Pleural Effusion Nursing Diagnosis & Care Plan


The words pleural effusion surrounded by healthcare related vector images

Contents: 

Pathophysiology 

Pleural effusion is the accumulation of excess fluid in the lung space, the space between the membrane lining the lungs and the membrane lining the chest wall. Both membranes, the visceral and parietal layer, produce and reabsorb fluid at a specific rate. An interference in the function of fluid production or reabsorption will lead to fluid excess and build-up between the tissues. 

There is just enough pleural fluid present in a healthy person to aid in the breathing mechanism during lung expansion and relaxation. 

Causes 

There are two types of pleural effusions: 

Transudative: a state in which decreased protein leads to pressure changes in the blood vessels causing leakage of protein-poor fluid into the lung space. 

  • Heart failure 
  • Hepatic cirrhosis 
  • Malnutrition 
  • Nephrotic syndrome 

Exudative: Inflammatory process leading to leakage of protein-rich fluid into the lung space. 

  • Pneumonia 
  • Cancer 
  • Tuberculosis
  • Autoimmune disease 

Signs & Symptoms 

  • Sharp, stabbing pain in the chest on inspiration
  • Dyspnea 
  • Orthopnea 
  • Dry, non-productive cough (fluid leakage is outside of the lung in the pleura, hence no productive cough) 
  • Diminished breath sounds
  • Tachycardia 
  • Unrelated symptoms of the condition causing pleural effusion 
  • Possible mediastinal shift on x-ray 

Diagnosis 

  • Chest x-ray 
  • Ultrasonography – to detect a small amount of pleural fluid 
  • Computed Tomography (CT) – to distinguish pleural fluid from tissue 
  • Thoracentesis – to drain fluid and obtain samples

Treatment 

  • Pleurectomy – removal of the pleura causing an inflammatory response causing the two layers to fuse as they heal. This prevents fluid from accumulating. 
  • Pleurodesis – instillation of medication into the lung space to cause an adhesion between the two layers to prevent fluid from pooling in that space. 
  • Chest tube placement – to drain fluid. 
  • Thoracentesis
  • Treating the underlying cause.

Nursing Diagnosis for Pleural Effusion 

Nursing Care Plans for Pleural Effusion 

Impaired Gas Exchange r/t decreased function of lung tissue 

Expected Outcome: The patient will have improved gas exchange as evidenced by blood gas values within the normal range. 

Assess the lung sounds for adventitious breath sounds. 

An initial assessment provides baseline information

Observe the patient’s characteristics of breathing. Monitor rate, depth, and rhythm of respirations. 

Changes in respiration may be an indication of worsening in respiratory status. 

Review the patient’s past medical history. 

This might reveal information about the underlying cause of pleural effusion. 

Place the patient in a high-Fowler’s position. 

Sitting upright promotes lung expansion and facilitates breathing. This promotes gas exchange in unaffected lung tissues. 

Encourage to cough and perform deep breathing exercises. 

These exercises help clear and maximize the functions of remaining healthy lung tissue.

Monitor blood gases regularly. 

These values allow for the early detection of a deterioration or improvement in gas exchange. 

Monitor pulse oximetry continuously. 

With pulse oximetry, one can monitor oxygen saturation and detect early changes in oxygenation. 

Provide oxygen therapy. 

The patient may require supplemental oxygen to maintain an oxygen saturation above 90%. 

Administer diuretics as ordered. 

Diuretic medications rid the body of fluid, hence may help reduce fluid accumulation in the lung spaces. 

Administer medications treating the underlying cause for pleural effusion. 

Treatment of the diseases that caused the pleural effusion should be included in the care plan. 

Ineffective Breathing Pattern r/t compromised lung expansion

Expected Outcome: The patient will maintain an effective breathing pattern as evidenced by respiration rate, depth, and rhythm being within normal limits. 

Note the patient’s respiratory rate, rhythm, and depth.

Changes in breathing patterns may indicate a deterioration in respiratory status. 

Prepare the patient for possible thoracentesis. 

Explain what to expect and be sure the physician talked to the patient as well. 

It is important that the physician explained the procedure before obtaining informed consent. Knowing what to expect may lower anxiety. 

Monitor vital signs before, during, and after the procedure.

Removing a large amount of fluid in a short period can lower blood pressure. 

Review anticoagulation studies before the procedure.

It is helpful to know when the patient last received blood-thinning medication and the coagulation values before the procedure. Anticoagulation studies show the amount of time for blood to clot, hence how likely it is for the patient to bleed during or after the procedure. Anticipate chest tube placement for large fluid volumes in the lung space. 

