PLEURAL EFFUSSION

Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the
layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest
cavity and act to lubricate and facilitate breathing. Normally, a small amount of fluid is present in the pleura.

Types of fluids:

• Serous fluid (hydrothorax)

• Blood (haemothorax)
• Chyle (chylothorax)- Chyle is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty
acids
• Pus (pyothorax or empyema)

CAUSES:
Excess fluid may be either protein-poor (transudative) or protein-rich (exudative). These two categories
help determine the cause of the pleural effusion.

The most common causes of transudative (watery fluid) pleural effusions include:
• Heart failure
• Pulmonary embolism
• Cirrhosis
• Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly caused by:
• Pneumonia
• Cancer
• Pulmonary embolism
• Kidney disease
• Inflammatory disease
Other less common causes of pleural effusion include:
• Tuberculosis
• Autoimmune disease
• Bleeding (due to chest trauma)
• Chylothorax (due to trauma)
• Rare chest and abdominal infections
• Asbestos pleural effusion (due to exposure to asbestos)
• Meig’s syndrome (due to a benign ovarian tumor)
• Ovarian hyperstimulation syndrome
• Emphysema- an obstructive lung disease because the destruction of lung tissue around smaller sacs, called
alveoli, makes these air sacs unable to hold their functional shape upon exhalation.
• Infection
• Thoracentesis- s an invasive procedure to remove fluid or air from the pleural space for diagnostic or
therapeutic purposes.

Certain medications, abdominal surgery and radiation therapy may also cause pleural effusions.
Pleural effusion may occur with several types of cancer including lung cancer, breast cancer and lymphoma. In
some cases, the fluid itself may be malignant (cancerous), or may be a direct result of chemotherapy.
SIGNS AND SYMPTOMS:
Some patients with pleural effusion have no symptoms, with the condition discovered on a chest x-ray that
is performed for another reason. The patient may have unrelated symptoms due to the disease or condition that has
caused the effusion. Symptoms of pleural effusion include:

• Chest pain
• Dry, nonproductive cough
• Dyspnea (shortness of breath, or difficult, labored breathing)
• Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)
• Tachycardia
• Cyanosis
• Chest asymmetry

DIAGNOSIS:
• Chest x-ray
• Computed tomography (CT) scan of the chest
• Ultrasound of the chest
• Thoracentesis (a needle is inserted between the ribs to remove a biopsy, or sample of fluid)
• Pleural fluid analysis (an examination of the fluid removed from the pleura space)
• When the pleural effusion has remained undiagnosed despite previous, less-invasive tests, thoracoscopy
may be performed. Thoracoscopy is a minimally invasive technique, also known as video-assisted
thoracoscopic surgery, or VATS, performed under general anesthesia that allows for a visual evaluation of
the pleura). Often, treatment of the effusion is combined with diagnosis in these cases.
TREATMENT:
• Treatment of pleural effusion is based on the underlying condition and whether the effusion is causing
severe respiratory symptoms, such as shortness of breath or difficulty breathing.
• Diuretics and other heart failure medications are used to treat pleural effusion caused by congestive heart
failure or other medical causes. A malignant effusion may also require treatment with chemotherapy,
radiation therapy or a medication infusion within the chest.
• A pleural effusion that is causing respiratory symptoms may be drained using therapeutic thoracentesis or
through a chest tube (called tube thoracostomy).
• For patients with pleural effusions that are uncontrollable or recur due to a malignancy despite drainage, a
sclerosing agent (a type of drug that deliberately induces scarring) occasionally may be instilled into the
pleural cavity through a tube thoracostomy to create a fibrosis (excessive fibrous tissue) of the pleura
(pleural sclerosis).
• Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and tetracycline) is 50
percent successful in preventing the recurrence of pleural effusions.

NURSING MANAGEMENT:
• Remain with the patient, stay calm.
• Place the client in high-fowler’s position.
• Pain management
• O2 therapy(high flow:10-15 LPM)
• ABG’s(arterial blood gas)