PLEURISY IS A LUNG DISEASE

1. PLEURISY
Presented by: TARIQ GILL

2. Ground rules

3. OBJECTIVES
At the end of session the audience will be able to:
Define Pleurisy
Explain the Sign and Symptoms of
Pleurisy
Understand the causes of Pleurisy
Explain how to diagnosis Pleurisy
Understand the Management of Pleurisy
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4. Pleurisy Facts

5. What is Pleurisy ?
• Pleurisy describes the chest pain syndrome
characterized by a sharp chest pain that worsens with
breathing.
• Pleurisy is caused by inflammation of the linings
around the lungs (the pleura), a condition also known
as pleuritis. There are two layers of pleura: one
covering the lung (termed the visceral pleura) and the
other covering the inner wall of the chest (the parietal
pleura). These two layers are lubricated by pleural
fluid.
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6. • Pleurisy is frequently associated with the
accumulation of extra fluid in the space between
the two layers of pleura. This fluid is referred to as a
pleural effusion.
• The pain fibers of the lung are located in the pleura.
When this tissue becomes inflamed, it results in a
sharp pain in the chest that is worse with breathing.
Other symptoms of pleurisy can include cough,
chest tenderness, and shortness of breath.
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Continued
What is Pleurisy ?

7. Pleurisy facts
• Pleurisy involves inflammation of the tissue layers
(pleura) lining the lungs and inner chest wall.
• Pleurisy is often associated with the accumulation of
fluid between the two layers of pleura, known as
pleural effusion.
• Pleurisy is caused by a variety of conditions, such as
infections, TB, congestive heart failure, cancer,
pulmonary embolism, and collagen vascular diseases.
• Symptoms of pleurisy include pain in the chest, which
is aggravated by breathing in, shortness of breath, and
local tenderness.
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8. • The diagnosis of pleurisy is made by the characteristic
chest pain and physical findings on examination of the
chest. The sometimes-associated pleural accumulation
of fluid (pleural effusion) can be seen by imaging
studies (chest X-ray, ultrasound, or CT).
• Analysis of pleural fluid aspirated from the chest can
help determine the cause of the pleurisy.
• Treatment of the underlying conditions is key to the
proper management of pleurisy.
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Pleurisy facts

9. How does the pleura work?
• The pleura is composed of two layers of thin lining tissue.
The layer covering the lung (visceral pleura) and the
parietal pleura that covers the inner wall of the chest are
lubricated by pleural fluid. Normally, there is about 10-20
ml of clear liquid that acts as a lubricant between these
layers. The fluid is continually absorbed and replaced,
mainly through the outer lining of the pleura. Pressure
inside the pleura is negative (as in sucking) and becomes
even more negative during inspiration (breathing in).
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10. • The pressure becomes less negative during
exhalation (breathing out). Therefore, the space
between the two layers of pleura always has a
negative pressure. The introduction of air (positive
pressure) into the space (such as from a knife
wound) will result in a collapse of the lung.
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How does the pleura work?

11. Sign and Symptoms of Pleurisy
• Symptoms and Complications Associated with Pleuritis
• There are many symptoms and complications associated
with pleuritis that can occur at any time and are not always
treatable. The following are possible symptoms and
complications that may be present when pleuritis is affecting
the individual:
• Shortness of breath – One of the main symptoms will
always be difficulty breathing as this complication will affect
the lungs. The pleuritis may have low or severe influence on
the ability to breathe and this makes it very difficult to be
able to do many things because of the shortness of breath.
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12. Sign and Symptoms
• Cough – Coughing is common in sufferers of pleuritis as the
disease deals with the lungs and often induces coughing
episodes. The coughs will generally cause a great deal of
pain for those who have pleuritis, as the disease will cause
the inflamed lining of the lungs to rub against other tissues
and organs which could become rather painful.
• Fever and Chills – Fevers and chills are very common as well in
individuals with pleuritis, as the buildup of fluid can also be toxic
and cause the body to heat up from the complications. Difficulty
breathing may not get enough oxygen to the blood, causing the
body to feel like it is getting colder. This artificially boosts body
heat in an attempt to recover the warmth that the body thinks
that it is missing.
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13. • Breathing Issues – Rapid, shallow breathing may be present as the
body tries to get enough oxygen to work correctly. This is the type
of breathing that people experience on the top of tall mountains
or in locations where there is very little oxygen to breathe, such as
smoke filled rooms during a fire. The body may try to do this when
the fluid buildup has occurred with pleuritis.
• Unexplained Weight Loss – Unexplained weight loss is a very
unusual indicator that pleuritis is present in the body. This can be
due to several different reasons but it is most likely because the
body does not know how to cope with the pleuritis. This can also
be due to the fact that it can become painful to eat when the
pleuritis is present and the pain does not allow for proper
digestion of food ingested. TARIQ GILL 13
Sign and Symptoms

