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Pleural effusion
Pleural effusion is the accumulation of excess fluid in the pleural cavity, which can impair breathing and is usually caused by conditions such as congestive heart failure, pneumonia, or malignancy. There are two main types of pleural effusion – transudative and exudative – distinguished by their characteristics and underlying causes. Diagnosis involves history, physical exam, and imaging, while management includes thoracentesis and nursing interventions to support respiratory function and prevent complications.
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Introduction to pleural effusion; presented by Mr. Anilkumar B R, highlighting its significance.
Definition of pleural effusion, causes including CHF, pneumonia; symptoms affecting breathing.
Differentiation between transudative and exudative pleural effusions.
Causes of transudative effusions like CHF and nephrotic syndrome; characteristics listed.
Causes of exudative effusions such as cancer and pneumonia; distinct characteristics highlighted.
Overview of fluid types accumulating in pleural space: serous, blood, pus, chyle.
Complications of large effusions; symptoms including pleuritic chest pain and dyspnea.
Methods for assessment including history, physical examination, and imaging studies.
Introduction to thoracentesis for fluid removal and analysis.
Objectives to treat underlying causes, perform thoracentesis, and relieve respiratory discomfort.
Nurse's role in patient care, preparing for procedures, managing pain & anxiety.
Interventions including oxygen administration, preparation for thoracentesis, monitoring.
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Pleural effusion
- 1. PLEURAL EFFUSION BY Mr. ANILKUMARB R Assit Professor Medical-surgical Nursing
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- 3. PLEURAL EFFUSION • Normally,the pleural space contains a small amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction. • But if fluid builds up from either increased production or inadequate removal pleural effusion results. • Pleural effusion B/L or unilateral (parapneumonic process)
- 4. PLEURAL EFFUSION • Refersto any significant collection of fluid within pleural space. • Any imbalance in formation, absorption lead accumulation of pleural fluid. Common condition: 1.CHF 2.Bacterial pneumonia 3.Malignancy(chest tumor) 4.Pulmonary embolism
- 5. Definition • A pleuraleffusion describes an excess of fluid in the pleural cavity, usually resulting from an imbalance in the normal rate of pleural fluid production or absorption, or both.
- 6. What is Pleuraleffusion? • Pleura effusion is a condition refers to a collection of fluid in the pleural space. It is almost secondary to other conditions.
- 7. Pleural effusion • Thisfluid excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during respiration.
- 8. TYPES OF PLEURALEFFUSION • TRANSUDATIVE EFFUSIONS • EXUDATIVE EFFUSIONS
- 9. TRANSUDATIVE EFFUSIONS • Transudativeeffusions arise from more commonly: Congestive heart failure Hepatic disease with ascites Nephrotic syndrome Peritoneal dialysis Hypoalbuminemia and disorders of increase extra cellular volume.
- 10. Characteristics of Tranudativeeffusion • Occurs primarily in non-inflammatory conditions. • low protein, low-cell-count fluid. • Clear to faint yellow tinge, no odor • pH 7.40 7.55‐ • Specific gravity < 1.015 • Protein content < 3g/100ml • Glucose level equal serum plasma
- 11. EXUDATIVE EFFUSIONS • Exudativeeffusion result from several conditions such as: 1.Tuberculosis 2.Subphrenic abscess 3.Pancreatitis 4.Bacterial or fungal pneuomonia 5.Empyema
- 12. 1. Cancer 2. Pulmonaryembolism 3. SLE & rheumatoid arthritis 4. Intra abdominal abscess 5. Esophageal perforation and chest injuries
- 13. Characteristics of Exudativeeffusion • Often turbid, bloody or purulent • pH < 7.30 • Specific gravity > 1.016 • Protein content > 3g/100ml • Glucose level < 60mg/dl. • High-protein fluid
- 14. Types of fluids THEREARE MAINLY Four types of fluids can accumulate in the pleural space: 1. Serous fluid (hydrothorax) : A hydrothorax is a condition that results from serous fluid accumulating in the pleural cavity. 2.Blood (haemothorax): is a condition that results from blood accumulating in the pleural cavity.
- 15. Types of fluids 3.Pus (pyothorax or empyema) : is an accumulation of pus in the pleural cavity.
- 16. 2. Chyle (chylothorax):chyle is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs) and it is formed in the small intestine during digestion of fatty foods .It is a type of pleural effusion . it results from lymphatic fluid (chyle) accumulating in the pleural cavity.
- 17. Complications • Large effusionscould lead to reparatory failure.
- 18. Clinical Manifestations The clinicalpresentation of pleural effusion depends on the amount of fluid present and the underlying cause. Many patients have no symptoms at the time a pleural effusion is discovered.
- 19. Clinical Manifestations 1. Pleuriticchest pain 2. Dyspnea 3. Nonproductive cough. • The chest pain is usually sharp and is exacerbated by movement of the pleural surfaces, as with deep inspiration, coughing, and sneezing.
- 20. Assessment & Diagnosis •History collection (A history of pneumonia, chest tumor cardiac, renal, or liver impairment and cancer related treatment) • Physical examination (decreased or absent breath sounds, decreased fremitus, and a dull, flat sound when percussed)
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- 22. Ultrasonography thorax • Evensmall amounts of pleural effusion can be detected accurately by ultrasonography. • CT-Scan thorax
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- 24. Medical Management • Theobjectives of treatment are to discover the underlying cause, to prevent reaccumulation of fluid, and to relieve discomfort, dyspnea, and respiratory compromise mainating oxygenation & facilating drainage)
- 25. Medical Management • Thoracentesisis performed to remove fluid, to obtain a specimen for analysis, and to relieve dyspnea and respiratory compromise. • Thoracentesis may be performed under ultrasound guidance.
- 26. Nursing Management • Thenurse’s role in the care of the patient with a pleural effusion includes implementing the medical regimen.
- 27. • The nurseprepares and positions the patient for thoracentesis and offers support throughout the procedure. • Pain management is a priority, and the nurse assists the patient to assume positions that are the least painful.
- 28. Nursing diagnosis • Riskfor infection related to introduction of foreign object ( thoracentesis needle, chest tube) in to chest cavity. • Impaired gas exchange related to ineffective breathing pattern. • Anxiety related to diagnosis and therapeutic procedure ( thoracentesis, chest drainage).
- 29. Nursing Interventions • Administeroxygen and in empyema antibiotics, as ordered. Record the client response to these treatments. • Encourage to perform to perform pulmonary exercise such as deep breathing, effective coughing and use of spirometry etc.
- 30. Nursing Interventions • Preparethe client for thoracentesis procedure and assist to physician during procedure and monitor complications associated with thoracentesis ( bleeding, pain, dyspena and cyanosis). • Monitor client respiratory status frequently. Obtain ABGs if necessary.
- 31. Nursing Interventions • Ensurechest tube patency by observing for fluctuations in the tubing. Record the amount, color, and consistency of any tube drainage.