UNIVERSITY OF

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SYSTEM DALTA LAS PIÑAS CAMPUS

Nursing Care Management 42121

RLE

Pleural Effusion Left probably

secondary to Parapneumonic vs
Malignancy

Submitted by:
Consolacion, Jill Rae L
BSN-4A

Submitted to:
Ms. Michelle Iduria

March 20, 2023

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Pleural Effusion
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.

What are the symptoms of pleural effusion?

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)

What causes 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

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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

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.

How is pleural effusion diagnosed?

The tests most commonly used to diagnose and evaluate pleural effusion include:
• 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)

How is pleural effusion treated?

• 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.

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• 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.

Surgery
Pleural effusions that cannot be managed through drainage or pleural sclerosis may require
surgical treatment.
The two types of surgery include:
• Video-assisted thoracoscopic surgery (VATS)
o A minimally-invasive approach that is completed through 1 to 3 small
(approximately ½ -inch) incisions in the chest. Also known as thoracoscopic
surgery, this procedure is effective in managing pleural effusions that are
difficult to drain or recur due to malignancy. Sterile talc or an antibiotic may be
inserted at the time of surgery to prevent the recurrence of fluid build-up.
• Thoracotomy (Also referred to as traditional, “open” thoracic surgery)
o A thoracotomy is performed through a 6- to 8-inch incision in the chest and is
recommended for pleural effusions when infection is present. A thoracotomy is
performed to remove all of the fibrous tissue and aids in evacuating the infection

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632)8871.06.39
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from the pleural space. Patients will require chest tubes for 2 days to 2 weeks
after surgery to continue draining fluid.

Patient’s Profile
Name Levy Enfactana Cruz
Age 71 years old
Civil Status Married
Religion INC
Admitting time and date March 20, 2023
Chief Complaint SOB
Pleural Effusion Left probably secondary to
Admitting Diagnosis
Parapneumonic vs Malignancy

History of Present Illness

Patient was recently admitted and treated as a case of pleural effusion at another institution.
They were unable to treat her condition and patient opted HAMA and transferred to this
institution.

2 weeks PTA, patient experienced SOB while doing ADLs.

Patient sought consult at different clinics and hospitals and was prescribed Unrecalled
antibiotics, patient was compliant with the medications.

1 week PTA, patient noticed increase in severity of SOB with

DOB, occasional nausea and vomiting 3 episodes while trying to take tablets, also with loss of
appetite (-) Chest pain, (-) dizziness.

2 days PTA, patient sought consult and was admitted. Treated as a case of pleural effusion but
opted HAMA and transferred to this institution, hence admission.

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632)8871.06.39
www.perpetualdalta.edu.ph
Las Piñas Campus
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Laboratory and Diagnostic Procedures:

Prothrombin Time (Done March 20, 2023/ 03:33AM)
Control 13.20 seconds
Test 13.85 seconds
INR 1.17
% Activity 82.20%

Partial Thromboplastin Time (Done March 20, 2023/ 03:33AM)

Test 29.00 seconds
Control 31.90 seconds

Clinical Chemistry (Done March 20, 2023/ 03:23AM)

Examination Result Normal Values
A/G Ratio 1.12 1.50-2.10g/L (Low)
Albumin 30.30 34-50g/L (Low)
Globulin 27.10 15-35g/L
Total Protein 57.40 64-82g/L (Low)

Chest mapping (Done March 19, 2023)

• Massive Pleural Effusion with sediments, Left
• Markedly elevated left hemidiaphragm
• Incidental note of massive ascites

ABG (Done March 19, 2023/ 09:18PM)

Examination Actual result Normal Values
pH 7.44 7.35-7.45
PCO2 28 35-45 mmHg
PO2 75 80-100 mmHg

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632)8871.06.39
www.perpetualdalta.edu.ph
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SO2 95% 90-100%

HCO3 19 22-26 mmoI/L
BE -4 +-2

Whole Abdomen Ultrasound (Done March 16, 2023)

• Moderate Ascites seen along the perihepatic space
• Right paracolic gutters
• Symmetrical gallbladder wall thickening likely
• Secondary to a reactive inflammatory process
• Fatty liver disease

Reference:
Cleveland Clinic. (2018, December 18). Pleural Effusion: Heart & Vascular Institute Overview |

Cleveland Clinic. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17373-

pleural-effusion-causes-signs--treatment

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632)8871.06.39
www.perpetualdalta.edu.ph
Las Piñas Campus