PLEURISY

Definiton
Pleurisy is a clinical term to describe pleuritis (inflflammation of
the pleura, both parietal and visceral).
Pathophysiology and Etiology
1. Inflflammation of the pleura stimulates nerve endings,
causing pain.
2. May occur in the course of many pulmonary diseases:
a. Pneumonia (bacterial, viral).
b. TB.
c. Pulmonary infarction, embolism.
d. Pulmonary abscess.
e. Upper respiratory tract infection.
f. Pulmonary neoplasm.
Clinical Manifestations
1. Chest pain—becomes severe, sharp, and knifelike on
inspiration (pleuritic pain)
a. May become minimal or absent when breath is held
b. May be localized or radiate to shoulder or abdomen
2. Intercostal tenderness on palpation
3. Pleural friction rub—grating or leathery sounds heard in
both phases of respiration; heard low in the axilla or over
the lung base posteriorly; may be heard for only a day or so
4. Evidence of infection; fever, malaise, increased white
blood cell count
Diagnostic Evaluation
1. Chest X-ray may show pleural thickening.
2. Sputum examination may indicate infectious organism.
3. Examination of pleural flfluid obtained by thoracentesis for
smear and culture.
4. Pleural biopsy may be necessary to rule out other conditions.
Management
1. Treatment for the underlying primary disease (pneumo
nia, infarction); inflflammation usually resolves when the
primary disease subsides.
2. Pain relief, using pharmacologic and nonpharmacologic
methods.
3. Intercostal nerve block may be necessary when pain
causes hypoventilation.
Complications
1. Severe pleural effusion
2. Atelectasis due to shallow breathing to avoid pain
Nursing Assessment
1. Assess patient’s level of pain.
2. Observe for signs and symptoms of pleural effusion (dysp
nea, pain, decreased diaphragmatic excursion on affected
side).
3. Auscultate lungs for pleural friction rub.
Nursing Diagnosis
Ineffective Breathing Pattern related to stabbing chest pain
Nursing Interventions
Easing Painful Respiration
1. Assist patient to fifind comfortable position that will pro
mote aeration; lying on affected side decreases stretching
of the pleura and, therefore, the pain decreases.
2. Instruct patient in splinting chest while taking a deep
breath or coughing.
3. Administer or teach self-administration of pain medica
tions as ordered.
4. Employ nonpharmacologic interventions for pain relief,
such as application of heat, muscle relaxation, and imagery.
5. Assist with intercostal nerve block if indicated.
6. Evaluate patient for signs of hypoxia (with SpO2 or ABG)
when anxiety, restlessness, and agitation of new onset are
noted, before administering as-needed sedatives. Consider
evaluation by a health care provider when these signs are
present, especially if accompanied by cyanotic nailbeds,
circumoral pallor, and increased respiratory rate.
Patient Education and Health Maintenance
1. Instruct patient to seek early intervention for pulmonary
diseases so pleurisy can be avoided.
2. Reassure and encourage patience because pain will subside.
3. Advise patient on reporting shortness of breath, which
could indicate pleural effusion.
Evaluation: Expected Outcomes
Respirations deep without pain