Pleurisy

Pleurisy for adult nursing

1. 7/24/2022 1 Pleurisy

2. Welcome

3. RESPIRATORY SYSTEM PLEURISY PREPARED BY: RN ARPANA BHUSAL Bns

4. CONTENT LAYOUT DEFINITION TYPES RISK FACTORS CAUSES PATHOPHYSIOLOGY SIGN AND SYMPTOMS 7/24/2022 4 Pleurisy

5. CONTENT LAYOUT DIAGNOSTIC EVALUATION TREATMENT NURSING MANGEMENT PREVENTION COMPLICATION PROGNOSIS 7/24/2022 5 Pleurisy

6. How Does pleura WORKS? The pleura is composed of two layers of thin lining tissue. the layer covering the lung (visceral pleura) and the parietal pleura that covers the inner wall of the chest are lubricated by pleural fluid. Normally, there is about 10-20 ml of clear liquid that acts as a lubricant between these layers.. 7/24/2022 Pleurisy 6

7. DEFINITION Pleurisy is a medical condition affecting the two layers of the tissue called “pleura”, which acts as a separator between the lungs and the chest wall. Pleurisy is defined as inflammation of the tissue layers (pleura) lining the lungs and inner chest wall These conditions manifest as a sharp chest pain called “ pleuritic chest pain”, and can be worse during respirations . 7/24/2022 Pleurisy 7

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9. DEFINITION Pleurisy is inflammation of the pleura often associated with the accumulation of fluid between the two layers of pleura, known as pleural effusion. Pleurisy causes roughening of the surfaces of the pleura. Pleurisy is a symptom rather than a disease. 7/24/2022 Pleurisy 9

10. DEFINITION It may develop in conjunction with: Pneumonia ; an upper respiratory tract infection, TB, or collagen disease( a component of the connective tissue) Trauma to the chest, Pulmonary embolism; Primary and metastatic cancer; and After thoracotomy 7/24/2022 Pleurisy 10

11. TYPES OF PLEURISY 1.Dry pleurisy. 2. Wet pleurisy. 7/24/2022 Pleurisy 11

12. TYPES Dry Pleurisy The amount of pleural fluid does not increase. Associated with: tuberculosis rheumatic fever 7/24/2022 Pleurisy 12

13. Types acute bacterial or viral pulmonary infections acute upper respiratory tract illness. The process is usually limited to the visceral pleura, with small amounts of yellow serous fluid . 7/24/2022 Pleurisy 13

14. TYPES Adhesion between pleural surfaces Pleural thickening Fibrothorax due to fibrin deposition and severe adhesions Note: fibrothorax  is defined as fibrosis within the pleural space, and occurs secondary to the inflammatory response. 7/24/2022 Pleurisy 14

15. TYPES 2 . Wet Pleurisy It is accompanied by abnormal increase in pleural fluids and divided into transudate and exudate . Generally, inflammatory disease and tissue destruction produce exudates with specific gravity of above 1.017 and high concentration of proteins and LDH(lactic acids dehydrogenase ) 7/24/2022 Pleurisy 15

16. TYPES If the effusion contains purulent materials, it is called empyma . If the empyma ultimately leads to fibrous fusing of the lungs and chest wall, it is then called fibro thorax . 7/24/2022 Pleurisy 16

17. TYPES Transudates which are produced by diseases such as CCF show lower values for these components with protein below 3.5 gm/dl and LDH below 200 units. The accumulation of pleural transudate is sometimes referred to as hydrothorax or pleural effusion 7/24/2022 Pleurisy 17

18. RISK FACTORS Advanced age Smoking Chronic lung diseases Asthma Bronchitis 7/24/2022 Pleurisy 18

19. RISK FACTORS Cystic fibrosis Heart failure Diabetes Cancer 7/24/2022 Pleurisy 19

20. ETIOLOGY Pleurisy can be caused by any of the following conditions: Infections The most common cause of pleurisy is infection. Several viruses that cause pleurisy include influenza or flu virus, cytomegalovirus (CMV) , parainflenza virus , and Epstein-Barr virus. 7/24/2022 Pleurisy 20

21. ETIOLOGY Bacterial infections resulting to pleurisy are less common and can be caused by streptococcus. More specifically, bacterial pneumonia , a respiratory infection that can result in inflammation of the air sacs in the lungs, and tuberculosis , a serious bacterial disease that typically infects the lungs can prompt pleurisy Fungal infection can also cause pleurisy. 7/24/2022 Pleurisy 21

