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Pleural Effusion (Diagnosis (Myatt, 2014) (Radiograph (x-ray):…
Pleural Effusion
Nursing Interventions (Arber et al., 2014)(Malone, 2016)
Pain management: assess patients' level of pain. Use pharmacological/nonpharmacological interventions to relieve pain
Monitor: for signs of bleeding, increased shortness of breath, and infection
Shortness of breath/dyspnea: deep breathing and coughing to promote lung expansion; position patient on unaffected side; smoking cessation; use of incentive spirometer
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Anxiety Management: provide support during thoracentesis, pain management, explain procedures to patients so they know what to expect
Chest Tube: Ensure drainage system is in place and below patients' chest level; inspect insertion site for irritation/complications; ensure there are no kinks in the tubing; assess and record drainage levels; assess for leaks; report any signs of bleeding
Promote Lung Expansion: proper positioning and pursed lip breathing to reduce feeling of breathlessness and control breathing rate
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Clinical Manifestations (Arber, et al., 2013)
Physical Assessment
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Auscultation: Diminished/absent breath sounds over effusion with an increase in resonance (egophony)
Palpation: increase in vocal fremitus about the effusion, but an absence of fremitus over the effusion
Inspection: asymmetric chest wall expansion with tracheal tug and accessory muscle use when breathing
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Pathophysiology (Myatt, 2014) (Schumann, 2013)
Space between the visceral pleural and the parietal plural fill with an excessive amount of fluid/pus secondary to a disease or trauma (>250mL)
Exudative: accumulation of fluid/cells due to increase permeability of the lung capillaries leading to inflammation from cancer malignancies, infections, embolism, or GI disease
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Transudative: caused by an increase in hydrostatic pressure within the capillaries of the lungs and a decrease in colloid osmotic pressure within the circulatory system
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Client Centred Care (Arber et al., 2013)(Malone, 2016) (Myatt, 2014)
Acknowledge Patients Lived Experience: Consider the patients past and current experiences that will influence the situation on hand
Allows patient to feel like they are being treated like a human, not their disease
Open communication: helps to identify what the patients specific needs are and includes them in their care
Patient/Family Education: enables patient and family to become more engaged and participate in care and decision making
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Treatment (Arber et al., 2013) (Norris, 2016)
Thoracentesis: a needle is inserted under localized anesthetic to drain fluid from the affected lung. Fluid sent for tests to determine possible cause for effusion
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Indwelling Pleural Drain: long-term catheter inserted into pleural space to drain fluid allowing patient to go home during treatment. Common for recurrent effusions
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Chemical Pleurodesis: is when irritating, sclerosing agents are injected into the pleural space causing artificial synthesis of the parietal and visceral linings
which can prevent recurrence of effusions
Tetracycline, bleomycin, and sterile iodised talc
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Diagnosis (Myatt, 2014)
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Radiograph (x-ray): confirms plural effusion as the fluid within the lung space shows white on an X-ray.
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Thoracentesis: a needle is inserted under localized anesthetic to drain fluid from the affected lung. Fluid sent for tests to determine possible cause for effusion
CT Scan: differentiate between malignancies, abscesses and pleural diseases
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Medications to treat Pleural Effusion (Skidmore-Roth, 2018)
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Diuretics: inhibits resorption of water, sodium, potassium and bicarbonate = increased urine volume
furosemide, torsemide, bumetanide, and ethacrynic acid
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Analgesics: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
opioids
morphine, codeine, oxycodone, hydrocodone
watch for respiratory depression, QT prolongation, hepatotoxicity, dependence
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Benzodiazepines: enhance the effect of GABA resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties
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Etiology (Myatt, 2014)(Schumann, 2013)
Systemic
Hydrothorax: non-inflammatory collection of fluid caused by chronic kidney disease, chronic liver disease, or congestive heart failure
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Local
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Chylothorax: lymphatic system leakage into pleural space from infections like pneumonia or tuberculosis
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Collaborative Care (Bailey, 2013)
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