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Pleural effusion
Pleural effusion is an abnormal collection of fluid in the pleural space between the lungs and chest wall. It can occur when fluid builds up faster than it drains away and common causes include congestive heart failure, pneumonia, and cancer. Diagnosis involves chest x-rays, CT scans, or analyzing fluid drawn from the pleural space during a thoracentesis procedure. Treatment depends on the underlying cause but may include diuretics, antibiotics, drainage of fluid, or surgery in severe cases.
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Pleural effusion
- 1. PLEURAL EFFUSION Presented By: Mr.OM VERMA Assistant professor Medical Surgical Nursing Reliance institute of nursing
- 5. INTRODUCTION The body producespleural fluid in small amounts to lubricate the surfaces of the pleura, it lines the chest cavity and surrounds the lungs. The pleural cavity contains a relatively small amount of fluid, approximately 10 ml on each side . Excessive Accumulation of fluid in the pleura
- 6. • PLEURAL EFFUSIONis an abnormal, excessive collection of this fluid . Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during respiration According to Javed ansari
- 7. • Pleural effusion,sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing. Brunner and Suddarth’s
- 8. Con……………………………….. • Pleural effusionis define as Build up of excess fluid between the layers of the pleura outside the lungs. Lippincott • pleural effusion refers to a collection of fluid in the pleural space • luckmaan
- 9. TYPES • TRANSUDATIVE PLEURAL EFFUSIONS •EXUDATIVE EFFUSIONS
- 10. Types of Effusions TRANSUDATIVEPLEURAL EFFUSIONS It caused by fluid leaking into the pleural space. This is caused by increased pressure in, or low protein content in, the blood vessels . A transudate is a clear fluid, similar to blood serum . It reflect a systemic disturbance of body
- 11. Causes of Transudates •Atelectasis • Cirrhosis • Congestive heart failure • Hypoalbuminemia • Nephrotic syndrome • Peritoneal dialysis
- 12. • ATELECTASIS • isthe collapse or closure of a lung resulting in reduced or absent gas exchange. • CIRROSIS • Hepatic Hydrothorax (Pleural Effusion) Pleural effusions complicate end- stage liver disease in 5% of patients. Effusions (defined as 500 mL or more of fluid within the pleural space) are typically right-sided. No cardiopulmonary cause for the pleural effusion is found.
- 13. • Congestive heartfailure • (ineffective pumping of blood through the circulatory system due to enlargement and weakening of the heart muscle) is the most common cause of pleural effusion. Pneumonia is a common lung infection and may result in pleural effusion.
- 14. • Hypoalbuminemia is amedical sign in which the level of albumin in the blood is abnormally low. Nephrotic syndrome If there are too much protein losing from patient’s blood vessel, he will have more severe edema, Hypoalbuminemia in NS can cause a decrease in oncotic pressure causing extravasation (leakage ) of fluid into the interstitial space. In conditions of severe hypoalbuminemia, fluid extravasation may cause occurrence of pleural effusion.
- 15. Peritoneal dialysis • complicationsin PD patients and result from the migration of dialysis fluid under pressure from the peritoneal cavity into the pleural space..
- 16. Types Of Effusionscont.. EXUDATIVE EFFUSIONS A fluid rich in protein and cellular elements that oozes ( leaking) out of blood vessels due to inflammation . It is caused by blocked blood vessels, inflammation, lung injury, and drug reactions. An exudate—which often is a cloudy fluid, containing cells and much protein .
- 17. Causes of Exudates: •Atelectesis – collapse of both lungs Hemothorax Infection • (bacteria, viruses, fungi, tuberculosis, or parasites) Uremia • fluid, electrolyte, and hormone imbalances and metabolic abnormalities,
- 18. Asbestos exposure • Thesediseases can lead to irritation, swelling and inflammation, which in causes the blood vessels in the pleurae to leak extra fluid into the pleural space. Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs
- 20. Pathophysiology Due to etiologicalfactors It is explained by increased pleural fluid formation or decreased pleural fluid absorption Increased pleural fluid formation can result from elevation of hydrostatic pressure (increasing weight of fluid ) & decreased osmotic pressure.