22. ETIOLOGY 2. Inhaled chemicals or toxic substances:   Asbestosis. 3. AUTOIMMUNE DISORDERS: Illnesses such as lupus or rheumatoid arthritis involve the immune system abnormally attacking healthy tissues. 7/24/2022 Pleurisy 22

23. ETIOLOGY 4. trauma Mechanical injury can result to pleurisy. The pleurisy can have swelling and inflammation when there is bruising or fracture of the ribs. Rib fractures or irritation from chest tubes used to drain air or fluid from the pleural cavity in the chest 7/24/2022 Pleurisy 23

24. ETIOLOGY 5. PULMONARY EMBOLISM:  Blood clot inside the blood vessels to the lungs. These blood clots blocks the lungs and causes reduced blood and oxygen to portions of the lung and can result in death to that portion of lung tissue (termed lung infarction). This can cause pleurisy. 6. PNEUMOTHORAX 7/24/2022 Pleurisy 24

25. ETIOLOGY 7. CANCER When a tumor grows in the pleural cavity, fluid buildup occurs, causing pleurisy and pleural effusion. F or example, the spread of lung cancer to the pleura. 7/24/2022 Pleurisy 25

26. ETIOLOGY(8/9) 8. CERTAIN DRUGS Certain medications can produce pleurisy as a side effect. These include certain chemotherapy medications( e.g , methotrexate and bleomycin ), antiarrhythmic medications ( e.g amiodarone and procainamide), tuberculosis medication (e.g. ionazid ) , and high blood pressure medications( e.g , hydralazine) 7/24/2022 Pleurisy 26

27. ETIOLOGY 9. TUMORS OF THE PLEURA Mesothelioma or sarcoma 10. CARDIAC CONDITIONS  Heart failure Heart attack(Myocardial infarction) 7/24/2022 Pleurisy 27

28. Patho-physiology Infection/ inflammation/trauma ( causative factors) Pleura are affected, it becomes edematous and congested Fibrous exudates will present 7/24/2022 Pleurisy 28

29. PATHOPHYSIOLOGY Now , when the inflamed pleural membrane rubs together during inspiration, the result is severe, sharp and knife like pain 7/24/2022 Pleurisy 29

30. Sign and symptoms 1 . Pleuritic Chest Pain 2.Shortness of breath 7/24/2022 Pleurisy 30

31. Sign and symptomS 3 . Fever ,Chills, 4. Cough Malaise and increased WBC count 7/24/2022 Pleurisy 31

32. SIGN AND SYMPTOMS 6. Unexplained weight loss 7. Sore Throat . 7/24/2022 Pleurisy 32

33. SIGN AND SYMPTOMS 8 . Dyspnea 9.Purulent sputum 10. Limited chest movement on affected site 11. Tenderness of intercostal space on affected site. 12. Dull sound on percussion on affected site 13.Diminished breath sounds. 7/24/2022 Pleurisy 33

34. DIAGNOSTIC EVALUATION The diagnosis of pleurisy is made by the characteristic of chest pain and physical findings on examination of the chest. Analysis of pleural fluid aspirated from the chest can help determine the cause of the pleurisy. 7/24/2022 Pleurisy 34

35. DIAGNOSTIC EVALUATION History taking 2. Physical examination 7/24/2022 Pleurisy 35

36. DIAGNOSTIC EVALUATION 3. CHEST X-ray 4. BLOOD TEST 7/24/2022 Pleurisy 36

37. DIAGNOSTIC EVALUATION 5. SPUTUM EXAMINATION 6. CT SCAN 7/24/2022 Pleurisy 37

38. DIAGNOSTIC EVALUATION 7. ULTRASOUND 8. MRI 7/24/2022 Pleurisy 38

39. DIAGNOSTIC EVALUATION 9. ELECTROCARDIOGRAM(ECG) 10. BRONCHOSCOPY 7/24/2022 Pleurisy 39

40. DIAGNOSTIC EVALUATION 11 . THORACENTESIS 12. THORACOSCOPY . 7/24/2022 Pleurisy 40

41. DIAGNOSTIC EVALUATION 13. Pleural biopsy 7/24/2022 Pleurisy 41

42. TREATMENT Treatment for pleurisy focuses primarily on underlying cause The objectives of treatment are : To discover the underlying cause and to relieve the pain. To remove the fluid, air or blood from pleural spaces To relieve symptoms 7/24/2022 Pleurisy 42

