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Pleural effusion

7/1/2012. 2. Causes of Pleural Effusion Transudates increase venous pressure (cardiac failure, constrictive pericarditis, fluid overload) hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption) hypothyroidism Meig's syndrome (due to a benign ovarian tumor) . 7/1/2012. 3. Causes of

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Pleural effusion

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    1. 7/2/2012 1 Pleural effusion

    2. 7/2/2012 2 Causes of Pleural Effusion Transudates increase venous pressure (cardiac failure, constrictive pericarditis, fluid overload) hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption) hypothyroidism Meigs syndrome (due to a benign ovarian tumor)

    3. 7/2/2012 3 Causes of pleural effusion Exudates Pneumonia TB Pulmonary infarction, pulmonary embolism Rheumatoid arthritis SLE Bronchogenic carcinoma Malignant metastases, cancer lung, cancer breast etc Lymphoma Mesothelioma Lymphangitis carcinomatosis

    4. 7/2/2012 4 After heart surgery Exudative (protein-rich fluid) pleural effusions are most commonly caused by: Other less common causes of pleural effusion include: Bleeding (due to chest trauma) Chylothorax (due to trauma) Certain medications, abdominal surgery and radiation therapy may also cause pleural effusions.

    5. 7/2/2012 5 Clinical Features Some patients have no symptoms Incidentally discovered on a chest x-ray Symptoms due to the disease or condition that has caused the effusion. Symptoms of pleural effusion include: Chest pain Dry, nonproductive cough Dyspnea Orthopnea

    6. 7/2/2012 6 Investigations Chest x-ray Computed tomograpy (CT) scan of the chest Ultrasound of the chest Thoracentesis Pleural fluid analysis Thoracoscopy, also known as video-assisted thoracoscopic surgery, or VATS Often, treatment of the effusion is combined with diagnosis in these cases.

    7. 7/2/2012 7 Treatment Treatment of underlying condition shortness of breath or difficulty breathing. - thoracentesis Diuretics and other heart failure medications if needed Malignant effusion - chemotherapy, radiation therapy or a medication infusion within the chest. Thoracentesis or through a chest tube If uncontrollable or recurrent due to a malignancy despite drainage, a sclerosing agent Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and tetracycline) is 50 percent successful in preventing the recurrence of pleural effusions.

    8. 7/2/2012 8 Surgery Pleural effusions that cannot be managed through drainage or pleural sclerosis may require surgical treatment. Two types of surgery : Video-assisted thoracoscopic surgery (VATS) Thoracotomy When infection is present. To remove all fibrous tissue and To evacuating the infection from the pleural space.

    9. 7/2/2012 9 Nursing Care Implement medical regimen relevent to the underlying disease Prepare and position the patient for thoracentesis Support the patient throughout the procedure (sedate, prevent shock during puncture of pleura - keep vein patent with Ringer's lactate or saline) Manage pain Assist the patient to position himself in the least painful posture Take care of the water seal drainage system if present Record drainage

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    11. 7/2/2012 11 Massive pleural effusion right side

    12. 7/2/2012 12 Left sided pleural effusion

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    19. 7/2/2012 19 Spiral computerized tomography shows a large right pleural effusion and a small pericardial and left pleural effusion.

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