PLEURAL

CONDITIONS
I. PLEURISY
Pleurisy is the inflammation of the pleura
caused by infection (e.g. Pneumonia)
❑ DIAGNOSTIC TESTS

1. X-RAY
2. SPUTUM EXAM
3. THORACENTESIS
Nursing Management for

Thoracentesis: Both Dx and Therapeutic

procedure 3.Side Lying

#DURING the procedure: DO
Needles are punctured on NOT!
8th- 9th ICS (lower because 1.Move
FLUID is drained. If air, 2.Cough
punctured at 1st-2nd ICS) 3.Breathe deeply

#BEFORE: BEST POSITIONS! #AFTER:

1.Orthopneic Best pOsition: UNAFFECTED
2.Sitting SIDE
4. PLEURAL BIOPSY
❑ MANAGEMENT:

1. Treat
the underlying CAUSE
2. SYMPTOMATIC relief
a. Relieve PAIN

b. ENDOMETHACIN – NSAID given to pt with

PLEURISY to relieve pain when coughing/
deep breathing
3. Watch out for s/sx of developing
PLEURAL EFFUSION
(SOB, Pain, dull percussion, diminished breath
sounds)
II. PLEURAL EFFUSION
Pleural Effusion

PLEURAL EFFUSION— collection of fluid in

the pleural space
-- rarely a primary dses but is
usually SECONDARY to other dses. (TB, lung
CA)

NORMAL amount of PLEURAL FLUID:

5- 15mL
Pleural Effusion -- >15mL of pleural fluid
❑ COMPLICATIONS OF (SECONDARY
CAUSES):
1. Heart failure
2. TB

3. Pneumonia

4. Pulmonary Infection
5. Malignancy- Brochogenic Cancer

6. Nephrotic syndrome
7. Pulmonary embolus
❑ TYPES
❑ TYPES OF PLEURAL EFFUSION
ACCORDING TO ETIOLOGY:
1. EXUDATE (Empyema)
- results from inflammation by bacterial products
or tumors involving the pleural surfaces

2.TRANSUDATE (Hemo/Hydrothorax) – filtrates of

plasma that move across intact capillary walls (L
ventricular failure, imbalance in hydrostatic and
oncotic (Albumin)pressure) --extravasation of fluid
into tissues or cavity
CHEMICAL PLEURODESIS
EMPYEMA/ PYOTHORAX
PULMONARY EDEMA
 CAUSES/ PATHOPHYSIOLOGY:
❖ Inadequate left ventricular function
❖ Sudden increase in the intravascular
pressure in the lung
❖ EX:

1. pneumonectomy
2. rapid reinflation of the lung after
removal of fluid or air
❖ Fluid shifting in the alveolar tissues

❑ SIGNS & SYMPTOMS:

1. Respiratorydistress
2. Anxiety & agitation

3. Foamy & frothy, blood tinged secretions

4. Confusion or stuporous

5. Acute Respiratory Distress

PINK FROTHY SPUTUM
 ❑ ASSESSMENT & DIAGNOSTIC
TESTS
1. Auscultation – (+) crackles
2. Chest x-ray
3. Tachycardia

4. 02 sat - <95%

5. ABG analysis – increasing

hypoxemia and respiratory acidosis
❑ MEDICAL MANAGEMENT
GOAL: CORRECT THE UNDERLYING
 CAUSE
1. If CARDIAC ORIGIN: Improve left ventricular
function
MEDICAL:
❖ Use of:

A. Inotropic medications

B. VasoDILATORS

C. PREload and AFTERload agents

SURGICAL:
❖ Intra – aortic balloon pump

2. DUE TO FLUID OVERLOAD

 ❖ Diuretics

A. Loop diuretics (Ex: bumex, edecrin)

B. K-sparing – (Ex: midamor, dyrenium,
aldactone)

C. Fluids restriction
❑ OTHER MANAGEMENT:

3. Oxygen – corrects hypoxemia which

improves cardiac output also
 decreasing pulmonary congestion 4.
Intubation & mechanical ventilation 5.
Morphine – reduces pain and anxiety
(monitor for the RR)
❑ NURSING MANAGEMENT

1. Assistin 02 therapy
2. Admin meds as prescribed & monitor the
patient (RR and O2 sats)
3. POSITIONs OF CHOICE: high-Fowler’s or
orthopneic position
ACUTE RESPIRATORY FAILURE
(ARF)
�� Sudden and life-threatening
deterioration of the GAS EXCHANGE
�� Exist when the exchange for CO2 in the
lungs canNOT keep up with the rate O2
consumption and CO2 production by the
cells of the body
❑ NORMAL:

�� pH = 7.35 – 7.45
�� PaO2=85 – 100
mmHg �� PaCo2 = 35 –
45 mmHg

❑ In ARF:

�� PaO2 ____50 mmHg

�� PaCO2 ____50

mmHg �� pH ____7.35

❑ CAUSES:
�� 1. decreased RESPIRATORY
 DRIVE: �� Ex: severe brain injury
�� Multiple Sclerosis

�� Use of Sedative Meds

�� Metabolic dis/ors

2. Dysfunction of the CHEST WALL: �� Ex:

Dis/ors of the nerves, spinal cord, muscle, or NMJ
involved in respiration (e.g. Myasthenia Gravis,
Guillain-Barre Syndrome, Cervical Spine Paralysis)
�� 3.
dysfunction of the LUNG
PARENCHYMA:
�� Condition that interferes with
ventilation (prevents lung expansion)

Ex: - pleural effusion

- Hemothorax
- Pneumothorax
- Upper airway obstruction
❑ OTHER CAUSES:

1. Anesthetic, analgesic, and sedative

agents (e.g. narcotic analgesics) 2.
Pain
3. Major abdominal, cardiac, or thoracic
surgery
❑ SIGNS & SYMPTOMS

1. Restlessness (1st sign of hypoxia) 2.

Fatigue
3. H/a

4. Dyspnea, air hunger (due to acidosis)

5. Tachycardia, increased BP
6. Confusion, lethargy, tachypnea,
diaphoresis, respiratory arrest
❑ MANAGEMENT

1. Identify the cause & treat the cause 2.

Admin O2- maintain PaO2 to >60 – 70
mmHg (thru intubation and mechanical
intubation)
3. Position of Choice: high-Fowler’s
4. Encourage DBCE
 ACUTE RESPIRATORY
DISTRESS SYNDROME (ARDS)
1. Sudden pulmonary edema
2. Arterial hypoxemia

3. Reduced lung compliance

4. Inc. bilateral infiltrates (CXR)

-- occurs in the absence of LSHF

ACUTE RESPIRATORY DISTRESS
SYNDROME
❑ ETIOLOGIC FACTORS:

1. Aspiration (gastric secretion, drowning)

2. Drug ingestion/ over dosage

3. Prolonged inhalation of high concentration 02,

smoke, corrosive substances
4. Localized infection

5. Trauma

6. Fat/ air emboli

ARDS
PATHOPHYSIOLOGY
Lung injury
Capillary membrane edema(pulmonary
damage edema)
Decreased
surfactant
production
Capillary
hemorrhage/ leaking
atelectasis

___ compliance

VQ abnormalities
(____physiologic
shunting)
Interstitial

❑ SIGNS & SYMPTOMS

1. Arterial hypoxemia
 2. X-ray – bilateral infiltrates

3. Increased alveolar dead space and decreased

LUNG COMPLIANCE (“stiff lungs”)
4. Tachypnea
5. Dyspnea
6. Decreased breath sound
7. ABG ____
8. Intercostal retractions & crackles
❑ MANAGEMENT

❑ GOALS:
1. Maintain Pa02 > 60 mmHg via
intubation
2. Maintain O2 sat = 90% 3.
Treat the underlying cause
❑ OTHER MANAGEMENT:

1. Supportive care – O2 therapy via

mech vent
2. Circulatory support - IVF
 3. PositiveEnd-Expiratory Pressure – a
ventilator control and setting goal
to keep alveoli open
4. Pharmacology (Corticosteroids)

5. Nutrition: 35 – 45 kcal/kg

❑ NURSING MANAGEMENT

1. Close monitoring
2. Position of CHOICE: high-Fowler’s
3. Remain calm
4. Rest

5. Ventilator
considerations
-use of Neuromuscular
agents
PULMONARY EMBOLISM

��A pulmonary embolism (PE) is a blood clot

that develops in a blood vessel in the body
(often in the leg). It then travels to a lung
 artery where it suddenly blocks blood flow.
PULMONARY EMBOLISM

RISK FACTORS:
1. Prolonged immobilization/ sitting/ travelling
2. Surgery

3. Obesity

4. Pregnancy

5. Smoking

6. Advanced age

7. Constrictive clothing
8. CHF

Pulmonary Embolism S&Sx

• Sudden shortness of breath (most common) •

Chest pain (usually worse with breathing) • A
feeling of anxiety
• A feeling of dizziness, lightheadedness, or fainting •

Irregular heartbeat
• Palpitations (heart racing)

• Coughing or coughing up blood

• Sweating

• Low blood pressure

Diagnostics

• Chest X-ray.
• Pulmonary angiogram. •

CT scan.
• MRI.

Treatment:

•Anticoagulants. Also described as blood thinners,

these medicines decrease the ability of the blood to
clot. This helps stop a clot from getting bigger
 and keep new clots from forming. Examples
include warfarin and heparin.
• Fibrinolytic therapy. Also called clot busters, these

medicines are given intravenously (IV or into a

vein) to break down the clot. These medicines are
only used in life-threatening cases.