THE UNIVERSITY OF DODOMA

COLLEGE OF HEALTH AND ALLIED SCIENCE

SCHOOL OF NURSING AND PUBLIC HEALTH

DEGREE PROGRAM: BACHELOR OF SCIENCE IN NURSING

COURSE NAME: MEDICAL NURSING

COURSE CODE: NS 224

COURSE INSTRUCTOR: DR. ANGELINA JOHO

NATURE OF WORK: GROUP ASSIGNMENT

GROUP NUMBER: 07

SN NAME OF PARTICIPANTS REGISTRATION SIGNATURE

NUMBER
1 KELINY VICTOR T21-03-09384
2 CASTORY TULLO T21-03-00013
3 MULOKOZI DIONISE T21-03-05992
4 LUCY MANGA T21-03-10638
5 YOHANA M. MISALABA T21-03-00770
6 MAHUNGA K. MADUHU T21-03-14279
7 JALIKA TWAHA T21-03-02493
8 TULINGE K. TRYPHONE T21-03-10558
9 CHACHA A. MUSSA T21-03-05048
QUESTION; DESCRIBING EPIDEMIOLOGY, ETIOLOGY, PATHOPHYSIOLOGY AND
MANAGEMENT OF PLEURISY

Objectives

By the end of this presentation, everyone should be able to :-

 Explain the concept of pleurisy as a respiratory disease

 Explain epidemiological factors of pleurisy
 Explain the Pathophysiology of the disease
 Identify the causes of pleurisy
 Identify the clinical manifestations of pleurisy suffering patient
 Identify the laboratory diagnosis and interpretation of pleurisy
 Explains the medical management regime of pleurisy
 Explains nursing management of a patient suffering from pleurisy
 Formulating nursing care plan for a patient suffering from pleurisy
Introduction

Pleurisy is a condition in which the pleura becomes inflamed.

Pleura is a membrane consisting of a layer of tissue that lines the inner side of the chest cavity
and a layer of tissue that surrounds the lungs.
Who is at risk?

Pleurisy can affect people of all ages, but people of 65 years and over are most at risk, because
they’re more likely to develop a chest infection.

Certain groups of people have a higher risk of developing serious pleurisy , are:-

Elderly people

Pneumonia patients (viral and bacteria pneumonia)

People with a weakened immune system – this could be due to a recent illness, a transplant,
high-dose steroids, chemotherapy or a health condition, such as an undiagnosed HIV infection

Distribution: pleurisy is world wide distributed depending on its cause, cases are many where
viral and bacteria pneumonia is common especially in USA, EUROPE Southeast ASIA and
Africa.

People with a weakened immune system – this could be due to a recent illness, a transplant,
high-dose steroids, chemotherapy or a health condition, such as an undiagnosed HIV infection

Mortality: The mortality rate of pleurisy is between 8.4% to 20% depending cause and
associated complications

Classification

Acute pleurisy :is characterized by sharp chest pain when breathing deeply and lasts for few
days

Chronic pleurisy :This lasts for days to weeks. It might result from an infection, such as
tuberculosis (TB), or another health issue, such as rheumatoid arthritis or cancer
Types of pleurisy

 Dry pleurisy

In dry pleurisy, little or no abnormal fluid accumulates in the pleural cavity, and the inflamed
surfaces of the pleura produce an abnormal sound called a pleural friction rub when they rub
against one another during respiration.

 Wet pleurisy

In wet pleurisy, fluids produced by the inflamed tissues accumulate within the pleural cavity,
sometimes in quantities sufficient to compress the underlying lung and cause shortness of breath.

Pathophysiology

Recalling that the visceral and parietal pleurae are the membrane that surround the lungs.
Between these membranes is small amount of serous fluid that prevents friction as the Pleurae
slide over each other during respiration. If the membranes become inflamed for any reason, they
do not slide as easily. Instead of sliding, one membrane may “catch” on the Other , causing it to
stretch as the patient attempts to take a breath. This causes the characteristic sharp pain on
inspirational.

The irritation causes an increase in the formation of Pleural fluid, which in turn reduces friction
and decreases pain.

Causes of pleurisy (etiology)

Infection

An infection is the most common cause of pleurisy. Any type of infection has the potential to
spread to the pleura, but viral infections are usually responsible.

 Viruses known to cause pleurisy include:

 The influenza (flu) virus
  The Epstein-Barr virus – which causes glandular fever
 Cytomegalovirus (CMV) – a common virus found in most people, which doesn’t usually
cause any noticeable symptoms
 Parainfluenza – the virus that causes the childhood condition croup

In some cases, pleurisy is caused by bacteria, such as:

 Streptococcal bacteria – often associated with pneumonia, throat infections and some
types of skin infections, such as impetigo and cellulitis
 Staphylococcal bacteria – often associated with skin infections, food poisoning and, more
seriously, blood poisoning (sepsis)
 Meticillin-resistant Staphylococcus aureus (MRSA) can cause pleurisy, especially
in hospital patients. MRSA is a type of bacteria with a resistance to a number of
commonly used antibiotics.

