Pleural effusion:
an abnormal collection of fluid in the pleural space (space around lungs)
-symptomatic >300 mL of fluid
Transudate pleural effusion:
-occurs d/t increased hydrostatic pressure or low plasma oncotic pressure
conditions that alter hydrostatic or oncotic pressure in the pleural space such as
CHF, cirrhosis , nephrotic syndrome
-a clear build up of fluid
-low in protein and LDH
Exudative pleural effusion:
occurs d/t inflammation or infection
-ex. pneumonia, cancer, viral infection, PE
-high in protein and LDL
-will be a thick purulent fluid
dx test: fluid culture
Risk factors for a pleural effusion:
,-trauma --> causes inflammation and irritates the pleural lining
-increased pressure in the lungs --> HF, PE, end stage liver failure, post open heart
surgery
-infection --> complication of pneumonia, cancer, or inflammatory disorders
Labs for pleural effusion:
-culture and sensitivity (to look for bacteria or infection)
-CBC (will see elevated monocytes (inflammation), elevated neutrophils (bacterial),
elevated lymphocytes (viral)
-lactate
-cytology analysis (if malignancy is suspected)
Dx testing for a pleural effusion:
-chest X-ray (to see if there is fluid accumulation)
-CT scan
-pleural fluid sample via thoracentesis
-ultrasound
-pleural biopsy
-thoracoscopy
-bronchoscopy
,S/S pleural effusion:
-dyspnea
-non-productive cough
-pleuritic chest pain (worsens with deep breathing; we can give them a pillow for
relief)
-decreased chest wall movement (because they have shallow respirations and
constriction)
severe symptoms: over 300 mL of fluid
-tachypnea
-tachycardia
-decreased breath sounds
-dullness on percussion
-egophony (increased resonance of voice sounds heard when auscultating the lungs)
Non-surgical treatment for pleural effusion:
treat the underlying condition
-diuretics (to get rid of excess fluid)
-antibiotics (if its caused by an infection)
-albumin (because they have low protein)
-corticosteroids (for inflammation)
-anti-inflammatory agents
-immunosuppressants
, Thoracentesis:
surgical treatment for a pleural effusion
-patient is positioned in an orthopneic position
-fluid is extracted at the base of the lung because fluid gravitates toward the bottom
-a collection bag may be needed if there is a large amount of fluid extracted
Other surgical treatment for pleural effusion:
-pleurodesis --> collapses the space between the layers of fluid preventing future
accumulation
-chest tube
-pleurectomy --> surgical incision into the pleura to surgically remove affected pleura
-pleuropneumonectomy --> full removal of the lung
-pleuro lobectomy --> partial removal of the lung
Chest tubes:
Purpose --> to drain fluid, blood or air from the lung or pleural cavity
Use --> pleural effusion, hemothorax, pneumothorax
-First chamber: drainage collection chamber
-Second chamber: water seal (prevents air from moving back up the tubing into the
chest)