- 21. It leads toincreased capillary permeability ( capacity of a blood vessel wall to allow for the flow of small molecules (drugs, nutrients, water, ions) or even whole cells & passage of fluid is through openings in the diaphragm Hence production increases & absorption is decreases lymphatic obstruction Pleural effusions produce a restrictive ventilatory defect and also decrease the total lung capacity and vital capacity
- 23. CLINICAL MANIFESTATION Pleuritic chestpain indicates inflammation of the parietal pleura Physical examination findings that can reveal the presence of an effusion dull or flat note on percussion diminished or absent breath sounds on auscultation. Chest pain, usually a sharp pain that is worse with cough or deep breaths, Cough, Fever, Rapid breathing, Shortness of breath
- 24. DIAGNOSTIC EVALUATION During aphysical examination, the doctor will listen to the sound of your breathing with a stethoscope and may top on your chest to listen for dullness. The following tests may help to confirm a diagnosis : Chest CT scan Chest x-ray Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancer cells) Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs) Ultrasound of the chest
- 25. • Chest Radiography:The posteroanterior and lateral chest radiographs are still the most important initial tools in diagnosing a pleural effusion. • Ultrasound is useful both as a diagnostic tool and as an aid in performing thoracentesis. It assist in identifying pleural fluid loculations. • Computed Tomography: Cross-sectional computed tomography (CT) It helps distinguish anatomic compartments more clearly This modality is useful as well in distinguishing empyema
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- 28. • Treatment dependson the cause of your pleural effusion and how bad your symptoms are. You may need any of the following: • Diuretics laxis may help you lose extra fluid caused by heart failure or other problems. • Antibiotics help prevent or treat an infection caused by bacteria. • Analgesic drug to relief pain
- 29. • NSAIDs helpdecrease swelling and pain or fever.. • Steroids or other types of medicines may be given to decrease swelling. • Drainage of extra pleural fluid may be done using thoracentesis or a chest tube. A chest tube may stay in your chest for days or weeks. This allows the extra fluid around your lungs to drain over time. You may need medicines put directly into your chest if the fluid does not drain out easily.
- 30. SURGICAL PROCEDURE In somecases, the following may be done: Surgery • Thoracentasis Pleural fluid is drawn out of the pleural space in a process called thoracentesis. A needle is inserted through the back of the chest wall in the sixth, seventh, or eighth intercostal space into the pleural space. The fluid may then be evaluated. • Gram stain and culture to identify
- 31. Nursing Diagnosis & Nursing Intervention •1. Ineffective breathing pattern related to decreased lung expansion(accumulation of liquid), as evidenced by dyspnea, changes in depth of breathing, accessory muscle use. Interventions • Maintain a comfortable position is usually elevated headboard • Given oxygen through a cannula (8mls)
- 32. 2. Acute Painrelated to accumulation of fluid in the pleural space and rubbing of thoracostomy tube to the lungs • Interventions • -The presence of pain, the scale and intensity of pain was well assessed • -The client taught about pain management and relaxation with distraction • -Chest tube secured to restrict movement and avoid irritation • -Given prescribed analgesics i.e diclofenac 75mg.
- 33. 3. Risk fornutrition impariment, less than body requirement related to inability to ingest adequate nutrients Interventions • -Patient relative i.e his father encouraged to give him energy reaching food stuff together with energy supplement so that he can get enough energy. • -Administer DNS as prescribed to the patient to increase energy lost.
- 34. 4. Risk forfluid volume deficit related to chest tube drainage. • Interventions • -encourage the patient to drink enough water to supplement the one lost by chest tube drainage • -IV fluids & DNS to replace fluid lost in drainage system monitored in 24hours.
- 35. 5. Risk forinfection related to the presence of fluid in the pleural space and the incision site. • Interventions • -The patient dressed at the incision site when it is wetted, probably after 2 to 3 days • -Given antibiotics as prescribed i.e IV metronidazole 500mg 8 hourly, IV ceftiaxone 1gm.
- 36. Possible Complications A lungthat is surrounded by excess fluid for a long time may be damaged. Pleural fluid that becomes infected may turn into an abscess, called an empyema, which will need to be drained with a chest tube. Pneumothorax (air in the chest cavity) can be a complication of the thoracentesis procedure.