Pleural Effusion

Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail:
unp_nursingvc@yahoo.com CP#
09177148749, 09175785986
I. INTRODUCTION AND OBJECTIVES
A. INTRODUCTION
A pleural effusion is collection of fluid abnormally present in the pleural space,
usually resulting from excess fluid production and/or decreased lymphatic absorption. It is
the most common manifestation of pleural disease, and its etiologies range in spectrum from
cardiopulmonary disorders and/or systemic inflammatory conditions to malignancy.
Approximately 1.5 million pleural effusions are diagnosed in the United States each year.
The body produces pleural fluid in small amounts to lubricate the surfaces of the
pleura. This is the thin tissue that lines the chest cavity and surrounds the lungs. There are
two types of pleural effusion: The Transudative pleural effusion and The Exudative effusion.
Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from
increased pressure in the blood vessels or a low blood protein count. Heart failure is the most
common cause and Exudative effusion is caused by blocked blood vessels or lymph vessels,
inflammation, infection, lung injury, or tumors.
Factors that increase the chance of developing pleural effusion
include: pneumonia, tuberculosis or other lung diseases, heart attack, heart failure, or infectio
nssuch as pericarditis, recent cardiac surgery, pleurisy, tumors, cancers, such as lung, breast,
surgery, especially involving the heart, lungs, abdomen and organ transplantation. Tests to
diagnose pleural effusion include chest x-ray, ultrasound, CT scan, thoracentesis, pulmonary
function tests and biopsy
1|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
Mr. Realina is a 55-year-old man from Ayusan Norte, Vigan City who was admitted
at Ilocos Sur cooperative medical mission group and hospital last April 12, 2023 due to body
weakness and cough for 5 days. He is experiencing poor appetite, epigastric pain, chest pain
and fatigue.
B. OBJECTIVES
GENERAL OBJECTIVE
To understand and have a deeper knowledge on what is pleural effusion, its associated
factors, causes, how it is acquired, prevented and its treatment, in order to render an effective
nursing care plan for the patient.
SPECIFIC OBJECTIVES
 Build rapport and gain the trust of the patient and the family members to build an
effective interpersonal relationship.
 Acquire comprehensive knowledge about pleural effusion
 Familiarize with the etiology of the disease.
 Review and understand the anatomy and physiology of the systems and organs
involved/affected.
 To illustrate and explain the pathophysiology of pleural effusion.
 Describe the potential complications of pleural effusion.
 Describe and interpret the laboratory results and diagnostic tests of the patient which
lead to the diagnosis of the disease.
2|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
 Be able to make an effective nursing care plan for the patient.
 Impart health teachings to the patient and family members on how to take care patient
with pleural effusion.
II. PATIENT’S PROFILE
A. BIOGRAPHICAL PROFILE
Name: Bonnie Pre Realina
Age: 55 years old
Sex: Male
Address: Ayusan Norte, Vigan City, Ilocos Sur
Date of Birth: June, 5 1968
Place of Birth: Ayusan Norte, Vigan City, Ilocos Sur
Civil Status: Married
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: High school Graduate
A. FAMILY PROFILE
Family Type: Lineal Family
Family Composition: Eldest
Father: Bon Realina
Occupation: N/A
3|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
Mother: Wendy Realina
Occupation: N/A
A. MEDICAL PROFILE
Date of admission: April 12, 2023
Time of admission: 7:10 pm
Institution: Ilocos Sur cooperative medical mission group and hospital
Chief Complaint: Body weakness and cough
Admitting Diagnosis: N/A
Admitting Physician/s: N/A
Attending Physician/s: Dr. Abraham Auberum Austria
Final Diagnosis: Pleural Effusion
III. NURSING HPI
A. CHIEF COMPLAINT
Body weakness and cough
B. HISTORY OF HEREDITARY/FAMILIAL DISEASE
According to the wife, the patient’s mother has a history of pneumonia which
diagnosed 10 years ago and his youngest sister also diagnosed of tuberculosis 3 years go.
No one in the family has diagnosed with pleural effusion.
4|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
C. PAST HEALTH HISTORY
During the interview, the wife was asked about her husband’s past health history. She
told me that they went for check-up 3 months ago because he is experiencing difficulty of
breathing. The doctor advised the patient to have x-ray and it was discovered that he has a
tumor in his lungs. He was not admitted and immediately went home after the doctor gave
his medications. Moreover, he has no history of allergies, no recent surgical procedures,
no emotional and psychiatric problems.
D. HISTORY OF PRESENT ILLNES
Mr. Realina is a 55-year-old man from Ayusan Norte, Vigan City, Ilocos Sur, who has
presented with a cough for 5 days and body weakness upon admission on April 12, 2023
at 7:10 in the evening. Prior to admission, the patient's wife informed me that her husband
had been suffering from coughs, body weakness and that he was having difficulty
breathing. At the time of admission, the patient's vital signs were as follows: 36.2°C
temperature, 32 respiratory rate, and 128 pulse rate.
5|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
IV. DIAGNOSTIC PROCEDURES
A. IDEAL
Name of the procedure Description Importance

