2. PLEURAL EFFUSION

3. INTRODUCTION

4. DEFINITION
Pleural effusion is a collection of
abnormal amount of fluid in the pleural space.

5. INCIDENCE
The estimated prevalence of pleural effusion
is 320 cases per 100,000 people in industrial
countries.

6. CLASSIFICATION
Based on mechanism and type of pleural fluid :
◦Exudative
◦Transdutaive

7. ETIOLOGY
❄Exudative
◦Infective
◦Collagen vascular disease
◦Neoplastic
◦Uremia

8. ◦Drugs
◦Post radiation
◦Traumatic

9. ❄Transudative
◦Nephrotic syndrome
◦Congestive heart failure
◦Hepatic failure
◦Protein energy malnutrition
◦Hypothyroidism

10. ◦Empyema
It is the collection of purulent fluid in the
pleural space caused by the conditions such as
pneumonia, TB, lung abscess and infection of
surgical wounds of chest.

11. ◦Transudative effusions
Also known as hydrothoraces, occur
primarily in non inflammatory conditions. It is an
accumulation of low protein, low cell count fluid.

12. ◦Exudative effusions
Exudative effusions occur in an area of
inflammation caused by accumulation of high
protein fluid.
Results from increased capillary permeability

13. PATHOPHYSIOLOGY
Transudative pleural effusion
Increased hydrostatic pressure,
Decreased oncotic pressure
|
Unable to remain the fluid with in the a
intravascular space

14. Fluid shift into interstitial space
|
Effusion

15. Exudative effusion
Invasion of microbes
|
Initiation of inflammatory reaction
|
Vasodilation

16. Increase in capillary permeability
|
Leak of plasma protein
|
Decrease oncotic pressure

17. |
Fluid shift into interstitial space

18. CLINICAL MANIFESTATION
🌸shortness of breath /dyspnea
🌸pleuritic chest pain that is worse on
Inhalation
🌸Dry, non productive cough

19. On physical examination
🍄Inspection
◦Absent or diminished movement of chest on
affected side
◦Fullness of chest with bulging intercostal space

20. 🍄Palpation:
◦Diminshed breath sound over the site of
effusion
◦Decreased or absent tactile fermitus
🍄percussion :
◦Stony dullness

21. 🍄Auscultation :
◦Absence of breath sounds over effusion
◦Vocal resonance absent
◦Signs of pneumonia like bronchial breathing,
crackles etc..

22. DIAGNOSTIC EVALUATION
◦History collection
◦Physical examination
◦Chest x ray
◦Total leukocyte count
◦Ultrasonography

23. ◦CT Scan
◦Pleural fluid aspiration / Thoracentesis
◦Bacterial culture
◦A pleural biopsy

24. MEDICAL MANAGEMENT
🍄General
◦Focused on underlying causes
◦Antitubercular drugs
◦Metranidazole
◦Chloroquine

25. SURGICAL MANAGEMENT
Thoracentesis

26. ◦Chest drainage tube
◦Chemical pleurodesis
◦Surgical pleurectomy
◦Pleuroperitoneal shunt

27. NURSING MANAGEMENT
◦Nursing diagnosis
◦Nursing interventions
-Institute treatment to resolve underlying
cause as ordered
-Assist in thoracentesis
-Maintain chest drainage as needed

28. -Provide care after pleurodesis

29. COMPLICATIONS
◦Respiratory distress
◦Chest pain
◦Iatrogenic pneumothorax
◦ Re –expansion pulmonary oedema
◦Infection