Unit III 3. Pleural Effusion.ppt

pleural effusion

1. B. SC NURSING
MEDICAL-SURGICAL NURSING -I
UNIT-III NURSING MANAGEMENT OF
PATIENTS WITH RESPIRATORY
PROBLEMS
PLEURALEFFUSION
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2. GENERALOBJECTIVE
•Attheendoftheclassstudentswillgainin
depthknowledgeregardingpleuraleffusion,
developsdesirableattitudeandabletoapply
thisknowledgewhenevernecessary.

3. Specificobjective
•Explainthecausesofpleuraleffusion
•Describethepathophysiologyofpleuraleffusion
•Explainthesignsandsymptomsofpleural
effusion
•Describethediagnosticinvestigationsforpleural
effusion
•Summarize themedicalandnursing
managementofpleuraleffusion
PLEURALEFFUSION

4. PLEURALEFFUSION
Introduction:
•Pleuraleffusionsareaccumulationsoffluid
withinthepleuralspace.Theyareclassifiedas
transudatesorexudates.
•TRANSUDATES-fluidbuildupcausedbysystemic
conditions[duetocardiacorrenalproblem]
•EXUDATES-fluidbuildupcausedbytissueleakagedue
toinflammationorlocalcellulardamage.
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5. Definition:
•Pleuraleffusionisdefinedasabnormalaccumulation
offluidinthepleuralspace.
•Fluidcanaccumulatearoundthelungsduetopoor
pumpingbytheheartorbyinflammation.
•Theexcessiveamountsofsuchfluidcanimpair
breathingbylimitingtheexpansionofthelungsduring
respiration.
PLEURALEFFUSION
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7. 5
PLEURAL FLUIDFORMATION
Normally,10to20mlofpleuralfluidisspread
thinlyovervisceralandparietalpleurae,facilitating
movementbetweenthelungsandchestwall.
Thefluidentersthepleuralspacefromsystemic
capillariesintheparietalpleuraeandexitsvia
parietalpleuralstomasandlymphatic's.

8. PLEURAL FLUIDFORMATION
Pleural fluid accumulates when too much fluid
enters or too little exits the pleural space.
The fluid will be clear or pale yellow.

9. .Clear ultra filtrate ofplasma
•Volume -0.3ml/kg[eg.50kg=12ml]
•Cells/ mm3 -1000 –5000
•Mesothelial cells -60%
•Monocytes -30%
•Lymphocytes -5%
•Protein -1-2g/dl
COMPOSITION OF PLEURAL FLUID

10. CLASSIFICATION
a)Basedonsite
Apical
Interlobar
Sub-pulmonic-base[btwpleuraanddiaphragm]
Mediastinal-btwthelungs

11. B)Basedonmechanismandtypeofpleuralfluid
Transudative
Exudative
Serousfluid[hydrothorax]-accumulationofserousfluidin
pleuralcavity
Blood[haemothorax]-bloodaccumulatinginpleuralcavity
Pus[pyothoraxorempyema]-accumulationofpusin
pleuralcavity
Chyle[chylothorax]-milkybodyfluidcontainsfattycells

12. ETIOLOGY
•A viral infection such as the flu[influenza]
•A bacterial infection,such as pneumonia
•A fungal infection
•Autoimmune disorder eg.rheumatoid arthritis
•Certain medications
•Lung cancer near the pleural surface

13. PATHOPHYSIOLOGY
•Due to etiological factor
•Increased pressure in pulmonary capillaries
•Increased amount of fluid enter the interstitial
spaces of lung
•Increased interstitial pressure in interstitial
spaces

14. Fluid moves from the pulmonary interstitial spaces
into pleural space
Pleural effusion

15. Dyspnea-breathlessness
Pleuriticchestpain-avaguediscomfortorsharp
painthatworsensduringinspiration
Painisusuallyfeltovertheinflamedsite.
Dullpercussionoverareaofeffusion
Decreasedbreathsoundsofareaofeffusion
Pleuralrub,cracklessoundsonauscultation
SYMPTOMS

