Introduction

 Pleural effusion, a collection of fluid in

the pleural space, is rarely a primary
disease process but is usually secondary
to other diseases

 The pleural space normally contains

only about 10-20 ml of serous fluid
Contd…
 Pleural fluid normally seeps continually
into the pleural space from the capillaries
lining the parietal pleura and is reabsorbed
by the visceral pleural capillaries and
lymphatic system
 Any condition that interferes with either
secretion or drainage of this fluid leads to
pleural effusion
 Definition
Pleural effusion is a collection of
abnormal amount of fluid in the
pleural space
 Classification

Transudative effusions

Exudative effusions
 Transudative effusions
 Transudative effusions also known as
hydrothoraces , occur primarily in
noninflammatory conditions; is an
accumulation of low-protein, low cell
count fluid
Cause of transudative effusion

Increase hydrostatic pressure found in heart

failure ( most common cause of pleural
effusion)
Decrease oncotic pressure ( From
hypoalbuminemia) found in cirrhosis of liver
or renal disease.
 In this condition, fluid movement is faciliated
out of the capillaries and into the pleural space
Exudative effusions
 Exudative effusions occur in an area of inflammation;
is an accumulation of high-protein fluid.

 An exudative effusion results from increased capillary

permeability characteristic of inflammatory reaction.

 This types of effusion occurs secondary to conditions

such as pulmonary malignancies, pulmonary
infections and pulmonary embolization.
Etiology
 Disseminated cancer (particularly lung and
breast), lymphoma
 Pleuro-pulmonary infections (pneumonia).
 Heart failure, cirrhosis, nephrotic syndrome
 Other conditions sarcoidosis, systemic lupus
erythematosus (SLE)
 Peritoneal dialysis
 Pathophysiology
Transudative pleural effusions:

 hydrostatic pressure , oncotic pressure

 Unable to remain the fluid with in a intravascular space

 Fluid shift interstitial space

Effusion
Contd….
Exudative effusions
 Invasion of microbes

 Initiation of inflammatory reaction

 Vasodilation increase capillary permeability

 leak of plasma protein decrease oncotic pressure

fluid shift into interstitial space

 Clinical Manifestations

 Usually the clinical manifestations are those caused

by the underlying disease and severity of effusion

 Pneumonia causes fever, chills, and pleuritic chest

pain,

 malignant effusion may result in dyspnea and

coughing
Contd…
 When a small to moderate pleural effusion is
present, dyspnea may be absent or only
minimal.
 Pleuritic chest pain,
 Dullness or flatness to percussion
 Decreased or absent breath sounds
Diagnostic Evaluation
Chest X-ray or ultrasound detects
presence of fluid.

Thoracentesis biochemical,
bacteriologic, and cytologic studies of
pleural fluid indicates cause.
Management
 The objectives of treatment are to discover the
underlying cause, to prevent reaccumulation of
fluid, and to relieve discomfort, dyspnea, and
respiratory compromise

General
 Treatment is aimed at underlying cause
(heart disease, infection).
 Thoracentesis is done to remove fluid,
collect a specimen, and relieve dyspnea
For Malignant Effusions
Chest tube drainage, radiation,
chemotherapy, surgical pleurectomy,
pleuroperitoneal shunt, or pleurodesis
Complications

Large effusion could lead to

respiratory failure
Nursing Assessment

Obtain history of previous pulmonary

condition
Assess patient for dyspnea and
tachypnea
Auscultate and percuss lungs for
abnormalities
Nursing Diagnosis

Ineffective Breathing Pattern related

to collection of fluid in pleural space
Nursing Interventions
Maintaining Normal Breathing Pattern
 Institute treatments to resolve the underlying cause as
ordered.
 Assist with thoracentesis if indicated
 Maintain chest drainage as needed
 Provide care after pleurodesis.
 Monitor for excessive pain from the sclerosing agent, which
may cause hypoventilation.
 Administer prescribed analgesic.
 Assist patient undergoing instillation of intrapleural lidocaine
if pain relief is not forthcoming.
 Administer oxygen as indicated by dyspnea and hypoxemia.
 Observe patient's breathing pattern, oxygen saturation
Evaluation: Expected Outcomes

 Reports absence of shortness of breath

THANK YOU
References
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Bucher. (2011). Lewis’s Medical Surgical Nursing:
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 Black, J.M., Hawks, J.H., & Annabelle, M.K. (2005).
Medical-Surgical Nursing-clinical management for positive
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 Suzanne C. S., Brenda G. B., Janice L. H. , and Kerry H. C.
Brunner & Suddarth’s Textbook of Medical-Surgical
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