In order to allow movement of pleural surfaces and prevent friction, the pleural space contains 5 to 15 mL of fluid which acts as a lubricant. An increase in the collection of fluid without drainage will result to pleural effusion.
Pleural effusion is the abnormal accumulation of fluid in the pleural space. It is rarely a primary disease process but is usually secondary to other diseases (Smeltzer, et al., 2010). It may be a complication of underlying conditions such as heart failure, TB, pneumonia, nephritic syndrome, connective tissue disease, pulmonary embolism, and neoplastic tumors.
What are the types of effusion?
The effusion is usually composed of clear fluid or it can either be bloody or purulent. A transudative effusion is a condition where filtrates of plasma that move across intact capillary walls. Usually, there is an alteration in the reabsorption of the pleural fluid and the pleural membranes remain normal. On the other hand, exudative effusion results from inflammation by bacterial products or tumors involving the pleural surfaces (Smeltzer, et al., 2010).
- Pleuritic pain that is sharp and increases with inspiration
- Dry nonproductive cough
- Dyspnea on exertion
- Decreased breath sounds
- Elevated temperature
Assessment and Diagnostic Findings
- Decreased or absent breath sounds and decreased fremitus upon physical examination
- Chest x-ray reveals pleural effusion and a mediastinal shift away from the fluid
- Bacterial culture of pleural fluid for presence of infection
- Identify and treat underlying cause.
- Thoracentesis is performed to evacuate fluid and as well as relieve dyspnea and respiratory distress.
- Once the condition does not respond and recurrent pleural effusion results, pleurodesis is prescribed. Pleurodesis involves instillation of a sclerosing ingredient into the pleural space via a thoracotomy tube.
Pleural Effusion Nursing Care Plan