2. PLEURAL EFFUSION
Pleural effusion, an
excess collection of
fluid in the pleural
Normally, the pleural
space contains a
small amount of fluid
(5 to 15 mL), which
acts as a lubricant that
allows the pleural
surfaces to move
Due to etiological causes
Excess production & accumulation of Fluid in the pleural
The effusion can be composed of a relatively clear fluid, or it
can be bloody or purulent.
An effusion of clear fluid may be a transudate or an
Pleural effusion may be categorized as
either Transudate (watery fluid )or exudate
Transudate is usually composed of ultrafiltrates
of plasma due to an imbalance in vascular
hydrostatic and oncotic forces in the chest (heart
Exudate is typically produced by inflammatory
conditions (lung infection, lung cancer). Exudative
pleural effusions are usually more serious and
difficult to treat.
6. Clinical manisfestation
Fever with chills
Pleuritic chest pain
shortness of breath.
Loss of appetite.
Decreased chest wall movement.
Decreased breath sounds
7. Diagnostic studies.
Complete health history
Physical examination: on auscultation
Decreased or absent breath sounds,
a dull, flat sound when percussed
Chest x-ray, chest CT scan
A pleural biopsy also may be performed.
Pleural tapping (Thoracentesis) to check type of fluid
(exudate / transudate).
Pleural fluid is analyzed by
Chemistry studies (glucose, amylase, lactic
dehydrogenase (LDH) , Protein),
Cytologic analysis for malignant cells
Culture (Gram stain, Acid fast bacillus stain (for TB),
Blood test : Blood for LDH, glucose, protein,
9. DIAGNOSTIC APPROACH TO PLEURAL EFFUSION IN ADULTS
An effusion is exudative if it meets any of the
following three criteria:
(1) the ratio of pleural fluid protein to serum protein is
greater than 0.5
(2) the pleural fluid lactate dehydrogenase (LDH) to
serum LDH ratio is greater than 0.6,
(3) pleural fluid LDH is greater than two thirds of the
upper limit of normal
10. Chest X-rays showing white areas at the lung
base suggest of pleural effusions
13. MANAGEMENT OF PLEURAL EFFUSION.
Treatment of the underlying cause (eg, heart
failure, pneumonia, lung cancer, cirrhosis).
Diuretics and other heart failure medications
chemotherapy, radiation therapy for cancer.
Inserting a chest tube connected to a water-seal
drainage system or suction to relieve pain and
reduce fluid in pleural space.
A chemical pleurodesis
Chemically irritating agents (eg. doxycycline, and
tetracycline bleomycin or talc) are instilled in the
pleural space by using a thoracoscopic approach
The chest tube is clamped for 60 to 90 minutes.
The tube is unclamped
Chest drainage may be continued several days
To promote the formation of adhesions between the
visceral and parietal pleurae.
Pleurectomy- consists of
surgically stripping the
parietal pleura from the
This produces and
inflammatory reaction that
causes adhesion formation
between the two layers as
A thoracotomy is
performed to remove all
of the fibrous tissue and
in evacuating the
infection from the pleural
18. NURSING DIAGNOSIS.
1. Ineffective Breathing Pattern RT Decreased Lung
Volume Capacity as evidenced by tachypnea
Monitor and record vital signs
Elevate head of the patient
Encourage patient to perform deep breathing
Assist client in the use of relaxation technique
Administer supplemental oxygen as ordered
19. 2. Impaired Gas Exchange R/T Alveolar –Capillary
Membrane Changes and respiratory fatigue
Secondary to Pleural Effusion
Monitor respiratory rate, depth and rhythm
Auscultate breath sounds,
Encourage frequent position changes and deep-
Provide supplemental oxygen at lowest
Administer prescribed medications as ordered
21. NURSING MANAGEMENT
Identify and treat the underlying cause
Monitor breath sounds
Place the client in a high Fowler’s position
Encourage coughing and deep breathing
Prepare the client for thoracentesis
If pleural effusion is recurrent, prepare the client for
pleurectomy or pleurodesis as prescribed