pleural effusion

pleural effusion

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2. Prepared By:
PranitaAryal
Roll No. 07
BNS 3
rd
Year
TU, IOM
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7. Introduction
Pleuraleffusionacollectionoffluidinthepleuralspace,
israrelyaprimarydiseaseprocessbutisusually
secondarytootherdisease.
Normally,thepleuralspacecontainsasmallamountof
fluid(5to15ml),whichactsasalubricantthatallowsthe
pleuralsurfacetomovewithoutfriction.
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8. Cont….
Pleuralfluidnormallyseepscontinuallyintothepleural
spacefromthecapillariesliningtheparietalpleuraandis
reabsorbedbythevisceralpleuralcapillariesand
lymphaticsystem.
Anyconditionthatinterfereswitheithersecretionor
drainageofthisfluidleadstopleuraleffusion.
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9. Definition
Pleuraleffusionisanabnormal,excessivecollectionof
fluidinthepleuralspaces.
Toomuchfluidimpairstheabilityofthelungtoexpandand
move.
Itmaybeacomplicationofheartfailure,TB,pneumonia,
pulmonaryinfection,nephroticsyndrome
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12. Epidemiology
TheincidenceinU.Sisestimatedtobeatleast1.5million
casesannually.MostcasesarecausedbyCHF,bacterial
pneumonia.
Inindustralizedcountriestheprevalencerateis320cases
per1lakhpeople.
Theincidenceisequalbetweenthesexes.Nearlytwo
thirdsofmalignantpleuraleffusionoccurinwomen
associatedwithbreastmalignancies.
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13. Classification
Transudativeeffusion
Exudativeseffusion
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14. TransudativeEffusion
Transudativeeffusionisalsoknownashydrothorax,occur
primarilyinnoninflammatoryconditions;isan
accumulationoflowprotein,lowcellcountfluid.Itis
causedbyfluidleakingintothepleuralspace.
Ithasaclearfluidsimilartobloodserum.
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15. Causesoftransudativeeffusion
Increasehydrostaticpressureinheartfailure(most
commoncauseofpleuraleffusion)
Decreaseoncoticpressure(fromhypoalbuminemia)
foundincirrhosisofliverandrenaldisease
Atelectasis
Nephroticsyndrome
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16. CharacteristicsofTranudative
effusion
Occursprimarilyinnon-inflammatoryconditions.
Lowprotein,low-cell-countfluid.
Cleartofaintyellowtinge,noodor.
pH7.40-7.55
Specificgravity<1.015.
Proteincontent<3g\100ml.
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17. Exudativeeffusion
Exudativeeffusioncontainafluidrichinproteinand
cellularelementsthatoozesoutofbloodvesselsdueto
inflammation.
Anexudateseffusionresultfromincreasedcapillary
permeabilitycharacteristicofinflammatoryreaction.
Afluidiscloudycontainingcellsandmuchprotein.
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18. Cont…
Thistypesofeffusionoccurssecondarytoconditionsuch
as:
Tuberculosis
malignancies,pulmonaryinfection
pulmonaryembolism
Empyema
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19. CharacteristicsofExudateeffusion
Oftenturbid,bloodyorpurulrnt.
pH<7.30
Specificgravity<1.016.
Proteincontent<3g\100ml
Highproteinfluid
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21. Etiology
Pneumonia,pulmonaryinfection
Heartfailure
Disseminatedcancer(particularlylungand
breast,lymphoma)
Pleuro-pulmonaryinfection
Cirrhosis,nephroticsyndrome
Otherconditionsarcoidosis,systemiclupus
erythematosus(SLE)
Peritonealdialysis
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22. Etiologycontd..
Viralinfection:Otherconditionsarcoidosis,systemic
lupuserythematosus(SLE)
Peritonealdialysis
(Excessivefluidmayaccumulatebecausethebodydoesnot
handlefluidproperly(suchasincongestiveheartfailure,or
kidneyandliverdisease).Thefluidinpleuraleffusionsalsomay
resultfrominflammation,suchasinpneumonia,autoimmune
disease,andmanyotherconditions).
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23. Pathophysiology
Transudativeeffusion
Duetodifferentetiologicalfactors.
Increasehydrostaticpressure,decreaseoncoticpressure
Unabletoremainthefluidwithinaintravascularspace
Fluidshiftinterstitialspace(effusion)
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24. exudative effusion
(pathophysiology)
Invasion of microbes
Initiation of inflammatory reaction
Vasodilation increase capillary permeability
Leak of plasma protein decrease oncotic pressure
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25. Cont…..
Fluid shift into interstitial space
effusion
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26. Mechanism
Alteredpermeability(e.g.inflammation.
Reductioninintravascularoncoticpressure
(e.g.hypoalbuminemia)
Increasedcapillaryhydrostaticpressure
(e.g.congestiveheartfailure)
Decreasedlymphaticdrainage.
Increasedfluidinperitonealcavity,withmigration
acrossthediaphragmviathelymphatics(e.g.hepatic
cirrhosis,peritonealdialysis).
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27. ClinicalManifestation
Theclinicalpresentationofpleuraleffusiondependson
theamountoffluidpresentandtheunderlyingcauses.If
theeffusionissmall(250ml),it’spresencemaybe
discoveredonlyonchestx-ray
Manypatienthavenosymptomsatthetimeapleural
effusionisdiscovered.
