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Pleural Effusion: Pathophysiology

A pleural effusion is an abnormal collection of fluid in the pleural space that can be caused by various underlying conditions like heart failure, pneumonia, cancer, or tuberculosis. It is diagnosed through chest x-ray, CT scan, or thoracentesis to analyze the fluid. Treatment involves identifying and managing the underlying cause, relieving symptoms through thoracentesis or chest tube placement, and in cases of recurrent malignant effusions, chemically pleurodesis to prevent reaccumulation of fluid. Nursing care focuses on improving gas exchange through positioning, breathing exercises, and oxygen supplementation as well as monitoring for infection or pain issues.

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134 views6 pages

Pleural Effusion: Pathophysiology

A pleural effusion is an abnormal collection of fluid in the pleural space that can be caused by various underlying conditions like heart failure, pneumonia, cancer, or tuberculosis. It is diagnosed through chest x-ray, CT scan, or thoracentesis to analyze the fluid. Treatment involves identifying and managing the underlying cause, relieving symptoms through thoracentesis or chest tube placement, and in cases of recurrent malignant effusions, chemically pleurodesis to prevent reaccumulation of fluid. Nursing care focuses on improving gas exchange through positioning, breathing exercises, and oxygen supplementation as well as monitoring for infection or pain issues.

Uploaded by

Nyambura
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PLEURAL EFFUSION

Definition; It is a collection of fluid in the pleural space, it is rarely a primary disease


process but usually secondary to other diseases.
It may be a complication of heart failure, Tuberculosis, pneumonia, nephrotic syndrome
connective tissue disease, pulmonary embolus, and neoplastic tumors. It is more common
in bronchogenic tumors.

PATHOPHYSIOLOGY
Normally the pleural space contains a small amount of fluid which acts as a lubricant that
allows the pleural surfaces to move without friction. (5-15mls).
The effusion can be a relatively clear fluid, or it can be bloody or purulent. An effusion of
clear fluid may be transudate or exudates. A transudate (filtrate of plasma that moves
across intact capillary walls) it occurs when factors influencing the formation and
reabsorption of fluids is altered, usually by imbalances in hydrostatic or oncotic pressure.
The finding of a transudative effusion implies that the pleural membranes are not
diseased. It mostly occurs in from heart failure.
Exudates (extravasation of fluid into tissues or a cavity) usually results from
inflammation by bacterial products or tumors involving the pleural surfaces.

CLINICAL MANIFESTATIONS
Chest pain due to presence of inflammation of the pleura in the area is not always
present.

Difficulty breathing (dyspnea) due to diminished chest expansion in the


area.
Decreased breath sounds on auscultation over the area due to presence of
fluid.
Dullness on percussion over the affected area due to the presence of fluid.
Fever due to infection with empyema.
Increased pulse and respirations; decreased BP due to blood loss with hemothorax.
Low oxygen saturation on pulse oximeter.
They are usually caused by the underlying disease.
-Pneumonia; fever, chills and pleuritic chest pain
- Malignancy; Dyspnea, difficulty lying flat, and coughing
The severity of symptoms is determined by the size of the effusion, the speed of its
formation, and the underlying lung disease. A large pleural effusion causes dyspnea; a
small to moderate pleural effusion causes minimal or no dyspnea at all.

ASSESSMENT AND DIAGNOSIS FINDINGS


The area of the pleural effusion reveals decreased or absent breath sounds, decreased
fremitus, and a dull, flat sound on percussion. In an extremely large effusion, it reveals a
patient in an acute respiratory distress. Trachea deviation away from the affected side
may be apparent.
Chest X-ray, CT scan, thoracentesis, and physical exam confirm the presence of fluid.
Lateral decubitus x-ray can also be taken.

Bacterial culture for the pleural fluid may be done, gram stain, acid fast bacilli stain for
TB, Red and white blood cell counts, chemistry studies(glucose, amylase, lactate
dehydrogenase, protein), cytologic analysis for malignant cells, and PH
A pleural biopsy may be diagnostic.
MEDICAL MANAGEMENT
1. Objective is to find the underlying cause of the pleural effusion; to prevent
reaccumulation of fluid and to relieve discomfort, dyspnoea and respiratory
compromise. Specific treatment is directed at the underlying cause. E.g.
pneumonia, Tb, cirrhosis.
2. Thoracentesis is performed to remove fluid, obtain specimen for analysis and
relieve dyspnoea and respiratory compromise.
3. Depending on the size of the effusion, pt may be treated by removing fluid
through thoracentesis or inserting a chest tube connected to a water seal drainage
system or suction to evacuate the pleural space and re expand the lung.
4. If malignancy, effusion tends to recur within a few days or weeks. Repeated
thoracentesis results in pain, depletion of protein and electrolytes and sometimes
pneumothorax. In this case once the pleural space is adequately drained, a
chemical plurodesis is performed to obliterate the pleural space and prevent
reaccumulation of fluid. It may be formed using a thorascope approach or chest
tube. The chemical agent (Talc or another chemical irritant) is instilled into the
pleural space.
Other treatment for effusion caused by malignancy include; surgical pleurectomy,
insertion of a small catheter attached to a drainage bottle for OPD management
(pleurx catheter), and implantation of a pleuralperitoneal shunt.

NURSING DIAGNOSES
Impaired gas exchange
Risk for infection
Pain
NURSING INTERVENTION
Administer supplemental oxygen therapy to help meet bodys needs.
Monitor for changes in vital signs.
Have the patient perform turning, coughing, deep-breathing exercises to
enhance lung expansion.
Monitor chest tube drainage for color, amount, and changes in drainage.
Assure patency of chest tube to make sure the tube is draining properly.
Explain to the patient: Disease process, Need for coughing and deep breathing.
Position patient for comfort. Sometimes laying on the affected side for short periods
will help reduce chest wall movement and pain
Administer pain medication, preferably around-the-clock, to prevent pain from
becoming severe. Pain must be controlled so patient can breathe deeply and prevent
further complications.
If opioids are required to control pain, carefully monitor respirations and cough.
Opioids can suppress respirations and cough, which can further complicate the
underlying disorder.
Teach patient the importance of deep breathing and
coughing. This can help prevent further complications, but may be difficult if associated

with pain or suppressed by opioids.


Evaluation
If interventions have been effective, the patient should report a decrease in dyspnea and
anxiety. Pain will be controlled so that the patient is able to take deep breaths and cough
effectively, and the patient will be free of signs and symptoms of infection.

References

Nursing

Care

of

Patients

with

Lower

Respiratory

31William & Hopper (F)-31 11/1/06 9:42 AM Page 601

Tract

Disorders

601

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