Pleural effusion

Definition, causes, S/S tests and Management

1. PLEURAL EFFUSION

2. Anatomy of Lung Pleura

3. 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.

4. CAUSES Two classifications are ; 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.

5. 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

6. 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

7. 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

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

9. 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.

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

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

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

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

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

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

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

17. Nursing Management The nursing management of the bronchiastasis include the following steps Assessment Nursing diagnosis Nursing intervention Health Education

18. Nursing Management The nursing management of the bronchiastasis include the following steps Assessment Nursing diagnosis Nursing intervention Health Education

19. Nursing Assessment 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 Assess patient for dyspnea & tachypnea Auscultate & percuss lungs for the presence of the abnormalities

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

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