Anticipate chest tube placement.
Use best practice guidelines to manage chest tube care:

Check the skin condition of the tube insertion site. 

Any insertion site poses a risk for infection. Interruption of the skin barrier makes it easier for bacteria to invade the body.

Check for crepitus around the tube insertion site.

The presence of subcutaneous air indicates that air is escaping into the tissues. 

Assess for tracheal shift. 

A tracheal shift is one sign of a possible tension pneumothorax. 

Keep the drainage system below the patient’s chest.

Having the chest tube box below the patient’s chest enhances gravity and promotes drainage.

Maintain the level of the water in the water seal chamber at the recommended level.

The water seal allows fluid and air to escape from the lung space but prevents air from entering.

Monitor amount, color, and consistency of drainage. Note changes. 

Changes in characteristics of drainage may require different or additional interventions. 

Review chest-x rays daily. 

With x-rays, the healthcare team can follow whether treatments are working and check the placement of chest tubes. 

Acute Pain r/t inflammatory process

Expected Outcome: The patient will report an acceptable pain level of 3 or less on a pain scale of 0 to 10, as evidenced by vital signs that are within normal range and verbalization of comfort. 

Assess the patient’s pain level at least every four hours and one hour after giving pain medication. Note characteristics of pain. 

Frequent assessment of pain level helps to identify whether treatment is effective or if adjustments are necessary.

Administer pain medication as ordered. 

Pain medicine is one tool to control pain. 

Assist the patient with non-pharmacological methods of pain relief.

Splinting the chest when coughing 
Frequent repositioning
Heat or cold therapy 
Guided imagery 

These methods may help as an additional treatment to pain medication. 

Align activities with times when pain medication has been administered. 

Carrying out activities during times when pain medication is most effective makes it the least painful for the patient. 

Anxiety r/t inability to take deep breaths 

Expected Outcome: The patient will use effective coping strategies as evidenced by reduced anxiety experienced. 

Assess the patient’s coping skills. 

Coping mechanisms that worked previously might not work anymore in new and unfamiliar situations. 

Note the patient’s anxiety level. 

This information helps guide treatment. Someone with severe anxiety attacks requires different medical interventions than someone with mild anxiety and nervousness. 

Stay with the patient during anxiety episodes. 

Acknowledging the patient’s perception of anxiety shows that the nurse takes the patient seriously and builds trust. 

Interact with a level of confidence and reassurance with the patient. 

Signs of stability and confidence keep the patient as calm as possible and may lower anxiety levels.

Teach the patient deep breathing exercises.

Fast and shallow breathing during an anxiety episode may worsen the patient’s respiratory status.

Risk for Infection r/t pooling of fluid in the lung space 

Risk factors: 

  • Invasive equipment (chest tube) 
  • Invasive procedures 
  • Inadequate defense mechanisms 
  • Compromise from underlying diseases
Encourage the patient to cough and deep breathe every two hours. 

These exercises clear secretions and promote lung expansion. 

Encourage the patient to sit up in the chair as much as possible and elevate the head when in bed. 

An upright position allows for optimal movement of the diaphragm and other muscles that help with breathing and prevents pooling of fluid in the lungs.

Monitor temperature frequently. 

Temperature spikes or sustained elevated temperature may indicate a source of infection in the body. 

Monitor white blood cell count (WBC) regularly. 

Depending on the patient’s condition and past medical history, a sudden increase of WBCs might indicate infection. Trending WBCs allows for the early detection of possible infection. 

Administer antibiotics as prescribed. 

Antibiotics fight bacterial infection and slow bacterial growth. 

Inspect insertion sites for redness, swelling, drainage, and pain. 

These might be indicators of local infection. 

Clean incision sites and access sites frequently as ordered. 

Incision sites and access sites provide a greater risk for bacteria to be introduced into the body. Special wound cleansers help keep incisions free from bacteria.

More Care Plans: 

Deficient Fluid Volume Nursing Diagnosis & Care Plan

Ineffective Airway Clearance Nursing Diagnosis & Care Plan

Ineffective Health Maintenance [Care Plan]

Gastritis Nursing Diagnosis & Care Plan

Ineffective Health Maintenance [Care Plan]

Activity Intolerance Nursing Diagnosis & Care Plan

References: 

https://www.healthline.com/health/pleural-effusion#types

https://my.clevelandclinic.org/health/diseases/17373-pleural-effusion-causes-signs–treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647819/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753987/

Silvestri, L. (2014). Saunders comprehensive review for the NCLEX-RN examination (6th ed.). St. Louis, Mo.: Elsevier/Saunders.

Recent Posts