Definition, causes, S/S tests and Management

1. PLEURAL EFFUSION

2. Anatomy of Lung
• Pleura

4. DEFINITION
Pleural effusion is excess
fluid that accumulates between the two pleural layers,
the fluid-filled space that surrounds the lungs.
Excessive amounts of such fluid can impair breathing by
limiting the expansion of the lungs during ventilation.

5. CAUSES
Two classifications are ;
1) Transudate pleural effusions
It formed when fluid leaks from blood vessels into the
pleural space. It has a low content of protein, cells, or
solid materials derived from cells..e.g. Congestive heart
failure, liver failure or cirrhosis, kidney failure or nephritic
syndrome, and Peritoneal dialysis.

6. 2) Exudate pleural effusions
It caused by inflammation of the pleura itself
and are often due to disease of the lung. E.g.
lung cancer, pneumonia and tuberculosis, any
surgical intervention

7. TYPES OF FLUIDS
• Four types of fluids can accumulate in the
pleural space:
• Serous fluid (hydrothorax) : A hydrothorax is a
condition that results from serous fluid
accumulating in the pleural cavity. This specific
condition can be related to cirrhosis with ascites
in which ascitic fluid leaks into the pleural cavity
• Blood (haemothorax): is a condition that results
from blood accumulating in the pleural cavity

8. • Chyle (chylothorax): chyle is a milky bodily fluid
consisting of lymph and emulsified fats, or free
fatty acids (FFAs). It is formed in the small
intestine during digestion of fatty foods . - is a
type of pleural effusion . It results from lymphatic
fluid (chyle) accumulating in the pleural cavity.
• Pus (pyothorax or empyema) : is an accumulation
of pus in the pleural cavity

9. Clinical Manifestation
Shortness of Breath
Chest Pain
Fever, chills, and pleuritic
chest pain
Dyspnea and coughing

10. Diagnostic Evaluation
 History Collection
 Physical Examination
 chest x-ray, chest CT scan, and thoracentesis
confirm the presence of fluid
 Pleural fluid is analyzed for;
bacterial culture, Gram stain, acid fast bacillus stain
 Cytologic analysis for malignant cells, and pH.
 A pleural biopsy also may be performed.

11. Management
MEDICAL MANAGEMENT
Objective
• Discover the underlying cause
• Prevent reaccumulation of fluid
• To relieve discomfort, dyspnea and respiratory
compromise

12. Cont….
GENERAL MANAGEMENT
1. Thoracentesis- It is performed to remove fluid, to
obtain a specimen for analysis, and to relieve
dyspnea and respiratory compromise.
2. Pleurectomy- This is an operation to remove the
pleura.

13. Cont….
MANAGEMENT FOR MALIGNANT EFFUSION
1. Chest tube drainage, intercostals chest drainage,
water seal drainage

15. Cont….
MANAGEMENT FOR MALIGNANT EFFUSION
2. Radiation therapy

18. Cont….
MANAGEMENT FOR MALIGNANT EFFUSION
3. Chemotherapy

19. Cont….
MANAGEMENT FOR MALIGNANT EFFUSION
4. Pleuractomy

20. Cont….
MANAGEMENT FOR MALIGNANT EFFUSION
5. Thoracocentesis

21. Nursing Management
The nursing management of the bronchiastasis
include the following steps
1. Assessment
2. Nursing diagnosis
3. Nursing intervention
4. Health Education

22. Nursing Management
The nursing management of the bronchiastasis
include the following steps
1. Assessment
2. Nursing diagnosis
3. Nursing intervention
4. Health Education

23. Nursing Assessment
1. Obtain history of previous pulmonary condition
– History of recent respiratory disease include the mode
on onset
– Presence of purulent sputum, amount of sputum, fever,
chills, chest pain
– Any family illness
2. Assess patient for dyspnea & tachypnea
3. Auscultate & percuss lungs for the presence of the
abnormalities

24. Nursing Diagnosis
1. Impaired gas exchange related to disease condition
2. Ineffective airway clearance related to excessive
pleural effusion
3. Activity intolerance related to altered respiratory
function
4. Acute pain related to inflammatory process
5. Risk for injury secondary to complication
6. Knowledge deficit to treatment protocol & method
of Prevention
7. Disturb sleeping pattern related to hospitalization

25. complication
The complication of the pleural effusion
• Breathlessness
• Chest pain
• Chest expansion poor
• Breath sounds reduced
• Chest wall percussion dull