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Your textbook
doesn’t say much
about this problem
Textbook lists it as
a common
complication of
pneumonia
So what is it?
Inflammation of the
linings around the
lung
What are they?
– One covers the lung
- visceral
– One covers the
inner chest wall -
parietal
– Both lubricated by
pleural fluid
Pleurisy
Sometimes called “pleuritis”
Lung’s pain fibers are located in the
pleura.
– As tissue becomes inflamed
Sharp pain occurs
Worse with inspiration
Chest pain common symptom
Other symptoms
– Shortness of breath
– Cough
– Chest tenderness
– May have fluid accumulate in space between
pleura
Called pleural effusion
More on pleurisy - Causes
Infections Cancers
– Bacterial – Lung, breast, etc.
Including TB Tumors of pleura
– Fungus – Mesothelioma
– Parasites – Sarcoma
– Viruses Congestion
Inhaled chemicals – HF
or toxic substances Pulmonary Embolism
Collagen vascular Trauma
diseases – Eg. Rib fx
– Lupus – Irritation from chest
– RA tubes
Lymph channel
obstruction
– Usu from tumors Causes cont:
Certain drugs
– Cause Lupus-like
syndromes
Hydralazine
Procan
Dilantin etc.
Abd conditions
– Pancreatitis
– Cirrhosis of the liver
Alcoholics at risk
Lung infarction
– Usu 2nd poor blood Fibrous tumor of pleura
supply
Ever hear of Mesothelioma?
Caused by
asbestos
(inhalation)
Results in cancer
of pleura - the
lining
Radical surgery to
remove tumor is
sometimes done
How is pleurisy diagnosed?
Pain is distinctive
– In chest, usu sharp, worsens with resp
– Can often hear pleural friction rub
Differsfrom pericarditis which is synchronized
with heartbeat
Breath sounds may be diminished if large
amount pleural fluid present
– Dull to percussion
CXR
U/S
CT Scan to detect trapped pockets of fluid
Removal of fluid
– “transudative fluid”
Normal levels
Aspirated with needle Indicates HF, liver
and syringe (called???) and kidney disease
– Check for color,
consistency, and clarity
Pulmonary emboli
(lab) can cause either
– Called “exudate” if high in type of fluid
protein, low in sugar, high
in LDH enzyme, and WBC
count
– (indicates inflammation)
– Caused by infection (eg.
Pneumonia), cancer, lupus,
RA. TB
Treatment of Pleurisy
Pain
– External splinting
– Pain medication
Treat underlying cause
– Thoracentesis to remove
fluid from pleural cavity
If infected - RX ATB
– Pus?
Chest drain inserted
– Adhesions?
Decortication done - removes
scar tissue, pus, & debris
– Complicated?
Open surgical procedure -
thoracotomy
How would you care for
someone with pleurisy?
Count off 1 thru 8
Come up with a l Infections
basic care plan for l Cirrhosis of Liver
pleurisy related to l Breast Ca
the cause (see l Dilantin
right) l Rib Fracture
Consider:
l PE
l Mesothelioma
– Prevention
– Symptom RX
l CHF
– Nutrition
– Other Interventions
– How to Evaluate
What’s the difference … ?
Infiltrate
versus
Pleural effusion
Is one harder to
RX?
Let’s check out some images
eMedicine.com
What are some treatments?
Excess fluid in
lungs
– 2nd inflammatory
process
Triggers:
– Infections
– Irritating agents
Two categories
– CAP
– HAP (nosocomial)
Pathophys (page 633)
– Which means
what?
Risk Factors (page 634)
Table 34-3
Common
organisms
– Table 34-4 (p 634)
– WHY?
Health Promotion/
Disease Prevention
Pneumonia Assessment
Vaccine – What are S&S?
– Most common – What history do
pneumococcal you need to take?
organisms – What diagnostics
covered might be done?
Client education Why?
Page 638
– Cough
enhancement?
– O2 Rx?
– Resp Monitoring?
What’s missing
from this list?
What meds? P 639, 34-7
CAP
– Most common type
HAP
– What is difference?
What about
aspiration
pneumonia?
– Types?
Chemical
Foreign body
Toxic gases/smoke
Risk Assessment
More
How to Score Risk
Risk 30 Day Mortality Risk Based on:
Level Class
Low Less than 0.5% I Algorithm
< 51 I 3/1,472
(0.2%)
None Outpatient Therapy
should be
considered
51-70 II 7/1,374
(0.5%)
None Especially for
classes I, and II
91- IV 149/1,605
(9.3%)
6/50
(12.0%)
Hospitalize
130
> 130 V 109/438
(24.9%)
28/85
(32.9%)
Hospitalize
Medically unstable
– Had 1 of 7 factors
– 60% > risk
Readmission OR
Death
Seven Factors?
– Temp, heart rate, BP,
resp rate
– O2 level (ABG)
– Mental status
– Able to eat/drink?
Stanton (2002).
Other Preventions
Flu Vaccine
– Better mortality rate (in-
hospital)
– Spaude (2007)
Inhaling Pepper Oil
Also tried Lavender Oil
and distilled H2O
– Reduces risk of aspiration
PX
Improves swallow,
promotes brain activity,
appetite stimulus
– Ebihara (2006) (Japan)
ED Algorithm for NH
acquired PX
– Better outcomes
– Curr Med Res Opin (2004)
ED Algorithm for NH PX
1. Discharge to NH
l Cefepime or Ceftriaxone + Macrolide
l OR Resp. Fluoroquinolone
l Admit Stable Patient
l Cefepime or Ceftazidime or Pip/Tazo
l Plus Resp. Fluoroquinolone or Macrolide
l Admit Unstable Patient
l Cefepime or Pip/Tazo
l Plus Quinolone or Aminoglycoside
l Plus Vancomycin