintain supplemental oxygen to treat hypoxemia NURSING MANAGEMENT
  22. • Position the patient in fowlers to increase patient comfort and to facilitate aeration in lungs. • Chest tube care • Monitor for bubbling of the suction chamber for chest tube drainage system • Ensure that tubing's are secured properly • Keep drainage container below the chest level
  23. 2.Ineffective breathing pattern related to pain and position as Evidenced by shortness of breath ,shallow respiration Goal : demonstrates an effective respiratory rate , rhythm and depth of respiration NURSING MANAGEMENT
  24. • Intervention: • Monitor respiratory rate, rhythm depth and effort of respiration. • Auscultate breath sounds, noting areas of decreased ventilation • Pain management • Provide optimal pain relief with prescribed analgesics • Ventilation assistance • Position the patient will alleviate dyspnoea • Assist with incentive spirometer.
  25. REFERENCE 1.Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Harding, M.M. (2017). Medical-surgical nursing: assessment and management of clinical problems (10th ed.). St. Louis: elsevier.Pp.No-595-598. 2.Berthold Jany and Tobias Welte,.(2017) . pleural effusion in adults—etiology, diagnosis, and treatment 3.Kamran boka, guy w .Soo hoo,(2017) . pleural effusion : news perspective Drug and disease from medscape.