43. Treatment Bacteria (Bacterial pneumonia) Antibiotics that are specific for bacteria- caused pleurisy to manage the infection. 2. FUNGAL Antifungal for fungal- caused pleurisy. 7/24/2022 Pleurisy 43

44. TREATMENT 3. Viral If pleurisy is caused by a virus- antiviral may not be required as it can resolve on its own. The doctor may ask the patient to rest for a few days, with close monitoring. 7/24/2022 Pleurisy 44

45. TREATMENT 4. PAIN AND INFLAMMATION Non-steroidal anti-inflammatory drugs(NSAIDs), such as; Indomethacin are effective to relieve pleuritic pain. Indomethacin , in dosages of 50 to 100 mg orally up to three times per day with food, has been found to be effective in relieving pleural pain 7/24/2022 Pleurisy 45

46. TREATMENT In case, when NSAIDs are not helpful , paracetamol or codeine can be administered . Codeine can also help suppress cough. Removal of fluid from the chest cavity (thoracentesis) can relieve the pain and shortness of breath. Take deep breaths every 1-2 hours while awake 7/24/2022 Pleurisy 46

47. TREATMENT 5. DRUG-INDUCED If a patient has suspected drug-induced pleuritis or drug-induced lupus pleuritis, the causal agent should be discontinued. 6.TOXIN SUBSTANCE Smoking cessation should be advised for patients with pleurisy caused by asbestosis 7/24/2022 Pleurisy 47

48. TREATMENT 7. LUPUS OR TUBERCULOSIS corticosteroids such as prednisolone, dexamethasone, or methylprednisolone to reduce swelling. 8. CHEST DRAIN 7/24/2022 Pleurisy 48

49. TREATMENT 9. Chest physiotherapy-- deep breathing and coughing. 10. Blood clots If pleurisy is caused by blood clots in the arteries of the lungs, medications that prevent further blood clots such as heparin may be prescribed. 7/24/2022 Pleurisy 49

50. TREATMENT 10. OXYGEN ADMINISTRATION If the condition is severe, particularly if it is accompanied by pneumonia, oxygen may be required . 12. Radiation treatment or chemotherapy In some cases, doctor use cancer treatments to shrink tumors that cause pleurisy. 7/24/2022 Pleurisy 50

51. LIFESTYLE AND HOME REMEDIES Take prescribed medication 2. Get plenty of rest 3.Do not smoke 4.Breath deeply 7/24/2022 Pleurisy 51

52. NURSING MANAGEMENT 7/24/2022 52 Pleurisy

53. NURSING MANAGEMENT Nursing assessment Obtain history of previous pulmonary condition Take history with emphasis on onset and nature of chest pain. Obtain history of illness such as systemic lupus erythematous, tuberculosis infection, etc. History of cigarette, alcohol and tobacco use 7/24/2022 Pleurisy 53

54. NURSING MANAGEMENT Obtain history of drugs used Assess patient for dyspnea and shortness of breath Assess breath sounds and monitor respiratory rate Percussion for dullness sound. Ascultate for pleural friction rub. 7/24/2022 Pleurisy 54

55. NURSING DIAGNOSIS 1. Acute pain (pleuritic) related to inflammatory process as evidenced by chest pain. 2. Ineffective breathing pattern related to bacteria-caused pleurisy as evidenced by shortness of breath and cough. 3. Impaired gas exchange related to decreased function of lung tissue. 4. Anxiety related to pain, dyspnea and prognosis of disease. 5. Risk for infection related to pooling of fluid in lung space 7/24/2022 Pleurisy 55

56. NURSING MANAGEMENT REDUCING PAIN Assess the patient by using pain rating scale for intensity, characteristics and location of pain. Watch patient for signs of discomfort and pain. Assist patient on deep breathing exercise and relaxation technique. Assist the patient to change position . 7/24/2022 Pleurisy 56

57. NURSING MANAGEMENT Maintain calm environment. Administer the prescribed pain medications and assess response at least 30 minutes after drug administration. Assist patient to a position of comfort, possibly lying on affected side, to decrease stretching of pleurae. 7/24/2022 Pleurisy 57

58. NURSING MANAGEMENT 2. MAINTAIN EFFECTIVE PATTERN Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Administer the prescribed antibiotic medications. Elevate the head of the bed. Assist the patient to change position as tolerated. Encourage the patient to lie on the affected side if possible 7/24/2022 Pleurisy 58