 Other causes
 Other possible causes of pleurisy include:
 Injury – if the ribs are bruised or fractured, the pleura can become inflamed
 Pulmonary embolism – a blood clot developing inside the lungs
 Sickle cell anaemia – a blood disorder that usually affects people of African or
Caribbean descent
 Chemotherapy and radiotherapy
 HIV or AIDS
 Lung cancer
 Mesothelioma – a type of cancer caused by inhaling asbestos
 Autoimmune conditions, such as rheumatoid arthritis and lupus, are other possible causes
of pleurisy. In these conditions, something goes wrong with the immune system (the
body’s natural defence against infection and illness) and it begins to attack healthy
tissue.”

Clinical manifestations
The signs and symptoms of pleurisy might include:

 Sharp and knife like chest pain that worsens when you breathe, cough or sneeze
 Shortness of breath — because you are trying to minimize breathing in and out
 A cough — only in some cases
 A Fever — only in some cases
 Pleural friction rub sound
 Sore throat if associated with infection
 Intercostal tenderness on palpation

Pain caused by pleurisy also might affect shoulder or back.

In some cases of pleurisy, Fluid builds up in the small space between the two layers of tissue
(pleural space). This is called pleural effusion. When there is a fair amount of Fluid, pleuritic
pain lessens or disappears because the two layers of pleura are no longer in contact. A large
amount of Fluid in the pleural space can create pressure, compressing lung to the point that it
partially or completely collapses. This makes breathing difficult and might cause you to cough.

The extra Fluid can also become infected. This is called an empyema. An empyema is often
accompanied by Fever.

Differential diagnosis

 Pneumothorax
 Atelectasis
 Homothorax
 Pleural effusion

TESTS AND DIAGNOSIS

To diagnose pleurisy the following can be recommended :

Blood tests. A blood test might tell if a patient have an infection. Other blood tests also might
detect an autoimmune disorder, such as Rheumatoid arthritis or Lupus, in which the initial sign is
pleurisy.
Sputum examination to determine if there is respiratory infection that may cause pleurisy

Thoracentesis This involves the insertion of hollow needle into pleural cavity in order to drain
fluid, blood,pus or air

Chest X-ray. A chest X-ray can show if lungs are fully inflating or if there is air or Fluid
between the lungs and ribs. a special type of chest X-ray in which a patient lie on side (decubitus
chest X-ray).

Computerized tomography (CT) scan. In a CT scan, a computer translates information from

X-rays into images of thin sections (slices) of chest, producing more-detailed images. A chest
CT scan can show if there is a blood clot in the lung or find other causes of pleuritic pain.

Ultrasound. This imaging method uses high-frequency sound waves to produce precise images
of structures within the patient body. Ultrasound is used to determine whether a patient have a
pleural effusion.

Electrocardiogram (ECG or EKG). this heart-monitoring test to rule out certain heart
problems as a cause for Chest pain.

TREATMENTS AND DRUGS

Treatments used in pleurisy and pleural effusion focus primarily on the underlying cause.

If bacteria is the cause, antibiotics will control the infection. For example penicillin for
pneumonia, cephalosporins for methicilin resistant staphylococcus aureus

If the cause is viral, pleurisy will resolve on its own.

Analgestics like ibuprofen and acetaminophen to alleviate pain

The outcome of pleurisy treatment depends on the seriousness of the underlying disease. If the
condition that caused pleurisy is diagnosed and treated early, a full recovery is typical.
Corticosteroids to alleviate inflammation

NURSING MANAGEMENT:-

Assessment

 Assess patient’s level of pain.

 Observe signs and symptoms of pleural effusion (Dyspnea, pain).
 Auscultate lungs for pleural friction rub.

NURSING DIAGNOSIS:

 Ineffective breathing pattern related to stabbing chest pain.

Nursing Intervention:

 Easing painful respiration

 Provide comfortable position to patient
 Administer or teach self administration of pain medication as ordered
 Evaluate patient for signs of hypoxia.

Anxiety related to knowledge deficit.

Nursing Intervention:

 We should give psychological support to the patient.

 Maintain a peaceful environment
 To give comfortable rest
 Provide knowledge about disease and also give satisfactory answers to the questions of
patient.

Altered nutrition and hydration

Nursing Intervention:

 To give prescribed diet

 Advice to increase high protein diet
 Encourage for oral fluids.

Promoting comfort

Nursing Intervention:

 Provide restful position to patient.

 Assess nature and location of chest pain.
 Administer analgesics.
 Provide mouth care frequently.
 Give dry and warm condition to the patient.

