Pleurisy

Pleurisy

An inflammation of the pleura is what is meant by pleurisy.

Pleurisy, also known as pleuritis, is a condition that typically results from an underlying disease, injury, or respiratory infection.

Types of Pleurisy:

• Wet pleurisy: Is a more common and refers to an accumulation of fluid within the pleural space.
• Dry pleurisy: Is an inflammation of the pleural space without fluid.

Causes

• Infection, such as bacterial or viral respiratory diseases including pneumonia, TB, and others.
• Immune condition, such as rheumatoid arthritis and systemic lupus erythematosus.
• Diseases such liver cirrhosis, pancreatitis, and cancer.
• Chest injuries like rib fractures caused the lungs to collapse.
• Drugs like isoniazid, methotrexate, procarbazine, hydralazine, phenytoin, and quinidine that cause drug reactions.

Pathophysiology

Due to irritation and inflammation, the usual pleural fluids are displaced when pleural surfaces brush against one another, forcing the membranes to rub rather than glide across one another. Sharp chest pain is a major symptom of pleurisy and is brought on by this rubbing that further irritates nerve endings in the outer membrane.

Clinical Presentation:

• Fever,
• Cough,
• Chills,
• Shortness of breath,
• Weight loss,
• Loss of appetite,
• Sharp chest pain on inspiration: pain may be localized or radiate towards shoulder or abdomen.
• Rapid shallow breathing,
• Intercostal tenderness,
• Diminished breath sounds on affected side,
• Itching in sites on the back,
• Dizziness,
• Pleural rub can be heard on deep breathing.

Diagnosis

• History taking,
• Physical examination,
• Chest x-ray,
• CT scan and ultrasound,
• Thoracentesis and fluid analysis and blood test.

Treatment

Treatment of pleurisy is primarily focused on the treatment of underlying causes. So treatment includes:

• Treatment of primary cause.
• Pain management: Pain management includes pharmacological management by using analgesic and anti- inflammatory drugs, such as acetaminophen, ibuprofen, and indomethacin, codeine-based cough syrup for a cough.
• Antibiotics for bacterial infection and also to reduce the risk of infection
• Thoracentesis or chest tube insertion to drain fluid.

Prevention

• Providing early medical treatment.
• Maintaining healthy lifestyle.
• Avoid exposure to a harmful substance.

Nursing Consideration:

• Assess child’s level of pain and discomfort.
• Keep a child in an upright position if applicable.
• Provide painkiller as prescribed.
• Observe for signs and symptoms of pleural effusion.
• Advice to lying on affected side.
• Instruct patient in the splinting chest while taking a deep breathing or coughing.
• Auscultation of lungs to detect abnormal findings.
• Oxygen administration if difficulty in breathing.
• Reassure the parent and child.
• Give supportive care.
• Teach parent and child on signs and symptoms of pleural effusion, medication, nutrition, follow-up visit, and the importance of deep breathing and coughing exercise.

Reference

• Datta, P. (2009). Pediatric nursing (2nd ed.). New Delhi: Jaypee Brother’s medical publisher (P) LTD
• Ilner, D.A., & Hull, D.(2000). Hospital Pediatrics (3rd ed.). Churchill Livingstone
• Uprety, Ms. Kamala. Child Health Nursing. Dilibazar, Kathmandu: Ms. Hima Uprety, 2070.
• Sharma Lissauer, T,m & Clayden, G. (1997). Illustrated textbook of pediatric (2nd ed.). Mosby Company
• Shrestha, S., lohani, D., & Thakur, L, etal. (2000). Nursing care of children. Majahrajgunj Kathmandu: HLMC
• Sharma, P.R. (2002). A handbook of pediatric problems. Kathmandu: HLMC
• Smeltzer, S.C., & Bare, B.B. (2004). Brunner Siddharth's, a textbook of medical surgical nursing (10th ed.). Lippincott: Williams and Wilkins
• Wong’s (2001). Essential pediatric nursing (6th ed.). London: Mosby.
• Wong, D.l., & Hockenberry, M.J. (1999). Nursing care of infants and children (7th ed.). London: Mosby.