Daffodil International University

4/ 2 Sobhanbag, Mirpur

Assignment on: Pleural effusions

Course name: Health Care System Management & Administration

Course Code: MPH- 5151

Submitted to,

Dr. Salamat Khandker

Associate Professor
Department of Public Health
Daffodil International University
Submitted by,

Salina Nokrek, 192- 41- 1001

Khadija Yeasmin, 192- 41- 980
Samima Nasrin, 192- 41- 981
Section: B
Batch: 22nd (Weakened Program)
Department of Public Health
Daffodil International University

Date of Submission: 14 February, 2019

 Table of Content

SL No Content Page No
01 What are the kinds of patients admitted in NIDCH 01
02 Introduction 02
03 What is pleural effusion? 03
04 The most common causes of transudative (watery fluid) 02
pleural effusions

05 Types of pleural effusions 03

06 Pathophysiology 05
07 Management of pleural effusion 05

08 Investigation of pleural fluid 06

09 Nursing management 06
10 Conclusion 07
What are the kinds of patients admitted in NIDCH

1. Chronic Obstructive Pulmonary Disease,

2. Respiratory Tuberculosis,
3. Bronchiectasis,
4. Multiple injuries of thorax,
5. Injury of tibial artery,
6. Pneumothorax,
7. Pyothorax,
8. Malignant Neoplasm of esophagus
9. Asthma, and
10. Pleural effusion.

Page No: 01
Introduction:

Over 1 million patients develop a pleural effusion annually in the United States alone. Pleural
effusion have more than 60 different causes, and vary in size and risk of recurrence. Congestive
heart failure, malignancy, pulmonary infection and embolism account for over 90% of pleural
effusions.

Pleural effusions can impact profoundly on the cardiorespiratory system. Breathlessness, the
commonest presentation, is often debilitating and significantly impairs quality of life. Relief of
breathlessness often necessitates therapeutic pleural interventions with associated discomfort,
discomfort, risks of infection, bleeding, pneumothorax and even death. Management of pleural
effusions represents a significant healthcare burden worldwide. To date, research on, and hence
our understanding of, the effects of pleural effusions on respiratory physiology and breathlessness
has been limited. The conventional belief that pleural effusions cause breathlessness through
compression of the lung is overly simplistic. The severity of breathlessness often correlates poorly
with the size of the effusion. Conversely, symptom reduction from fluid drainage varies
significantly between patients, and no reliable predictors exist to identify those who will benefit.
Most previous studies have involved small cohorts and examined specific etiological factors in
isolation; few have compared physiological changes with symptoms.

Page No: 02
 What is 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 time the lungs and the inside of the
chest cavity and act to lubricate and facilitate breathing. Normally as small amount of fluid is present
in the pleura.

Epidemiology

The estimated prevalence pleural effusion is 320 cases per 100,000 people in industrialized
countries, with a distribution of etiologies related to the prevalence of under lying diseases.

In general, the incidence of pleural effusion is equal between the sexes. However, certain causes
have a sex predilection. About two thirds of malignant pleural effusions occur in women. Malignant
pleural effusions are significant associated with breast and gynecologic malignancies.

Pleural effusions usually occur in adults however, they appear to be increasing in children, often in
the setting of underlying pneumonia. Fetal pleural effusions have also been reported, under certain
circumstances. These may be treated prior to delivery.

Definition

A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid
production or decreased absorption.

What causes pleural effusion?

Depending on the cause, the excess fluid may be either protein-poor (trans dative) or protein- rich
(exudative). These two categories help to determine the cause of pleural effusion.

The most common causes of transudative (watery fluid) pleural effusions include:

 Congestive heart failure.

 Pulmonary ambolism
 Cirrhosis of liver
 Post open heart surgery
 Atelectasis –This may be due to malignancy
 Hypoalbuminemia
 Peritoneal dialysis
 Nephrotic syndrome
 Myxedema
 Cerebrospinal fluid(CSF) leaks to the pleura
 Trauma or surgery to the thoraces
 Extravascular migrators of central venous catheter

Page No: 03
 Exudative (protein-rich fluid) pleural effusion are most commonly caused by:

 Pneumonia
 Cancer
 Pulmonary embolism
 Kidney disease
 Inflammatory disease
 Pancreatitis
 Trauma
 Post cardiac injury syndrome
 Esophageal perforation
 Sarcoidosis
 Fungal infections
 Intra- abdominal abscess

Other less common causes of pleural effusion include:

 Tuberculosis
 Autoimmune ( due to chest trauma)
 RTA(road traffic accident)
 Rare chest and abdominal infection
 Asbestos pleural effusion (due to exposure to asbestos)
 Benign ovarian tumor
 Ovarian hyper stimulation syndrome

Most pleural effusion are caused by congestive heart failure, pneumonia, pulmonary embolism and
malignancy.

