1. PLEURAL EFFUSION
Presented By :-
Swati Patiyal
Msn Lecturer
NSCN Palampur

2. Physiology of the Normal Lungs
The lungs are soft, spongy, cone shaped organs located
in the chest cavity.
They are separated by the mediastinum and the heart.
There are 3 lobes on the right lung and 2 lobes on the
left lung

3.  The lungs are supplied with blood via the pulmonary and
bronchial circulations.
• Pulmonary circulation: supplied from the pulmonary artery
and provides for gas exchange function of the lungs.
• Bronchial circulation: distributes blood to the conducting
airways and supporting structures of the lungs .

4. Layers of the lung
 • Parietal Pleura -Lines the thoracic cavity, including the
thoracic cage, mediastinum, and diaphragm.
 • Pleural space- Thin, transparent, serous membrane
which lines the thoracic cavity a potential space between
the parietal pleura and visceral pleura
 • Visceral pleura- Lines the entire surface of the lung.

5. PLEURA

6. Parietal pleura
cover the inner
surface of the
thoracic cavity,
including the
diaphragm, and ribs.
Visceral pleura
envelope all surfaces
of the lungs,
including the
interlobar fissures.
At the Hilum
where pulmonary vessels, bronchi, and
nerves enter the lung tissue, the parietal
pleura is continuous with the visceral pleura.

7. 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.

8. 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

9. Definition
Pleural effusion is a collection of abnormal amount of
fluid in the pleural space.
OR
Presence of large amount of fluid in the pleural space
irrespective of the underlying causes

10. CLASSIFICATION
 Transudative effusions.
 Exudative effusions .

11. Transudative effusions
 Transudative effusions also known as hydrothoraces ,
occur primarily in non inflammatory conditions; is an
accumulation of low-protein, low cell count fluid

12. 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

13. Exudative effusions
 Exudative effusions occur in an area of inflammation;
is an accumulation of high-protein fluid.

14. CAUSE
 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

15. 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

17. Pathophysiology
 Transudative pleural effusions:
Hydrostatic pressure , Oncotic pressure
Unable to remain the fluid with in a intravascular space
 Fluid shift interstitial space Effusion

18.  Exudative effusions
 Invasion of microbes
 Initiation of inflammatory reaction
 Vasodilation increase capillary permeability
 leak of plasma protein decrease oncotic pressur

19. CLINICAL MANIFESTATIONS

20. SYMPTOMS
 * key symptom -------> shortness of
breath
 Fluid filling the pleural space makes it hard
for the lungs to fully expand, causing the
patient to take many breaths so as to get
enough oxygen.
 .

21. * If parietal pleura is irritated -------> mild pain or
a sharp stabbing ,pleuritic type of pain
** Some patients will have a dry cough Occasionally
------> no symptoms at all.
 * This is more likely when the effusion results from:
 recent abdominal surgery, cancer, or tuberculosis.
Decreased or absent breath sounds

22.  Tapping on the chest will show stony dullness, and
decrease breath sound.
 Pneumonia causes fever, chills, and pleuritic chest
pain,

23. DIAGNOSTIC EVALUATION
 During a physical examination, the doctor will listen
to the sound of your breathing with a stethoscope and
may tap on your chest to listen for dullness.
 x ray
The fluid itself can be seen at the bottom of the lung
or lungs, hiding the normal lung structure.
If heart failure is present,
 the x-ray shadow of the heart will be enlarged


26.  Chest Radiography :The posteroanterior and lateral
chest radiographs are still the most important initial
tools in diagnosing a pleural effusion.

27. Computed Tomography: Cross-sectional computed
tomography (CT) It helps distinguish anatomic
compartments more clearly This modality is useful as
well in distinguishing empyema Normal Pleural effus

28. Thoracentesis

29. Management of Pleural effusion
 The objectives of treatment are to discover the
underlying cause, to prevent re accumulation of fluid,
and to relieve discomfort, dyspnea, and respiratory
compromise.
 Therapeutic thoracentesis: may be done if the fluid
collection is large and causing chest pressure,
shortness of breath, or other breathing problems, such
as low oxygen levels. Removing the fluid allows the
lung to expand, making breathing easier.

30.  General Treatment is aimed at underlying cause (heart
disease, infection).
 Thoracentesis is done to remove fluid, collect a
specimen, and relieve dyspnea

32. Complications
 Large effusion could lead to respiratory failure.

33. Nursing assessment
 Obtain history of previous pulmonary condition
 Assess patient for dyspnea and tachypnea
 Auscultate and percuss lungs for abnormalities

34. Nursing Intervention
 • 1. Ineffective breathing pattern related to decreased
lung expansion(accumulation of liquid), as evidenced
by dyspnea, changes in depth of breathing, accessory
muscle use.
 Interventions •
 Maintain a comfortable position is usually elevated
headboard
 • Given oxygen through a cannula (8mls)

35.  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

36.  2. Acute Pain related to accumulation of fluid in the pleural
space and rubbing of thoracostomy tube to the lungs
 • Interventions • -
 The presence of pain, the scale and intensity of pain was
well assessed
• -The client taught about pain management and relaxation
with distraction
• -Chest tube secured to restrict movement and avoid
irritation
• -Given prescribed analgesics i.e diclofenac 75mg. 3

37.  3. Risk for nutrition impariment, less than body
requirement related to inability to ingest adequate
nutrients
 Interventions
 • -Patient relative i.e his father encouraged to give him
energy reaching food stuff together with energy
supplement so that he can get enough energy.
 • -Administer DNS as prescribed to the patient to
increase energy lost.

38.  4. Risk for fluid volume deficit related to chest tube
drainage.
 • Interventions
• -encourage the patient to drink enough water to
supplement the one lost by chest tube drainage
• -IV fluids & DNS to replace fluid lost in drainage
system monitored in 24hour

39.  5. Risk for infection related to the presence of fluid in
the pleural space and the incision site
 . • Interventions
 • -The patient dressed at the incision site when it is
wetted, probably after 2 to 3 days
• -Given antibiotics as prescribed i.e IV metronidazole
500mg 8 hourly, IV ceftiaxone 1gm.

40. References
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Bucher. (2011). Lewis’s Medical Surgical Nursing:
Assessment and Management of Clinical Problems. (7th
Ed.). Mosby. P 595
Black, J.M., Hawks, J.H., & Annabelle, M.K. (2005). Medical-
Surgical Nursing-clinical management for positive
outcomes.(6th ed.). P 1631
Suzanne C. S., Brenda G. B., Janice L. H. , and Kerry H. C.
Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing.(11th ed). 540
Lippincott Manual of Nursing Practice. (2010).William And
wiklins .ninth edition .302