16. DIAGNOSIS
•Chest x-ray

17. Pleuralfluidcytology
•WBCcount
•Predominantcelltype(neutrophil,Lymphocytes,
•Eosinophils,redbloodcells)
•Gram stain
•Acid fast for acid fast bacilli(AFB)
•Pleural fluid culture
•AFB culture
•Polymerase chain reaction for TB
DIAGNOSIS

18. •CT scan of chest
•Ultrasound of the chest
•Thoracentesis-a needle is inserted between
the ribs to remove a biopsy or to collect fluid]
•Pleural fluid analysis-examination of the fluid
removed from the pleural space.
•Thoracoscopy-minimally invasive technique
allows for a visual evaluation of the pleura
-It is also known as video assisted
thoracoscopic surgery[VATS]
-It is performed under general anesthesia

19. MANAGEMENT
Treatment of pleural effusion is based on the
underlying condition and whether the effusion is causing
severe respiratory symptoms such as shortness of breath
or difficulty breathing.
Congestive heart failure-treat with diuretics
Thoracentesis [ tube thoracostomy ]-drained through a
chest tube.
Pleural sclerosis performed with sclerosing agents[such
as doxycycline , tetracycline]

20. SURGICALMANAGEMENT :
1.VIDEOASSISTEDTHORACOSCOPIC SURGERY
•1-3smallincisionIsmadetoremovefluids
•Veryeffectiveinmanagingeffusion
•Antibioticsareinsertedatthetimeofsurgerytoprevent
therecurrenceoffluidbuildup.
2.THORACOTOMY -OPENTHORACICSURGERY
•Performedthrough6-8inchincisioninthechest
•Removesallthefibroustissue-chesttubeismaintained
for2weeksaftersurgeryfordraincollection

21. •Pleuralshock
•Airembolism
•Introductionofinfection
•Pneumothorax-lungcollapse
•Pulmonaryembolism
•Airembolism
•Acutepulmonaryedema
•Injurytovascularbundles
•Hydropneumothorax-presence
ofairandfluids
COMPLICATION

22. 1.Impairedgasexchangerelatedtofluid
collectioninpleuralspacesevidencedby
dullnessonpercussion,pleuralfrictionrub
onauscultation.
Goal:demonstratesfulllungexpansionwithnormal
oxygensaturationintervention:
•Monitorrespiratoryrateandoxygenationstatus
•Initiateandmaintainsupplementaloxygento
treathypoxemia
NURSINGMANAGEMENT

23. •Positionthepatientinfowlerstoincreasepatient
comfortandtofacilitateaerationinlungs.
•Chesttubecare
•Monitorforbubblingofthesuctionchamberfor
chesttubedrainagesystem
•Ensurethattubing'saresecuredproperly
•Keepdrainagecontainerbelowthechestlevel

24. 2.Ineffectivebreathingpatternrelatedtopainand
positionasEvidencedbyshortnessofbreath
,shallowrespiration
Goal:demonstratesaneffectiverespiratoryrate,
rhythmanddepthofrespiration
NURSINGMANAGEMENT

25. •Intervention:
•Monitor respiratory rate, rhythm depth and effort of
respiration.
•Auscultate breath sounds, noting areas of decreased
ventilation
•Painmanagement
•Provide optimal pain relief with prescribedanalgesics
•Ventilationassistance
•Position the patient will alleviatedyspnoea
•Assist with incentivespirometer.

26. REFERENCE
1.Lewis,S.L.,Dirksen,S.R.,Heitkemper,M.M.,Bucher,
L.,&Harding,M.M.(2017).Medical-surgicalnursing:
assessmentandmanagementofclinicalproblems
(10thed.).St.Louis:elsevier.Pp.No-595-598.
2.BertholdJanyandTobiasWelte,.(2017).pleural
effusioninadults—etiology,diagnosis,andtreatment
3.Kamranboka,guyw.Soohoo,(2017).pleural
effusion:newsperspectiveDruganddiseasefrom
medscape.