ULTRASONOGRAPHY Even small amounts of Ultrasonography is useful
THORAX pleural effusion can be in cases of loculated
detected accurately by pleural effusion for
ultrasonography. The confirmation of the
ultrasonographic image diagnosis and for marking
of pleural effusion is a site for thoracocentesis.
characterized by an echo- In the presence of
free space between the hemithorax opacification
visceral and parietal on chest radiography,
pleura. ultrasonography is also
helpful in distinguishing
between fluid-filled and
solid lesions. The
sonographic
characteristics of effusion
are helpful in
differentiating transudates
from exudates.
CT THORAX Computed tomography CT can be useful in
(CT) scanning with its helping to select the site of
cross-sectional images drainage of
can be used to evaluate empyema, differentiating
complex situations in empyema from lung
which the anatomy abscess, and identifying
cannot be fully assessed the location of the chest
by plain radiography or tube in failed empyema
ultrasonography. drainage.
F-18 F-18 fluorodeoxyglucose Fluorine 18 FDG PET-CT
FLUORODEOXYGLUCOSE positron emission helps assess the degree of
POSITRON EMISSION tomography seems inflammatory activity
TOMOGRAPHY promising for around the pericardium,
differentiating between without requiring
benign and malignant additional invasive
pleural diseases, with a procedures. Pericarditis
sensitivity of 97% and a may occur in isolation or
specificity of 88.5%. with myocardial
6|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
involvement
(perimyocarditis). Whole-
body imaging with F-FDG
PET-CT facilitates
identification of spread of
disease from the lungs and
assessment of therapeutic
response.
Thoracentesis Thoracentesis is a Thoracentesis helps
procedure that is determine the cause of the
performed to remove excess fluid. It also helps
fluid or air from the ease any shortness of
thoracic cavity for both breath or pain by
diagnostic and/or removing the fluid and
therapeutic relieving pressure on the
purposes. Thoracentesis lungs.
is also known as
thoracocentesis, pleural
tap, needle thoracostomy,
or needle decompression.
A cannula, or hollow
needle, is introduced into
the thorax after
administration of local
anesthesia.
Percutaneous pleural biopsies Percutaneous pleural Indications for
biopsies are of greatest percutaneous pleural
value in the diagnosis of biopsy include
granulomatous and undiagnosed pleural
malignant diseases of the effusions and pleural
pleura. They are thickening or pleural
performed on patients masses. Diagnostic
with undiagnosed thoracentesis should
exudative effusions and precede pleural biopsy for
nondiagnostic cytology, pleural effusions. The role
and when there is clinical and relative yield of
suspicion of tuberculosis diagnostic thoracoscopy
or malignancy. The should also be considered
biopsy specimens should when selecting closed
be placed in 10% pleural biopsy.
formaldehyde for
histological examination
and sterile saline for
7|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
tuberculosis culture.
Thoracoscopy Thoracoscopy should be The importance of
considered when less medical thoracoscopy has
invasive tests have failed been in the diagnosis and
to give a diagnosis. Harris treatment of malignant
et al54 studied 182 pleural effusions. Rigid
consecutive patients who thoracoscopy has been
underwent thoracoscopy demonstrated to have a
and showed a diagnostic diagnostic rate for pleural
sensitivity of 95% for effusion greater than 93%
malignancy. Apart from when compared to pleural
its diagnostic use, fluid cytology and/or
medical thoracoscopy had closed pleural biopsy
also been used as a
therapeutic tool in
chemical pleurodesis for
malignant pleural
effusion55 and
spontaneous
pneumothorax56 repair of
bronchopleural fistula,
performing drainage, and
lysis of loculations in
pleural infections.
Fiberoptic bronchoscope Fiberoptic bronchoscopy The fiberoptic
(FFB) is an invasive bronchoscope allows
procedure that has been direct airway inspection,
used for a long time for facilitating the diagnosis
diagnostic and of benign and malignant
therapeutic purposes. It airway lesions. In
contains a light source, addition, pulmonary
fiber optics, and a camera secretions or tissue
that allows direct samples can be collected
visualization of the upper using the bronchoscope
and lower airways. and techniques that allow
Generally, FFB is a safe sampling of the lower
procedure, which has a airways with minimal or
high diagnostic yield of no upper airway
respiratory disease. contamination.
CHEST X-RAY Chest x-ray is the most It can help to see how well
commonly used your lungs and heart are
examination to assess for working. Certain heart
the presence of pleural problems can cause
8|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
effusion; however, it changes in your lungs.

