Pleural Effusion Nursing Care Plan Notes
Definition
It is a collection of fluid in the pleural space of the lungs. Fluid normally resides in the pleural space and acts as a lubricant for the pleural membranes to slide across one another when we breathe. Fluid is constantly being added and reabsorbed by capillaries and lymph vessels in the pleura. When this recycling process is interrupted, a pleural effusion can result.
Causes
Physicians determine the cause of the effusion based on the type of fluid that is accumulating.
- Transudative (watery fluid) effusions: Heart failure, pulmonary embolism, cirrhosis, post open heart surgery, trauma
- Exudative (protein-rich fluid) effusions: Pneumonia , cancers, pulmonary embolism, kidney disease, inflammatory diseases
Pleural fluid may be bloody (hemorrhagic), chylous (thick and white), rich in cholesterol, or purulent.
Signs and symptoms
(Small effusions may not present with symptoms and may only be found via chest X-ray. Larger effusions can cause symptoms such as:)
- Decreased lung expansion
- Dyspnea
- Dry, non-productive cough
- Tactile fremitus
- Orthopnea
- Tachycardia
Diagnostic Procedures
- Chest x-ray
- CT scan of the chest
- Ultrasound of the chest
- Thoracentesis
- Pleural fluid analysis via thoracentesis
Medical Management
- Thoracentesis
- Pleurectomy- consists of surgically stripping the parietal pleura from the visceral pleura. This produces and inflammatory reaction that causes adhesion formation between the two layers as they heal.
- Pleurodesis- involves the instillation of a sclerosing agent (talc, doxycycline, or tetracycline) into the pleural space via a thoracotomy tube. These agents cause the pleura to sclerose together.
Nursing interventions for pleural effusions
- Identify and treat the underlying cause
- Monitor breath sounds
- Place the client in a high Fowler’s position
- Encourage coughing and deep breathing
- Prepare the client for thoracentesis
- If pleural effusion is recurrent, prepare the client for pleurectomy or pleurodesis as prescribed
