Pleural Effusion

  1. General information
    1. Collection of fluid in the pleural space
    2. A symptom, not a disease; may be produced by numerous conditions
    3. Classification
      1. Transudative: accumulation of protein-poor, cell-poor fluid
      2. Suppurative (empyema): accumulation of pus
    4. 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
  2. Medical management
    1. Identification and treatment of the underlying cause
    2. Thoracentesis
    3. Drug therapy
      1. Antibiotics: either systemic or inserted directly into pleural space
      2. Fibrinolytic enzymes: trypsin, streptokinase-streptodornase to decrease thickness of pus and dissolve fibrin clots
    4. Closed chest drainage
    5. Surgery: open drainage
  3. Assessment findings
    1. Dyspnea, dullness over affected area upon percussion, absent or decreased breath sounds over affected area, pleural pain, dry cough, pleural friction rub
    2. Pallor, fatigue, fever, and night sweats (with empyema)
    3. Diagnostic tests
      1. Chest x-ray positive if greater than 250 ml pleural fluid
      2. Pleural biopsy may reveal bronchogenic carcinoma
      3. Thoracentesis may contain blood if cause is cancer, pulmonary infarction, or tuberculosis; positive for specific organism in empyema
  4. Nursing interventions: vary depending on etiology
    1. Assist with repeated thoracentesis.
    2. Administer narcotics/sedatives as ordered to decrease pain.
    3. Assist with instillation of medication into pleural space (reposition client every 15 minutes to distribute the drug within the pleurae).
    4. Place client in high-Fowler's position to promote ventilation.

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