should be noted that on a Certain diseases can cause
routine erect chest x-ray changes in the structure of
as much as 250-600 mL the heart or lungs.
of fluid is required before
it becomes evident.
B. ACTUAL
Name of the Description Importance Interpretation/ Nursing

procedure Result Responsibilitie
s
Thoracentesis Thoracentesis Thoracentesis CELL CT./DIFF ● Check the
is a procedure helps CT: doctor’s order.
that is determine the WBC: 13x10^6/L
performed to cause of the ● Identify the
remove fluid excess fluid. SEGMENTERS: client.
or air from the It also helps 15.4%
thoracic cavity ease any ● Asked
for both shortness of MONOCYTES: patient to sign
diagnostic breath or pain 84.6% a consent form
and/or by removing that gives your
therapeutic the fluid and TOTAL: 100% permission to
purposes. Thor relieving do the test.
acentesis is pressure on Read the form
also known as the lungs. carefully and
thoracocentesis ask questions
, pleural tap, if something is
needle not clear.
thoracostomy,
or needle ● Explain and
decompression emphasize the
. A cannula, or importance of
hollow needle, the procedure.
is introduced
into the thorax ● Inform that
after he will be
administration experiencing
of local mild pain on
anesthesia. the site where
the needle was
pricked
9|PLEURAL EFFUSION
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
● Inform the
client that the
procedure
takes only few
minutes,
depending
primarily on
the time it
takes for fluid
to drain from
the pleural
cavity.
● Inform the
client not
to cough while
the needle is
inserted in
order to avoid
puncturing the
lung
● Explain
when and
where the
procedure will
occur and who
will be present.
● Explain the
procedure to
the patient and
SO,
reinforcing
what the
physician has
previously
explained to
the patient/SO
CHEST X-RAY Chest x-ray is It can help to ●Homogenous ●Remove all

the most see how well soft tissue mass metallic
commonly your lungs densities, right objects. Items
10 | P L E U R A L E F F U S I O N
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
used and heart are upper and left such as

examination to working. lower lobes jewelry, pins,
assess for the Certain heart buttons etc.
presence of problems can ●Intercurrent can hinder the
pleural cause pneumonia and/or visualization
effusion; changes in PTB, right of the chest.
however, it your lungs. ●Moderate
should be Certain pleural effusion, ●No
noted that on a diseases can right preparation is
routine erect cause required. Fasti
chest x-ray as changes in ●Atheromatous ng or
much as 250- the structure Aorta medication
600 mL of of the heart restriction is
fluid is or lungs. not needed
required before unless directed
it becomes by the health
evident. care provider.
●Ensure the
patient is not
pregnant or
suspected to be
pregnant. X-
rays are
usually not
recommended
for pregnant
women unless
the benefit
outweighs the
risk of damage
to the mother
and fetus.
●Assess the
patient’s
ability to hold
his or her
breath. Holdin
g one’s breath
after inhaling
enables the
lungs and heart
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
to be seen
more clearly in
the x-ray.
● Provide
appropriate
clothing. Patie
nts are
instructed to
remove
clothing from
the waist up
and put on an
X-ray gown to
wear during
the procedure.
●Instruct
patient to
cooperate
during the
procedure. The
patient is asked
to remain still
because any
movement will
affect the
clarity of the
image.
ULTRASONOGRAP Even small Ultrasonogra There is a free ● Check the