14. Sign and Symptoms
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• Sore throat – A sore throat is very common and makes it
possible to look for problems such as pleuritis when other
symptoms are present. This could be due to several
reasons including the spread of the pleuritis problem near
the esophagus. This infection occurring near the trachea
can usually make the throat feel very sore.
• Pain and Swelling of Joints – Joints swelling with pain are
often caused by arthritis and arthritis is one of the
underlying causes of pleuritis in some patients. It is very
important to look into the available options to treat this
pain to help alleviate the symptoms and possibly prevent
the further spread of pleuritis through arthritis.

15. • Collapsed Lung – When a lung weakens to a point that it no
longer can support itself, it collapses. This is something that can
occur in patients with pleuritis as it does cause weakening of the
lungs. Many people look into the available options to treat
pleuritis to prevent this from happening because a collapsed lung
may not work anywhere near as well as a fully working lung.
Collapsed lungs often need to be removed as well to prevent
various other complications.
• Complications from the Underlying Disease – The underlying
diseases that cause pleuritis can essentially cause many other
complications which could worsen the extent of pleuritis as well.
Make sure to look into the options of treating these underlying
diseases to help decrease the possibility of extraneous
complications.
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Sign and Symptoms

16. Cyanosis in pleurisy with effusion due to
respiratory insufficiency is caused by lung
collapse and limitation of its respiratory surface

17. Pleural Effusion
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20. PLEURAL EFFUSION
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21. What causes pleurisy?
• Pleurisy can be caused by any of the following
conditions:
• Infections: bacterial (including those that cause
tuberculosis), fungi, parasites, or viruses
• Inhaled chemicals or toxic substances: exposure to
some cleaning agents like ammonia
• Collagen vascular diseases: lupus, rheumatoid arthritis
• Cancers: for example, the spread of lung cancer or
breast cancer to the pleura
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22. • Tumors of the pleura: mesothelioma or sarcoma
• Congestion: heart failure
• Pulmonary embolism: blood clot inside the blood
vessels to the lungs. These clots sometimes severely
reduce blood and oxygen to portions of the lung and
can result in death to that portion of lung tissue
(termed lung infarction). This, too, can cause pleurisy.
• Obstruction of lymph channels: as a result of
centrally located lung tumors
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What causes pleurisy?

23. • Trauma: rib fractures or irritation from chest tubes used to
drain air or fluid from the pleural cavity in the chest
• Certain drugs: drugs that can cause lupus-like syndromes
(such as hydralazine [Apresoline], Procan [Pronestyl,
Procan-SR, Procanbid - these brands no longer are
available in the U.S.], phenytoin [Dilantin], and others)
• Abdominal processes: such as pancreatitis, cirrhosis of the
liver, gallbladder disease, and damage to the spleen.
• Pneumothorax: air in the pleural space, occurring
spontaneously or from trauma.
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What causes pleurisy?

