Pleural Effusion for Certified Emergency Nursing (CEN)

Pleural Effusion

Definition/Etiology:

Abnormal collection of fluid in pleural space- Not a disease, but symptom

Causes:

heart failure, nephrotic syndrome, malnutrition, pneumonia, cancer, liver cirrhosis, pancreatitis, infected wound, lung abscess, tumor, fibrosis, trauma, or infection

Pathophysiology:

????? TBD

Clinical Presentation:

• Dyspnea
• Cough
• Chest pain — mild to severe
• Dullness to percussion over effusion
• Decreased breath sounds on affected side
• Pleural friction rub
  • Sounds like creaking, walking on fresh snow, or rubbing your fingers together next to your ear
• Decreased chest expansion on affected side

Collaborative Management:

Assessments:

• AP, lateral chest X-ray
• CT or transthoracic ultrasound
• Pleural aspiration

Interventions:

• ABCs
• Supplemental oxygen
• Provide analgesia
• Identify and treat underlying cause
• Needle thoracentesis or chest tube if large and compromising respirations

Evaluation | Patient Monitoring | Education:

• Level of consciousness
• Hemodynamic status
• Cardiac rate and rhythm
• Breath sounds and pulse oximetry
• Pain relief

Linchpins: (Key Points)

“Water on the lungs” not in the lungs