Types of pleural effusions:

There are two main categories of pleural effusion.

1. Transudative pleural effusion:

Transudative pleural effusion are formed when fluid leaks from blood vessels in to the pleural space.
This is caused by increased pressure in the blood vessels or a low blood protein cadent. Congestive
heart failure is the most common cause, chemically transudate pleural effusion contains less protein
and LDH.

2. Exudative pleural effusion:

Exudative pleural effusion are caused by blocked blood vessels or lymph vessels, due to
inflammation of the pleura itself and are often disease of the lung.
Page No: 04
 Pathophysiology:
The balance of osmotic and hydrostatic pressure in parietal pleural capillaries normally result is fluid
movement in to the pleural space. Balanced pressure in visceral pleural capillaries promote
reabsorption of this fluid. Excessive hydrostatic pressure or decreased osmotic pressure can cause
excess fluid to pass across intact capillaries. The result is a transudative pleural effusion an ultra-
filtrate of plasma containing low concentrations of protein. Exudative pleural effusions result when
capillaries exhibit increase permeability with or without changes in hydrostatic and colloid osmatic
pressure, allowing protein- rich fluid to leak into the pleural space.

Symptoms of pleural effusion:

 Chest pain
 Dry, nonproductive cough
 Dyspnea
 Shortness of breath or difficulty in breath
 Orthopnea ( shortness of breath)
 Fever
 Prostration
 Weight loss

Management of pleural effusion:

Treatment of pleural effusion is based on the underlying condition and where the effusion is causing
severe respiratory symptoms, such as shortness of breath or difficulty breathing.

1. Lung infected or inflamed pleural effusions require draining to improve symptoms and prevent
complications. Various procedure is may be used to treat pleural effusions, including:

* Thoracentesis: A pleural effusion that is respiratory symptoms may be drained using

therapeutic thoracentesis, can remove large amounts of fluid.

*Tube thoracotomy (chest tube): A small incision is made in the chest wall, and a plastic
tube is inserted into the pleural space. Chest tubes are attached to section and are often kept in place
for several days.

*Pleural drain: For effusions that repeated occur, a large-term catheter can be inserted through
the skin is to the pleural space. A person with a pleural catheter can drain the pleural effusion
periodically at home.

Page No: 05
 *Pleural decortication: Surgeons can operate with tools inside the pleural space, removing
potentially dangerous inflammation and unhealthy tissue. Decortications means may be performed
using small incisions. (Thoracoscopy) or a large one (thoracotomy)

2. Diuretics and other heart failure medications are used to treat pleural effusions caused by
congestive heart failure or other medical causes.

3. A malignant effusion may also require treatment with chemotherapy, radiation therapy or a
medication infusion within the chest.

4. Chemical pleurodesis: adhesion formation is promoted when drugs are instilled in to the pleural
space to obliterate the space and prevent further accumulation of fluid.

Investigation of pleural fluid:

 Cytology
 Biochemistry
 AFB
 ADA

Nursing management:
 Establish rapport
 Identify the causative factor
 Examine the quality, frequency and depth of breathing, report any changes that occur
 Lay the patient is a comfortable position, in a sitting position, with the head of the bed elevated 60-
90 degrees.
 Monitor and record the vital sings.
 Perform auscultation of breath sounds every 2-4 hours.
 Administer supplemental oxygen need.
 Assess patient pain for intensity using a pain scale for location and for precipitating factors.
 Administer prescribed medications as order.
 Encourage patient to have adequate bed rest and sleep.
 Help and teach the patient to cough and breathe in effective way.
 Provide balance diet.

Prognosis:
 This is dependent on the cause of the effusion.
 If the cause is malignancy, the out-look is generally very poor.

Page No: 06
Conclusion:

Pleural effusions have major effects on the cardiorespiratory system and cause abnormalities in gas
exchange, respiratory mechanics and muscle function and hemodynamics. The association between
these abnormalities and effusion-related breathlessness, and the response following thoracentesis,
remains uncertain. Future research should aim to identify the key mechanisms driving breathlessness
in patients with a pleural effusion and the important predictors of improvement following pleural
drainage.

Page No: 07