Angelite Nurses: Pleural Effusion

Pleural Effusion

General information

Collection of fluid in the pleural space
A symptom, not a disease; may be produced by numerous conditions
Classification

Transudative: accumulation of protein-poor, cell-poor fluid
Suppurative (empyema): accumulation of pus

May be found in clients with liver/kidney disease, pneumonia, tuberculosis, lung abscess, bronchial carcinoma, leukemia, trauma, pulmonary edema, systemic infection, disseminated lupus erythematosus, polyarteritis nodosa

Medical management

Identification and treatment of the underlying cause
Thoracentesis
Drug therapy

Antibiotics: either systemic or inserted directly into pleural space
Fibrinolytic enzymes: trypsin, streptokinase-streptodornase to decrease thickness of pus and dissolve fibrin clots

Closed chest drainage
Surgery: open drainage

Assessment findings

Dyspnea, dullness over affected area upon percussion, absent or decreased breath sounds over affected area, pleural pain, dry cough, pleural friction rub
Pallor, fatigue, fever, and night sweats (with empyema)
Diagnostic tests

Chest x-ray positive if greater than 250 ml pleural fluid
Pleural biopsy may reveal bronchogenic carcinoma
Thoracentesis may contain blood if cause is cancer, pulmonary infarction, or tuberculosis; positive for specific organism in empyema

Nursing interventions: vary depending on etiology

Assist with repeated thoracentesis.
Administer narcotics/sedatives as ordered to decrease pain.
Assist with instillation of medication into pleural space (reposition client every 15 minutes to distribute the drug within the pleurae).
Place client in high-Fowler's position to promote ventilation.

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