24. How is pleurisy diagnosed?
• The pain of pleurisy is very distinctive. The pain is in the
chest and is usually sharp and aggravated by breathing.
However, the pain can be confused with the pain of:
• inflammation around the heart (pericarditis), or
• heart attack (myocardial infarction)
• To make the diagnosis of pleurisy, a doctor examines the
chest in the area of pain and can often hear (with a
stethoscope) the friction that is generated by the rubbing of
the two inflamed layers of pleura with each breath. The
noise generated by this sound is termed a pleural friction
rub.
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25. • (In contrast, the friction of the rubbing that is heard with
pericarditis occurs synchronous with the heartbeat and
does not vary with respiration.) With large amounts of
pleural fluid accumulation, there can be decreased breath
sounds (less audible respiratory sounds heard through a
stethoscope) and the chest is dull sounding when the
doctor drums on it (termed dullness upon percussion).
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How is pleurisy diagnosed?

26. • A chest X-ray taken in the upright position and while
lying on the side is a tool in diagnosing fluid in the
pleural space. It is possible to estimate the amount of
fluid collection by findings on the X-ray. Occasionally,
as much as 4-5 liters of fluid can accumulate inside the
pleural space.
• Ultrasound is a very method of detecting the presence
of pleural fluid.
• A CT scan can be very helpful in detecting very small
amounts of fluid and trapped pockets of pleural fluid,
as well as in determining the nature of the tissues
surrounding the area. TARIQ GILL 26
How is pleurisy diagnosed?

27. • Removal of pleural fluid with a needle and syringe
(aspiration) is essential in diagnosing the cause of
pleurisy. The fluid's color, consistency, and clarity
are analyzed in the laboratory. The fluid analysis is
defined as either an "exudate" (high in protein, low
in sugar, high in LDH enzyme, and high white cell
count; characteristic of an inflammatory process) or
a "transudate" (containing normal levels of these
body chemicals).
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How is pleurisy diagnosed?

28. • Causes of exudative fluid include infections (such as
pneumonia), cancer, tuberculosis, and collagen diseases
(such as rheumatoid arthritis and lupus).
• Causes of transudative fluid are congestive heart failure
and liver and kidney diseases. Pulmonary emboli can
cause either transudates or exudates in the pleural space.
• The fluid can also be tested for the presence of infectious
organisms and cancer cells. In some cases, a small piece
of pleura may be removed for microscopic study
(biopsied) if there is suspicion of tuberculosis (TB) or
cancer.
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How is pleurisy diagnosed?

29. • Biopsy – A biopsy of the pleura may be examined
when cancer or tuberculosis is suspected. This can
help determine what course of action to take with
the pleuritis to prevent further damages and
infection of the locations.
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How is pleurisy diagnosed?

30. How is pleurisy treated?
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• External splinting of the chest wall and pain medication
can reduce the pain of pleurisy. Treatment of the
underlying disease, of course, ultimately relieves the
pleurisy. For example, if a heart, lung, or kidney condition
is present, it is treated. Removal of fluid from the chest
cavity (thoracentesis) can relieve the pain and shortness
of breath. Sometimes fluid removal can make the pleurisy
temporarily worse because without the lubrication of the
fluid, the two inflamed pleural surfaces can rub directly on
each other with each breath.

31. • If the pleural fluid shows signs of infection, appropriate
treatment involves antibiotics and drainage of the fluid. If
there is pus inside the pleural space, a chest drainage tube
should be inserted. This procedure involves placing a tube
inside the chest under local anesthesia. The tube is then
connected to a sealed chamber that is connected to a
suction device in order to create a negative pressure
environment.
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How is pleurisy treated?

32. • In severe cases, in which there are large amounts of
pus and scar tissue (adhesions), there is a need for
"decortication." This procedure involves examining
the pleural space under general anesthesia with a
special scope (thoracoscope). Through this pipelike
instrument, the scar tissue, pus, and debris can be
removed. Sometimes, an open surgical procedure
(thoracotomy) is required for more complicated
cases.
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How is pleurisy treated?

33. • In cases of pleural effusion that result from cancer, the
fluid often reaccumulates. In this setting, a procedure
called pleurodesis is used. This procedure entails instilling
an irritant, such as bleomycin, tetracycline, or talc
powder, inside the space between the pleural layers in
order to create inflammation. This inflammation, in turn,
will adhere or tack the two layers of pleura together as
scarring develops. This procedure thereby obliterates the
space between the pleura and prevents the
reaccumulation of fluid.
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How is pleurisy treated?