59. NURSING MANAGEMENT Check out respiratory function, respiratory distress and changes in vital function. Position the patient in high fowler's position to maximize chest expansion and ease the work of breathing . Maintain calm environment. Check drainage if inserted. Administer oxygen, if ordered, based on oxygen saturation levels; assess for signs and symptoms of hypoxia . 7/24/2022 Pleurisy 59

60. NURSING MANAGEMENT 3 . IMPROVE GAS EXCHANGE Assess respiration; quality, rate ,rhythm, depth. Auscultate lung sounds. Observe color of skin, mucous membrane and nail beds for presence of cyanosis. Advice patient for complete bed rest. Encourage use of relaxation technique such as deep breathing. 7/24/2022 Pleurisy 60

61. NURSING MANAGEMENT 7/24/2022 Pleurisy 61 Administer 02 by appropriate means: nasal prongs , mask , venture mask. Provide for frequent rest periods; Assist with passive range-of-motion (ROM) exercises; encourage active ROM exercises.. Assist with thoracentesis, if indicated .

62. NURSING MANAGEMENT 4. REDUCING ANXIETY Correct dyspnea and relief physical discomfort. Explain diagnostic procedures and the patients role: correct misconception. Speak calmly and slowly. 7/24/2022 Pleurisy 62

63. NURSING MANAGEMENT Listen to patient concerns; attentive listening relieves anxiety and reduces emotional distress Encourage the patient to verbalize feelings and concerns; provide emotional support and guidance. Assist the patient in using positive coping strategies and relaxation techniques. 7/24/2022 Pleurisy 63

64. NURSING MANAGEMENT 5 . REDUCE RISK OF INFECTION Demonstrate and encourage good hand washing technique. Limit visitors. Promote adequate nutrition intake which facilitate healing process. Encourage adequate rest with moderate activity. Administer antibiotic as prescribed. 7/24/2022 Pleurisy 64

65. PATIENT TEACHING Disorder, possible underlying cause, diagnosis, and treatment, including medications to control pain and coughing need to take ibuprofen or other NSAIDs with food or meals to minimize GI distress possible sedative effects if codeine is prescribed, and the need for safety measures How to perform and deep-breathing exercises Importance of regular rest periods energy conservation measures anxiety reduction and coping strategies 7/24/2022 Pleurisy 65

66. Patient teaching Importance of seeking early intervention for pulmonary conditions signs and symptoms of possible complications, such as increasing respiratory distress, development of productive cough, and fever, and the need to notify the practitioner immediately Importance of adhering to recommended follow-up care to evaluate the condition and the underlying cause. 7/24/2022 Pleurisy 66

67. PREVENTION There is a vaccine against one of the most common organism that causes pneumonia. It is recommended that people who are at risk of pneumonia be immunized , including young children, older people over the age of 65, people with chronic medical conditions (such as diabetes) and people with reduced immunity . 7/24/2022 Pleurisy 67

68. PREVENTION Apart from vaccination , treating any infection of the respiratory tract promptly can also reduce the risk of developing pleurisy. Quit smoking. Early diagnosis and treatment of underlying cause of pleurisy. 7/24/2022 Pleurisy 68

69. COMPLICATIONS Pleural effusion Atelectasis. Emphysema Lung fibrosis Hemothorax 7/24/2022 Pleurisy 69

70. PROGNOSIS Most people who receive prompt diagnosis and treatment for the condition causing pleurisy recover fully People treated with antibiotics for an infection causing pleurisy usually feel better in about a week . Very rarely, people who are not treated may have life-threatening complications. The outlook also depends on the underlying condition that causes the pleurisy . 7/24/2022 Pleurisy 70

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72. REFERENCES Smeltzer.S.G. Bare.B.G. Hinkle.J.G. Cheezer K.H.(2010) “Brunner & Suddarth’s textbook of Medical- Surgical Nursing", Volume 1. (12 th edition). New Delhi, Kluwer India. Pvt. Ltd. 2078/04/10 at 1 pm Mandal G.N (2016) “A Textbook Of Medical Surgical Nursing”. 5 th edition. Kathmandu. Makalu Publication House.2078/04/11at 3 pm. 7/24/2022 72 Pleurisy

73. REFERENCE 2019. Mayo Foundation Of Medical Foundation And Research. Pleurisy https://www.mayoclinic.org@2021/07/25 at 3pm. Nov4,2019,pleurisy https://www.slideshare.net/gamandeep@2021/06/25 at 5pm 7/24/2022 Pleurisy 73

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