Pleurisy

"Pleurisy" refers to inflammation of the pleura (the membrane that surrounds and protects the lungs). Pleurisy, also known as pleuritis, is a disorder that affects the lining of the lung tissue and is often caused by an infection, illness, or injury to the respiratory system.

Types:

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

Causes:

• Infection, including pneumonia, tuberculosis, and other bacterial or viral respiratory infections.
• Immune disorders include systemic lupus erythematosus and rheumatoid arthritis.
• Diseases include cancer, pancreatitis, and liver cirrhosis.
• Injury in the chest such as rib fractures collapsed lungs.
• Drugs reaction such as isoniazid, methotrexate, procarbazine hydralazine, phenytoin, and quinidine.

Pathophysiology:

The normal pleural fluids exert a push on the membranes, allowing them to glide over one another, but irritation and inflammation cause the fluids to be displaced, causing the pleural surfaces to rub against one another. Sharp chest pain is the main symptom of pleurisy, which is caused by the irritation of 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 the shoulder or abdomen.
• Rapid shallow breathing
• Intercostal tenderness
• Diminished breath sounds on the affected side
• Itching in sites on the back.
• Dizziness
• The 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:
  • Medications like acetaminophen, ibuprofen, and indomethacin, as well as codeine-based cough syrup, are all examples of pharmacological therapy of pain.
• 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 the child’s level of pain and discomfort.
• Keep a child in an upright position if applicable.
• Provide painkillers as prescribed.
• Observe for signs and symptoms of pleural effusion.
• Advice to lie on the affected side.
• Instruct patient in the splinting chest while taking 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.
• Explain to the parents and the kid the significance of deep breathing and coughing exercises, as well as the signs and symptoms of pleural effusion, the medicine, the diet, the follow-up appointment, and the necessity of these things.