Pleural effusion

description on pleural effusion

1. PLEURAL EFFUSION

2. Introduction Pleural effusion, a collection of fluid in the pleural space, is rarely a primary disease process but is usually secondary to other diseases The pleural space normally contains only about 10-20 ml of serous fluid

3. Contd … Pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatic system Any condition that interferes with either secretion or drainage of this fluid leads to pleural effusion

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

5. Classification Transudative effusions Exudative effusions

6. Transudative effusions Transudative effusions also known as hydrothoraces , occur primarily in noninflammatory conditions; is an accumulation of low-protein, low cell count fluid

7. Cause of transudative effusion Increase hydrostatic pressure found in heart failure ( most common cause of pleural effusion) Decrease oncotic pressure ( From hypoalbuminemia ) found in cirrhosis of liver or renal disease. In this condition, fluid movement is faciliated out of the capillaries and into the pleural space

8. Exudative effusions Exudative effusions occur in an area of inflammation; is an accumulation of high-protein fluid. An exudative effusion results from increased capillary permeability characteristic of inflammatory reaction. This types of effusion occurs secondary to conditions such as pulmonary malignancies, pulmonary infections and pulmonary embolization.

9. Etiology Disseminated cancer (particularly lung and breast), lymphoma Pleuro -pulmonary infections (pneumonia). Heart failure, cirrhosis, nephrotic syndrome Other conditions sarcoidosis , systemic lupus erythematosus (SLE) Peritoneal dialysis

10. Pathophysiology Transudative pleural effusions: hydrostatic pressure , oncotic pressure Unable to remain the fluid with in a intravascular space Fluid shift interstitial space Effusion

11. Contd …. Exudative effusions Invasion of microbes Initiation of inflammatory reaction Vasodilation increase capillary permeability leak of plasma protein decrease oncotic pressure fluid shift into interstitial space

12. Clinical Manifestations Usually the clinical manifestations are those caused by the underlying disease and severity of effusion Pneumonia causes fever, chills, and pleuritic chest pain, malignant effusion may result in dyspnea and coughing

13. Contd … When a small to moderate pleural effusion is present, dyspnea may be absent or only minimal. Pleuritic chest pain, Dullness or flatness to percussion Decreased or absent breath sounds

14. Diagnostic Evaluation Chest X-ray or ultrasound detects presence of fluid. Thoracentesis biochemical, bacteriologic, and cytologic studies of pleural fluid indicates cause.

15. Management The objectives of treatment are to discover the underlying cause, t o prevent reaccumulation of fluid , and to relieve discomfort, dyspnea, and respiratory compromise General Treatment is aimed at underlying cause (heart disease, infection). Thoracentesis is done to remove fluid, collect a specimen, and relieve dyspnea

16. For Malignant Effusions Chest tube drainage, radiation, chemotherapy, surgical pleurectomy, pleuroperitoneal shunt, or pleurodesis

17. Complications Large effusion could lead to respiratory failure

18. Nursing Assessment Obtain history of previous pulmonary condition Assess patient for dyspnea and tachypnea Auscultate and percuss lungs for abnormalities

19. Nursing Diagnosis Ineffective Breathing Pattern related to collection of fluid in pleural space

20. Nursing Interventions Maintaining Normal Breathing Patter n Institute treatments to resolve the underlying cause as ordered. Assist with thoracentesis if indicated Maintain chest drainage as needed Provide care after pleurodesis. Monitor for excessive pain from the sclerosing agent, which may cause hypoventilation. Administer prescribed analgesic. Assist patient undergoing instillation of intrapleural lidocaine if pain relief is not forthcoming. Administer oxygen as indicated by dyspnea and hypoxemia. Observe patient's breathing pattern, oxygen saturation

21. Evaluation: Expected Outcomes Reports absence of shortness of breath

22. THANK YOU

23. References Chintamani , Lewis, Heitkemper , Dirksen, O’Brien and Bucher. (2011). Lewis’s Medical Surgical Nursing: Assessment and Management of Clinical Problems. (7 th Ed.). Mosby. P 595 Black , J.M. , Hawks , J.H. , & Annabelle , M.K . (2005). Medical-Surgical Nursing-clinical management for positive outcomes .(6 th ed .). P 1631 Suzanne C. S., Brenda G. B., Janice L. H. , and Kerry H. C. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing .( 11th ed ). 540 Lippincott Manual of Nursing Practice. (2010).William And Wilkins.Nineth edition. 302