PLEURAL EFFUSION
NCM 112: MEDICAL-SURGICAL NURSING
1St Semester | BSN – 3B
S.Y. 2023 – 2024
PLEURAL EFFUSION
Accumulation or collection of fluids in the pleural
space secondary to diseases
Pleural effusion disrupt the negative pressure in
the lungs and may cause atelectasis.
Normally, the pleural space contains small amount
of fluid (5-15 ml) which act as a lubricant that allows
the pleural surfaces to move without friction
Pleural effusion maybe a complication of heart
failure, TB, Pneumonia, nephrotic syndrome and
neoplastic tumors
The most common malignancy associated with
pleural effusion is bronchogenic carcinoma
TYPES
Transudate pleural effusion
(filtrate of plasma that moves across intact capillary
walls) occurs when factors influencing the formation
and reabsorption of pleural fluid are altered usually
by imbalances in hydrostatic or oncotic pressure.
This is commonly results from congestive heart
failure. In congestive heart failure, an increase in
pulmonary venous pressure contributes to the
formation of pleural effusions.
Another causes is atelectasis because of decrease
pleural pressure
Exudative Pleural effusion
Results from leakage of fluid across an injured
capillary bed into the pleural cavity
TYPES OF EXUDATIVE PLEURAL EFFUSION
Hemothorax- blood in the pleural space due to
cancer, trauma as the common cause of
hemothorax, CVP, thoracentesis and malignancy
Pyothorax/empyema- pus in the pleural space and
requires drainage from a chest tube due to
Pneumonia
Hyrothorax- water in the pleural space
CAUSES OF EXUDATIVE PLEURAL EFFUSION
Pneumonia is the most common cause of exudative
PE cause by S. Pneumoniae.
Second common cause of exudative PE is cancer
(lung, breast, gastric and ovarian). Exudative PE
caused by malignancy is bloody
fluid has high protein content that leaks across the
across the disrupted capillary
results from infected fluid accumulating in the
mediastinum and peritoneum and the fluids move
into the low pressure space of the pleural cavity
CLINICAL MANIFESTATIONS
Fever, chills, pleuritic chest pain,
Dyspnea difficulty lying on flat, coughing due to
large pleural effusion, small to moderate PE causes
minimal or no dyspnea
ASSESSMENT
Subjective findings: SOB, pleuritic chest pain
Objective Findings: tachypnea, hypoxemia, dullness
(hemothorax) to percussion, decreased or absent
breath sounds; decrease fremitus, Cyanosis
Tracheal deviation away from the affected side
Chest asymmetry (no movement on the side of
atelectasis)
Hyperresonance on chest percussion-
pneumothorax
DIAGNOSTIC FINDINGS
Chest X Ray, Physical findings and Thoracentesis
confirm the presence of fluid
Pleural fluid analysis- for bacterial culture, AFB
stain, and chemistry studies (glucose, amylase,
protein and for cytologic analysis for malignant cells
MEDICAL MANAGEMENT
The objective of treatment is to discover the
treatment of the underlying cause.
Thoracentesis -to remove fluid, to obtain specimen,
and to relieve dypsnea
Chest tube thoracostomy tube connected to water
seal drainage system- to evacuate the fluids and to
re-expand the lung.
THORACENTESIS
Aspiration of fluid or air from the pleural space
NURSING INTERVENTIONS BEFORE THE PROCEDURE
Secure written consent- invasive
Take V/S- aspiration of air/fluid from the
pleural space cause Hypovolemic shock
Position: upright, leaning on the over bed
table/Sitting position
Topical anesthesia is used at the site of
needle insertion
Pressure sensation is felt on insertion site
NURSING INTERVENTIONS POST PROCEDURE
Apply pressure to the puncture site
Turn the client on the unaffected side. To
prevent leakage of fluid in the thoracic cavity
Bed rest. To prevent postural hypotension
Check for expectoration of blood. Notify the doctor.
Indicates trauma to the lung
Monitor for complications:
Shock, Pneumothorax, and Respiratory arrest
If the cause is Malignancy
Pleurodesis is done
PLEURODESIS
Accomplished by CTT, pleural space drainage,
and intrapleural instillation of sclerosing agent
agent (tetracycline)
A chemically irritating agent is instilled or
aerosolized into the pleural space.
With the chest tube approach, the agent is instilled,
the tube is clamped for 60-90 minutes and the
patient is assisted to assume various positions to
promote distribution if the agent and to maximize its
contact to the pleural surfaces.
Tube is unclamped as ordered and chest drainage
continued for several days
Apply petroleum gauze to sucking chest wound
ISAIAH MAE P. AGULAY, SN 1