HY THORAX amounts of phy is useful pleural effusion doctor’s order.
pleural in cases of seen within the
effusion can be loculated right hemithorax. ● Identify the
detected pleural The underlying client.
accurately by effusion for lung parenchyma
ultrasonograph confirmation shows passive ● Asked
y. The of the atelectasis. patient to sign
ultrasonograph diagnosis and a consent form
ic image of for marking a Right = about 890 that gives your
pleural site for cc (moderate) permission to
effusion is thoracocentes do the test.
characterized is. In the No definite Read the form
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
by an echo- presence of evidence of fluid carefully and

free space hemithorax collection with ask questions
between the opacification the left if something is
visceral and on chest hemithorax. not clear.
parietal pleura. radiography,
ultrasonograp ● Explain and
hy is also emphasize the
helpful in importance of
distinguishin the procedure.
g between
fluid-filled ●Instruct
and solid patient to
lesions. The cooperate
sonographic during the
characteristic procedure. The
s of effusion patient is asked
are helpful in to remain still
differentiatin because any
g transudates movement will
from affect the
exudates. clarity of the
image.
Normal Value Actual Value Interpretation Nursing

Responsibility
HEMAT WBC 4.00-10.00 21.7 Elevated WBC Explain the
OLOGY
x10^3/uL means there is an procedure to
infection the significant
others of the
RBC 4.00-5.50 4.28 Normal patient to gain
x10^6/uL cooperation
and reduces
HGB 12.0-16.0 10.6 g/dL Normal anxiety.
HCT 40.0-54.0 33.9 % Normal

Ask the mother
if the baby had
MCV 80.0-100.0 79.4 fL Normal
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
ever felt faint,

MCH 27.0-34.0 24.7 pg Normal sweaty or
nauseated
MCHC 32.0-36.0 31.2 g/dL Normal when having
blood drawn.
RDW-CV 11.0-16.0 15.9% Normal
Ask the mother

RDW-SD 35.0-56.0 42.4 fL Normal to position he
baby in a
PLT 150-450 390 x Normal supine position
10^3/uL
and hold him
still while
MPV 6.5-12.0 6.8 fL Normal
getting the
blood sample.
PDW 9.0-17.0 15.5
Normal
PCT 0.108-0.282 0.265% Normal Assess the
veins to
determine the
best puncture
site then tie the
tourniquet 5cm
proximal to the
area.
Clean
venipuncture
site with an
antimicrobial
swab. Wiping
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
in a circular
motion
spiraling
outward.
Collect or
withdraw 5-
7ml of venous
blood into the
syringe.
Apply pressure
to the puncture
site for 2-3
minutes or
until bleeding
stops.
Check
venipuncture
site to see if
hematoma has
developed.
Observe client
for signs and
symptoms of
anemia,
including
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
pallor,
dyspnea, chest
pain and
fatigue.
Refer results to
Physician.
V. ANATOMY AND PHYSIOLOGY
The respiratory system is the network of organs and tissues that help you breathe. It
includes your airways, lungs and blood vessels. The muscles that power your lungs are
also part of the respiratory system. These parts work together to move oxygen throughout
the body and clean out waste gases like carbon dioxide.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
Nasal Cavity
- The nasal cavity is the inside of your nose. It is
lined with a mucous membrane that helps keep
your nose moist by making mucus so you won't get nosebleeds from a dry nose.
There are also little hairs that help filter the air you breathe in, blocking dirt and
dust from getting into your lungs.
Sinuses
-They are connected by narrow channels. The sinuses make thin
mucus that drains out of the channels of the nose. This drainage
helps keep the nose clean and free of bacteria. Normally filled with air, the sinuses
can get blocked and filled with fluid.
Pharynx
-Commonly called the throat, is a muscular, funnel-shaped passageway
inside the body. It connects the mouth and nose to the esophagus (leading to the stomach) and
larynx (leading to the trachea and then lungs).
Larynx
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
-a hollow tube that connects your throat (pharynx) to the rest of your respiratory system.
It helps you swallow safely and contains the vocal cords, so it’s often called the voice
box. Certain conditions and behaviors can damage your larynx and your voice, but some
strategies and specialists can help.
Trachea
-A long tube that connects your larynx (voice box) to your
bronchi. Your bronchi send air to your lungs. Your trachea is a key part of your
respiratory system. The trachea is made of rings of cartilage. It is lined with cells that
produce mucus. This mucus keeps allergens, dust particles or other debris out of your
lungs.
Lungs
-the center of the respiratory (breathing) system. Lung, in air-
breathing vertebrates, either of the two large organs
of respiration located in the chest cavity and responsible for adding oxygen to and
removing carbon dioxide from the blood. In humans each lung is encased in a thin
membranous sac called the pleura, and each is connected with the trachea (windpipe) by
its main bronchus (large air passageway) and with the heart by the pulmonary arteries.
The lungs are soft, light, spongy, elastic organs that normally, after birth, always contain
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986
some air. If healthy, they will float in water and crackle when squeezed; diseased lungs
sink.
Bronchi
-the large tubes that connect to your trachea (windpipe) and
direct the air you breathe to your right and left lungs. They are in
your chest. Bronchi is the plural form of bronchus. The left bronchus carries air to your
left lung. The right bronchus carries air to your right lung. Your bronchi are an essential
part of your respiratory system. As you breathe and your lungs expand, your bronchi
distribute the air within your lung.
Alveoli
Tiny air sacs at the end of the bronchioles (tiny branches of air tubes
in the lungs). The alveoli are where the lungs and the blood
exchange oxygen and carbon dioxide during the process of breathing in and breathing out.
Oxygen breathed in from the air passes through the alveoli and into the blood and travels
to the tissues throughout the body. Carbon dioxide travels in the blood from the body's
tissues and passes through the alveoli to be breathed out.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
09177148749, 09175785986