34. Nursing Considerations-Nursing Diagnoses
• Activity intolerance
• Acute pain
• Anxiety
• Impaired gas exchange
• Ineffective airway clearance
• Ineffective breathing pattern
• Ineffective coping
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35. Nursing Considerations-Expected Outcomes
• demonstrate energy conservation techniques
express feelings of increased comfort and relief of
pain
• verbalize strategies to reduce anxiety
• maintain adequate ventilation and oxygenation
• maintain a patent airway
• maintain a respiratory rate within 5 breaths of the
baseline
• use support systems to assist with coping.
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36. Nursing Considerations-Nursing Interventions
• Monitoring
• Vital signs
• Respiratory status, including respiratory rate and
depth and lung sounds
• Intake and output
• Pain level and relief Cough
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37. • Give prescribed drugs; if cough is present, administer
acetaminophen with codeine as ordered.
• Encourage deep breathing and coughing and use of an
incentive spirometer; have the patient splint the affected side.
• Assist patient to a position of comfort, possibly lying on
affected side, to decrease stretching of pleurae.
• Ensure a patent airway.
• Encourage use of nonpharmacologic pain relief measures, such
as heat, progressive muscle relaxation, and guided imagery.
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Nursing Considerations-Nursing Interventions

38. • Position the patient in high Fowler's position to
maximize chest expansion and ease the work of
breathing.
• Auscultate lung sounds.
• Administer oxygen, if ordered, based on oxygen
saturation levels; assess for signs and symptoms of
hypoxia when anxiety, restlessness, and agitation of
new onset are noted.
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Nursing Considerations-Nursing Interventions

39. • Provide for frequent rest periods; cluster care activities to
allow frequent rest periods.
• Assist with passive range-of-motion (ROM) exercises;
encourage active ROM exercises.
• Provide comfort measures.
• Assist with thoracentesis, if indicated.
• Encourage the patient to verbalize feelings and concerns;
provide emotional support and guidance.
• Assist the patient in using positive coping strategies and
relaxation techniques.
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Nursing Considerations-Nursing Interventions

40. Patient Teaching-General
• Disorder, possible underlying cause, diagnosis, and
treatment, including medications to control pain and
coughing need to take ibuprofen or other NSAIDs with
food or meals to minimize GI distress possible sedative
effects if codeine is prescribed, and the need for safety
measures
• How to perform splinting and deep-breathing exercises
• Importance of regular rest periods energy conservation
measures anxiety reduction and coping strategies
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41. Patient Teaching-General
• Importance of seeking early intervention for pulmonary
conditions
signs and symptoms of possible complications, such as
increasing respiratory distress, development of
productive cough, and fever, and the need to notify the
practitioner immediately
• Importance of adhering to recommended follow-up care
to evaluate the condition and the underlying cause.
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42. Can pleurisy be prevented?
• Some cases of pleurisy can be prevented,
depending on the cause. For example, early
intervention in treating pneumonia may prevent
the accumulation of pleural fluid. In the case of
heart, lung, or kidney disease, management of the
underlying disease can help prevent the fluid
collection.
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43. Prognosis and Outlook of Patients with
Pleuritis
• Many people with pleuritis will be able to make a
full recovery if their underlying problems are taken
care of. Proper treatment of the affliction makes it
possible to really come through strong. There is a
possibility of death caused by pleuritis in very
unhealthy individuals if they do not make the
necessary lifestyle changes needed to heal from the
complications of pleuritis.
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45. References
Fauci, Anthony S., et al. Harrison's Principles of Internal Medicine.
17th ed. United States: McGraw-Hill Professional, 2008.
Previous contributing author and editor: Zab Mohsenifar, MD and
William C. Shiel, Jr., MD, FACP, FACR
Medically reviewed by James E Gerace, MD; board certified internal
medicine with subspecialty in pulmonary disease
• Source: http://www.medicinenet.com/script/main/art.asp?article
key=19782
• http://quizlet.com/21767383/pleurisy-flash-cards/
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