Pleural Effusion
Definition
Pleural effusion is a condition where there is a buildup of fluid in the pleural cavity between the parietal pleura and visceral pleura can be fluid transudate or exudate fluid.
Etiology
Based on the type of fluid that is formed, divided into the pleural fluid transudate, exudate and hemorrhagic.
Pathophysiology
Under normal circumstances there is only 10-20 ml of fluid in the pleural cavity. The amount of fluid in the pleural cavity remains, due to the hydrostatic pressure of the parietal pleura by 9 cm H2O. Pleural fluid accumulation can occur if the colloid osmotic pressure decreases, for example in patients with hypoalbuminemia and increased capillary permeability due to any inflammatory process or a neoplasm, increased hydrostatic pressure due to heart failure and intra- pleural negative pressure in case of pulmonary atelectasis (Alsagaf, Mukti, 1995).
Pleural effusion occurs means of collecting a large amount of free fluid in the pleural cavity. Possible causes of effusion among others ; (1) the inhibition of lymphatic drainage of the pleural cavity, (2) heart failure that causes pulmonary capillary pressure and peripheral pressure becomes very high, giving rise to excessive transudation of fluid into the pleural cavity (3) Plasma colloid osmotic pressure greatly decreased, so also allows transudation fluid overload (4) infection or inflammation of any cause whatsoever on the pleural surface of the pleural cavity, which solves the capillary membrane and allows the flow of plasma proteins and fluid into the cavity rapidly (Guyton and Hall, 1997).
Assessment
The data were collected or studied include :
a. Patient identity
At this stage the nurse needs to know about the name, age, gender, home address, religion or belief, ethnic groups, language used, education and employment status of patients.
b. Main complaints
The main complaints are the main factors of patients to seek care or treatment to the hospital. Usually in patients with pleural effusion obtained complaints of shortness of breath, heaviness in the chest, pleuritic pain due to irritation of the pleura that is both sharp and localized primarily during coughing and breathing as well as non- productive cough.
c . History of present illness
Patients with pleural effusion will usually be preceded by signs such as cough, shortness of breath, pleuritic pain, heaviness in the chest, weight loss and so on. It should be also asked that began when a complaint arises. What action has been taken to reduce or eliminate these grievances.
d. Past medical history
It should be asked whether the patient had been suffering from lung diseases such as tuberculosis, pneumonia, heart failure, trauma, ascites, and so on. It is necessary to determine possible predisposing factors.
e. Family history of disease
Needs to be asked whether there are family members who suffer from diseases that are suspected as the cause of pleural effusion such as lung cancer, asthma, pulmonary tuberculosis, and so forth.
f. psychosocial history
Includes feelings of the patient against the disease, how to cope, and how the patient's behavior to the actions taken against themselves.
Some nursing diagnoses that may arise in patients with pleural effusion include:
1. Ineffective breathing pattern related to the decline in lung expansion secondary to the buildup of fluid in the pleural cavity (Tucleer Susan Martin, et al, 1998).
2. Imbalanced Nutrition Less Than Body Requirements related to an increase in metabolism, digestion appetite of respiratory failure secondary to suppression of abdominal structure (Barbara Engram, 1993).
3. Anxiety related to the threat of death imaginable (inability to breathe).
4. Disturbed Sleep Pattern related to persistent cough and shortness of breath as well as changes in the atmosphere (Barbara Engram).
5. Activity Intolerance related to fatigue (poor physical state) (Susan Martin Tucleer, et al, 1998).
6. Knowledge Deficit : about the condition , treatment rules related to lack of information displayed (Barbara Engram, 1993).
Definition
Pleural effusion is a condition where there is a buildup of fluid in the pleural cavity between the parietal pleura and visceral pleura can be fluid transudate or exudate fluid.
Etiology
Based on the type of fluid that is formed, divided into the pleural fluid transudate, exudate and hemorrhagic.
- Transudate can be caused by congestive heart failure (left heart failure), nephrotic syndrome, ascites (due to hepatic cirrhosis), superior vena cava syndrome, tumors, Meigs syndrome.
- Exudate caused by infection, tuberculosis, etc., preumonia, tumors, lung infarct, radiation, collagen diseases.
- Hemorrhagic effusion can be caused by tumors, trauma, pulmonary infarction, tuberculosis.
Pathophysiology
Under normal circumstances there is only 10-20 ml of fluid in the pleural cavity. The amount of fluid in the pleural cavity remains, due to the hydrostatic pressure of the parietal pleura by 9 cm H2O. Pleural fluid accumulation can occur if the colloid osmotic pressure decreases, for example in patients with hypoalbuminemia and increased capillary permeability due to any inflammatory process or a neoplasm, increased hydrostatic pressure due to heart failure and intra- pleural negative pressure in case of pulmonary atelectasis (Alsagaf, Mukti, 1995).
Pleural effusion occurs means of collecting a large amount of free fluid in the pleural cavity. Possible causes of effusion among others ; (1) the inhibition of lymphatic drainage of the pleural cavity, (2) heart failure that causes pulmonary capillary pressure and peripheral pressure becomes very high, giving rise to excessive transudation of fluid into the pleural cavity (3) Plasma colloid osmotic pressure greatly decreased, so also allows transudation fluid overload (4) infection or inflammation of any cause whatsoever on the pleural surface of the pleural cavity, which solves the capillary membrane and allows the flow of plasma proteins and fluid into the cavity rapidly (Guyton and Hall, 1997).
Assessment
The data were collected or studied include :
a. Patient identity
At this stage the nurse needs to know about the name, age, gender, home address, religion or belief, ethnic groups, language used, education and employment status of patients.
b. Main complaints
The main complaints are the main factors of patients to seek care or treatment to the hospital. Usually in patients with pleural effusion obtained complaints of shortness of breath, heaviness in the chest, pleuritic pain due to irritation of the pleura that is both sharp and localized primarily during coughing and breathing as well as non- productive cough.
c . History of present illness
Patients with pleural effusion will usually be preceded by signs such as cough, shortness of breath, pleuritic pain, heaviness in the chest, weight loss and so on. It should be also asked that began when a complaint arises. What action has been taken to reduce or eliminate these grievances.
d. Past medical history
It should be asked whether the patient had been suffering from lung diseases such as tuberculosis, pneumonia, heart failure, trauma, ascites, and so on. It is necessary to determine possible predisposing factors.
e. Family history of disease
Needs to be asked whether there are family members who suffer from diseases that are suspected as the cause of pleural effusion such as lung cancer, asthma, pulmonary tuberculosis, and so forth.
f. psychosocial history
Includes feelings of the patient against the disease, how to cope, and how the patient's behavior to the actions taken against themselves.
Some nursing diagnoses that may arise in patients with pleural effusion include:
1. Ineffective breathing pattern related to the decline in lung expansion secondary to the buildup of fluid in the pleural cavity (Tucleer Susan Martin, et al, 1998).
2. Imbalanced Nutrition Less Than Body Requirements related to an increase in metabolism, digestion appetite of respiratory failure secondary to suppression of abdominal structure (Barbara Engram, 1993).
3. Anxiety related to the threat of death imaginable (inability to breathe).
4. Disturbed Sleep Pattern related to persistent cough and shortness of breath as well as changes in the atmosphere (Barbara Engram).
5. Activity Intolerance related to fatigue (poor physical state) (Susan Martin Tucleer, et al, 1998).
6. Knowledge Deficit : about the condition , treatment rules related to lack of information displayed (Barbara Engram, 1993).
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