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28. ClinicalManifestationcontd..
Feverwithchills
Cough
Dyspnea
Dullnessandflatnessonchestpercussion
Decreasedorabsentbreathesound
Shortnessofbreathe.
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29. Cont…
Pleuriticchestpain
Dyspnea
-thechestpainisusuallysharpandisexacerbatedby
movementofthepleuralsurfaces,aswithdeepinspiration,
coughingandsneezing.
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30. Diagnosticevaluation
Historytaking
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31. Physical examination
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32. CT-Scan
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33. Chestx-ray
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34. Thoracentesis
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35. Pleuralbiopsy
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36. Analysisofpleuralfluid
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37. Complication
Largeeffusioncanleadtorespiratoryfailure.
Disseminatedcancer.
Pleuropulmonaryinfection.
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38. Management
Generalmanagement:
Treatmentisaimatunderlyingcauseegheartdisease,
tuberculosisinfection,cancer
Thoracocentesisisdonetoremovefluids.Collecta
specimenandrelievedyspnea.
Intrapleuralinstillationofmedicine:tetrascycline,
doxycycline
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39. Formalignanteffusion
Chesttubedrainage,radiationandchemotherapy,surgical
pleumonectomy,pleuroperitonealshuntorpleurodesis
thoracocentesismaybeprovidedonlytransientbenefitsin
malignantbecauseeffusionmayreaccumulatewithinfew
days
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40. Surgicalmanagement
Surgicalpleurectomy:
Pleurectomyisatypeofsurgeryinwhichpartofthe
pleuraisremoved.Thisprocedurehelpstoprevent
fluidfromcollectingintheaffectedareaandisused
forthetreatmentofmesothelioma,apleural
mesothelialcancer.
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41. NursingManagement
Assessment:
Obtainhistoryofpreviouspulmonarycondition
Assesspatientfordyspneaandtachypnea
Auscultationandpercussionofthelungsofabnormalities
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42. Nursingdiagnosis
Impairedgasexchangerelatedtodecreasedfunctionof
lungtissue
Ineffectivebreathingpatternrelatedtocompromisedlung
expansion
Acutepainrelatedtoinflammatoryprocess
Anxietyrelatedtoinabilitytotakedeepbreaths
Riskforinfectionr/tpoolingoffluidinlungspace
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43. Nursingintervention:
Toimprovegasexchange:
Assessrespiration;quality,rate,rhythm,depth.
Observecolourofskin,mucousmembraneandnailbeds
forpresenceofcyanosis.
Advicepatientforcompeltebedrest.
Encourageuseofrelaxationtechniquesuchasdeep
breathing.
Administer02byappropriatemeans:nasalprongs,mask,
venturemask.
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44. Maintaineffectivepattern:
Checkourespiratoryfunction,resiratorydistressand
changesinvitalfunction.
Maintainapositionofcomfort,withaheadofbedslightly
elevated.
Turntoaffectedsite.
Administeroxygentherapyasprescribedtomaintain
oxygenlevel.
Maintaincalmenvironment.
Checkdrainageifinserted.
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45. Toreducepain:
Assessthepatientbyusingpainratingscaleforintensity,
characteristicsandlocationofpain.
Assistpatientondeepbreathingexerciseandrelaxation
technique.
Assistthepatienttochangeposition.
Maintaincalmenvironment.
Administeranalgesicforpainasprescribed.
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46. Toreduceriskofinfection:
Demonstrateandencouragegoodhandwashing
technique.
Limitvisitors.
Promoteadequatenutritionintakewhichfacilitatehealing
process.
Encourageadequaterestwithmoderateactivity.
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47. Cont..
Patienteducationandhealthmaintenance:
Providecareafterpleurodesis
Monitorforexcessivepainandgiveanalgesic
Assistpatientundergoinginstillationofintrapleural
lignocaineifpainisnotrelief
Administeroxygenasindicateddyspneaandhypoxemia
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48. Cont….
Observedpatient’sbreathingpattern,oxygensaturation
andvitalsignforassessmentweatherimprovementor
deterioration
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49. Complication:
Alungthatissurroundedbyexcessfluidforalong
timemaybedamaged.
Pleuralfluidthatbecomesinfectedmayturnintoan
abscess,calledanempyema,whichwillneedtobe
drainedwithachesttube.
Pneumothorax(airinthechestcavity)canbea
complicationofthethoracentesisprocedure.
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50. CareofChestTubeDrainage
Neverliftdrainabovechestlevel
Theunitandalltubingshouldbebelowpatient’schest
leveltofacilitatedrainage
Tubingshouldhavenokinksorobstructionsthatmay
inhibitdrainage
Ensureallconnectionsbetweenchesttubesanddrainage
unitaretightandsecure
Connectionsshouldhavecabletiesinplace
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51. CareofChestTubeDrainage
contd
Tubingshouldbeanchoredtothepatient’sskintoprevent
pullingofthedrainpreventaccidentalremoval.
InPICUandNICUtubingshouldalsobesecuredtopatientbed
preventaccidentalremoval.
Ensuretheunitissecurelypositionedonitsstandorhangingon
thebed.
Ensurethewatersealismaintainedat2cmatalltimes.
Measuretheoutputofdrainage.
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