List of Nursing Diagnosis

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.

• 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.

Based on the location of the liquid is formed, effusions were divided into unilateral and bilateral. Unilateral effusion have no specific connection with the cause of disease but bilateral effusion is found in the following diseases : congestive heart failure, nephrotic syndrome, ascites, pulmonary infarction, systemic lupus erythematosus, tumors and 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).

Nursing Diagnosis for for Pleural Effusion : Activity Intolerance related to fatigue ( poor physical state ) .

Goal : Patient is able to carry out activities as optimal as possible .

Outcomes :
Fulfillment optimal activity , the patient looks fresh and vibrant , personal hygiene patient enough .

Interventionas :

1 Evaluation of the patient's response during the move , record the complaint and the level of activity and a change in vital signs .
Raasional : Knowing the extent of the patient's ability to perform the activity .

2 Help the patient to meet their needs .
Rationale : Encourage the patient to practice actively and independently .

3 Monitor the patient while doing the activity .
Rationale : Provide education to patients and families in the subsequent treatment .

4 Involve the family in patient care .
Rationale : a sign of the patient's weakness has not been able to move fully .

5. Explain to patients about the need for a balance between activity and rest .
Rationale : Rest need to lower the metabolic requirements .

6 Motivation and monitor the patient to perform activities gradually.
Rational : regular activity and gradually will help restore the patient to normal conditions .

Nursing Care Plan for Pleural Effusion

The gravity of the pleural effusion is determined by the amount of fluid, the rate of formation fluids and pressure levels in the lungs. If large effusion, lung expansion will be disrupted and the patient will experience shortness of breath, chest pain, non- productive cough even lung collapse will occur and there will consequently respiratory failure.

The conditions mentioned above are not uncommon cause of death in patients with pleural effusion. Various nursing problems arising in actual and potential problems due to pleural effusion include Disturbed Sleep Pattern, Impaired Gas Exchange, Fear / Anxiety and others .

Nursing Diagnosis : Disturbed Sleep Pattern

Goal : There was no disruption of sleep patterns and rest requirements are met.

Outomes : The patient will :

• no shortness of breath,
• can sleep comfortably without experiencing interference,
• can easily fall asleep within 30-40 minutes and the patient rest or sleep within 3-8 hours per day.

Interventions and Rational :

1. Give the position as comfortable as possible for patients.
Rasonal : semi-Fowler's position or a pleasant position will facilitate the circulation of O2 and CO2.

2. Determine the motivation habits before bedtime in accordance with the habits of patients before treatment.
Rationale : Changing patterns of habitual bedtime will disrupt the sleep process.

3. Instruct the patient to relaxation exercises before bed.
Rationale : Relaxation can help overcome sleep disorders.

4. Observation cardinal symptoms and the patient's general condition.
Rationale : Observations cardinal symptoms in order to determine changes in the patient's condition.

Pleural effusion is a clinical manifestation that can be found in approximately 50-60 % of patients with primary pleural malignancies. While 95 % of cases of mesothelioma ( pleural primary malignancies) can be accompanied by pleural effusion and approximately 50 % of breast cancer patients will eventually experience pleural effusion.

Incidence of pleural effusion is quite high especially in patients with malignancy if not administered properly it will reduce the quality of life of sufferers and increasingly burdensome condition of the patient. The lungs are part of the respiratory system is very important, in this organ disorders such as pleural effusion can cause respiratory problems and even can affect the cardiovascular system that can work ended in death.

Improving the condition of patients with pleural effusions requiring appropriate treatment by health workers, including nurses as providers of nursing care in hospitals. For that, the nurse needs to learn about the concept and management of pleural effusions and nursing care in patients with pleural effusion. So in this paper will discuss how the nursing care of patients with pleural effusion.

Nursing Diagnosis for Pleural Effusion : Fear / Anxiety related to the threat of death imaginable (inability to breathe).

Goal : Patient is able to understand and accept the situation so there is no anxiety.

Outcomes : The patient will :

• Being able to breathe normally , able to adapt to the situation.
• Non-verbal responses seem more relaxed and at ease, breath regularly with a frequency 16-24 times per minute, pulse 80-90 times per minute.

Interventions and Rationale :

1. Provide a pleasant position for the patient. Usually with a semi -Fowler. Explain about the disease and diagnosis.
Rationale: The patient is able to receive and understand the circumstances that might be used in the treatment of co-operation.

2. Teach relaxation techniques.
Rationale : Reduce muscle tension and anxiety.

3. Help in finding the source of the existing coping.
Rationale : The use of existing sources of coping constructively very helpful in dealing with stress.

4. Maintain a trusting relationship between the nurse and the patient.
Rationale : The relationship of mutual trust helps the therapeutic process.

5. Assess the factors that cause anxiety.
Rationale : Appropriate action is required to deal with the problems facing clients and build trust in reducing anxiety.

6. Help the patient recognize and acknowledge a sense of anxiety.
Rational : Anxiety is an emotion that effect when they are well identified, disturbing feelings be known.