Pleural Effusion

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Pleural Effusion

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

I. INTRODUCTION AND OBJECTIVES

A pleural effusion is collection of fluid abnormally present in the pleural space,

cardiopulmonary disorders and/or systemic inflammatory conditions to malignancy.

inflammation, infection, lung injury, or tumors.

Factors that increase the chance of developing pleural effusion

surgery, especially involving the heart, lungs, abdomen and organ transplantation. Tests to

diagnose pleural effusion include chest x-ray, ultrasound, CT scan, thoracentesis, pulmonary

function tests and biopsy

nursing care plan for the patient.

effective interpersonal relationship.

 Acquire comprehensive knowledge about pleural effusion

 Familiarize with the etiology of the disease.

 To illustrate and explain the pathophysiology of pleural effusion.

 Describe the potential complications of pleural effusion.

lead to the diagnosis of the disease.

 Be able to make an effective nursing care plan for the patient.

with pleural effusion.

II. PATIENT’S PROFILE

Name: Bonnie Pre Realina

Age: 55 years old

Address: Ayusan Norte, Vigan City, Ilocos Sur

Date of Birth: June, 5 1968

Place of Birth: Ayusan Norte, Vigan City, Ilocos Sur

Civil Status: Married

Religion: Roman Catholic

Educational Attainment: High school Graduate

Family Type: Lineal Family

Family Composition: Eldest

Father: Bon Realina

Mother: Wendy Realina

Date of admission: April 12, 2023

Time of admission: 7:10 pm

Institution: Ilocos Sur cooperative medical mission group and hospital

Chief Complaint: Body weakness and cough

Admitting Diagnosis: N/A

Admitting Physician/s: N/A

Attending Physician/s: Dr. Abraham Auberum Austria

Final Diagnosis: Pleural Effusion

III. NURSING HPI

Body weakness and cough

B. HISTORY OF HEREDITARY/FAMILIAL DISEASE

No one in the family has diagnosed with pleural effusion.

C. PAST HEALTH HISTORY

his medications. Moreover, he has no history of allergies, no recent surgical procedures,

no emotional and psychiatric problems.

D. HISTORY OF PRESENT ILLNES

temperature, 32 respiratory rate, and 128 pulse rate.

IV. DIAGNOSTIC PROCEDURES

Name of the procedure Description Importance

effusion; however, it changes in your lungs.

Name of the Description Importance Interpretation/ Nursing

CHEST X-RAY Chest x-ray is It can help to ●Homogenous ●Remove all

used and heart are upper and left such as

ULTRASONOGRAP Even small Ultrasonogra There is a free ● Check the

by an echo- presence of evidence of fluid carefully and