A SAMPLE OF NURSING CARE PLAN FOR A PATIENT SUFFERING FROM

PLEURISY

ASSESMENT DIAGNOSIS PLAN INTERVENTI RATIONA EVALUATIO

 ON LE N
Subjective Acute pain --After 8 --Encouraging --This --After 8 hour
data: related to hours of the patient to improve of patient
--patient breathing patient use relaxation lung nurse
reports pain difficulty due nurse techniques expansion intervention
scores of 8 out to interventio such as deep capacity relationship
of 10 on inflammation n breathing and and --Patient pain
visual of pleural relationship guided imagery decreased was reduced
analogue scale membrane as --patient’s -- breathing to a score of 3
--patient evidenced by pain will be Administering difficulty on visual
reports the patient reduced to pain --Antipain analogue scale
difficult in a score of medication as blocks pain --Respiration
breath and less than 4 ordered by transmissio rate
feeling of on visual physician, n 19breath/minu
tightness in analogue example: -- tes & oxygen
chest scale acetaminophen Monitoring saturation of
Objective --Patient 500mg x tds of vital sign 98%
data: will report x5/7 indicates
--Respiratory improved --Monitoring improveme
rate ease of respiration rate nt and need
24breath/minu breathing and oxygen of necessary
tes and saturation plan change
Oxygen decreased frequently
saturation of tightness in
90% the chest
--
inflammation
of pleural
membrane is
confirmed by
chest x-ray
--Patient --Ineffective --To --Frequent Clearing After 2 days
reports airway promote monitoring of airway help of patient
dyspnea clearance effective respiratory smoothenin nurse
--patient related to airway rate, rhythm g breathing relationship
resents with thickened and clearance and depths ---patient
decrease in tenacious and --Providing reported
chest sputum respiration suction as decreased
expansion production as function necessary to dyspnea
--Present of evidenced by after 2 days remove ---patient was
crackles visualization of patient secretion able to cough
during nurse --Monitoring up and
inspiration relationship oxygen expectorate
-- saturation and sputum
Encourage administering effectively
the patient supplemental --patient
to drink oxygen as respiratory
plenty of needed rate, rhythm
fluids to --Helping the and depths
help thin patient with remained
postural within normal
drainage and limits
percussion as
ordered
--Encourage
the patient to
drink plenty of
fluids to help
thin secretion
Subjective Risk for To reduce Monitoring To maintain After two
data: patient infective the risk of oxygen normal days of patient
repots peripheral the patient saturation oxygen nurse
shortness of tissue for every 4 hour saturation relationship
breath upon perfusion inadequate and providing for adequate --oxygen
exertion related to peripheral supplemental tissue saturation
Objective decreased tissue oxygen as need perfusion 97%
data; oxygen perfusion --Encourage --To --Improved
--oxygen saturation the patient to improve capillary refill
saturation level due to perform deep lung time on toes
90% on room the disease breathing functioning and fingers
air pathophysiol exercises and --To become less
--capillary ogy use incentive promote than 2 minutes
refill time spirometers venous --patient had
greater than 3 every two return increased
second in hours --To pedal pulse
fingers and --Assessing promote 80beats/minut
toes skin color blood flow es and radial
temperature pulse
and capillary 82beats/minut
refill every 4 es
hours --Patient skin
--Elevating the color and
patient feet’s temperature
above heart returned to
level baseline
--assisting the
patient with
ambulation and
encouraging
moderate
exercises
--administering
prescribed
 medication
such as
vasodilators
and
anticoagulant
as ordered
Assessing Possible --The client Assessing the Careful After nurse
vital sign activity will be able clients baseline analysis of patient
before and intolerance of to perform activity level activities relationship
after breath and activities of and determine and --The client
exercising fatigue daily living what activities exercising was able to
without the client is help to perform
experiencin currently prevent activities of
g shortness unable to further daily without
of breath perform due to injuries experiencing
and fatigue shortness of when the shortness of
--The client breath and patient is breath and
will be able fatigue subjected to fatigue
to maintain --Teaching the heavy --Vital sign
vital sign client energy activities. remained
within conservation --Team within normal
normal technique to collaboratio limits during
range minimize n help in and after
before and fatigue such as design activities
after alternating effective ---The
exercising period of rest plan of care healthcare
and activity team modified
--Encouraging the plan as
the client to needed to
maintain health ensure the
diet and client progress
 adequate
hydration
support energy
levels
--Collaborating
with healthcare
team to
determine the
appropriate
level of activity
for the client
and modify the
plan as needed
--Monitoring
the vital sign
during
activities
Assessing Redness for The patient Assessing This After the
patient enhanced will have patient’s improve patient nurse
exercising selfcare improved current patient self- relationship;
pattern, related to knowledge knowledge and care during --patient had
knowledge on increased and understanding and after enough
health eating exercising understandi on exercise and hospitalizati knowledge on
habits and health ng of the eating habits on healthy eating
eating habits relationship --Encouraging habits and
between patient to make exercise
exercising informed --patient had
and health decision about ability to
eating their exercise make
habits and eating appropriate
habit decisions
 --Providing about diet and
education on exercising
better
exercising
pattern and
eating habit
--Providing
education
materials such
as pamphlets
and websites
with reliable
information on
nutrition,
physical
exercise and
health

REFFERENCES

 NURSESLAB-Pleurisy in elderly patient january 2023

 Brunner and Suddath, textbook of medical and surgical nursing 12th edition
 CDC -Pneumonia and Pleurisy 2021
 Understnding -medical surgical nursing, LINDA S WILLIAMS third edition 2007
 Barnett,M. (2008) Nursing management of chronic obstructive pulmonary disease
 Brushier, B. Et al. (2014) Risk factors for pleurisy and management