Pleural Effusion

Pleural Effusion

It is fluid that has built up or gathered in the pleural space.

Types:

• Transudate :
  A substance that penetrates the surface of a membrane or tissue. Example: Hypertension
• Exudate:
  The blood vessel allows something to escape

 Etiology

• A rise in the systemic hydrostatic pressure, such as heart attack
• Hepatic and renal failure are two examples of decreased capillary oncotic pressure.
• Increased capillary permeability, such as an injury or infection.
• Dysfunctional lymphatic system, such as a tumor.

 Clinical manifestation

• Decrease in the affected side's chest wall's range of motion.
• Progressive dyspnea,
• Pleuritic chest pain,
• Decreased breath sounds,
• Fever,
• Weight loss,
• Respiratory distress.

Pathophysiology

A simple imbalance between fluid production and evacuation in the pleural space is the main cause of a pleural effusion. In order for the lung surface to glide within the thorax throughout the respiratory cycle, the pleural space normally has to contain a modest quantity of lubricating fluid. Normally, this potential space receives 15 mL of fluid every day, mostly from the parietal pleura's capillaries. The lymphatics in the parietal pleura eliminate this fluid. Each hemithorax contains a layer of fluid that is 2 to 10 mm thick and contains about 20 mL of fluid at a time.

When local or systemic derangements take place, this controlled fluid balance is disturbed. The fluid is known as an exudate and is protein- and LDH-rich when local variables are altered. Leaky capillaries from inflammation brought on by an infection, an infarct, or a tumor are examples of local causes. The fluid is referred to as a transudate and has low protein and LDH levels when systemic variables are altered and cause a pleural effusion. This may be brought on by excess ascites associated with cirrhosis, low oncotic pressure brought on by hypoalbuminemia, or elevated pulmonary capillary pressure in the presence of heart failure. Transudates are frequently multifactorial in clinical practice, with renal failure, cardiac failure, and poor nutritional status being a frequent trio.

Diagnostic evaluation

• Physical examination,
• Chest x-ray,
• CT scan,
• Thoracentesis,
• MRI,
• Blood test,
• Arterial blood gas,
• Biopsy.

Complication

• Heart failure,
• Tuberculosis,
• Pneumonia,
• Pulmonary infection.

Management

• Proper treatment of the underlined cause.
• Sodium restriction,
• Remove the fluid,
• Chest therapy.

Surgical

• Pleurectomy,
• Pleurodesis,
• Implantation of a pleuroperitoneal shunt.

Nursing management

• Tracking the vital signs,
• Implement the treatment plan,
• Administration of oxygen as necessary,
• Keep an eye on chest tube drainage,
• Boost the patient's confidence by outlining the nature of pain.
• The semi-seated position reduces dyspnea.
• During the exercise of coughing, apply pressure to the area that is hurting.
• Encourage the patient to practice deep breathing and coughing.
• The semi-seated position reduces dyspnea.
• Encourage the patient to turn frequently while lying in a comfortable position.
• Provide proper diet
• Provide proper ventilation.
• Adequate rest was given

References

• patient.info/health/pleural-effusion-leaflet
• www.webmd.com/lung/pleural-effusion-symptoms-causes-treatment