What is a pleural effusion?
Fluid in pleural space
How does a pleural effusion occur?
- Fluid separates visceral & parietal pleura
- Lung tissue compressed ---> atelectasis occurs
- Decreased: venous return
- Decreased: cardiac return
What are the characteristics of transudative Pleural Effusion?
- From: pulmonary capillaries
- Locatation: pleural space
- Fluid: thin, watery, few RBC & protein
- Pleural spaces=no part in formation of this fluid
What are the causes of a transudative pleural effusion?
- 1. Congestive Heart Failure- Left more likely
- 2. Hepatic Hydrothorax
- 3. Peritoneal dialysis
- 4. Nephrotic Synrome
- 5. Pulmonary Embolus
What are the characteristics of exudative Pleural Effusion?
- Develops: through inflammation of diseased pleural surfacesFluid: pus, WBC's, cell debris & thick protein
What are the causes of a exuative pleural effusion?
- 1. Malignancy
- 2. Malignant Mesotheliomas
- 3. Pneumonias- 40% have PE
- 4. TB
- 5. Fungal lung infection
- 6. Diseases of GI tract
- 7. Collagen Vascular Diseases
What are the diseases of GI tract that can cause a exudative pleural effusion?
- Esophageal perforations
- Diaphragmatic hernia
- Abdominal surgery
What are the collagen vascular diseases that can cause a exudative pleural effusion?
- Systemic lupus erythematosus
- Rheumatoid pleuritis
- Wegener's granulomatosis
- Sjogren's syndrome
What are some other pleural problems?
- Empyema: pus in pleural space
- Chylothorax: chyle in chest: neck/thorax traumas
- Hemothorax: blood in pleural space
What are the signs & symptoms of pleural effusion?
- Increased: HR, RR, BP, C.O.
- Decreased: chest expansion ----> chest pain
- Tracheal shift
- PFT: RESTRICTIVE
What are the signs & symptoms you can hear with pleural effusion?
- Dry, non-productive cough
- Decreased: tactile & vocal fremitus
- Dull percussion
- Dim. BS
- Displaced heart sounds
What are the ABG results of small & large PE?
- Small PE: acute alveolar hyperventilation with hypoxemia
- Large PE: acute ventilatory failure with hypoxemia
What does the chest x-ray of PE look like?
- Blunting of costophrenic angle
- Depressed diaphragm
- Possible mediastinal shift away from affected sideAtelectasis
What is the tx. with PE?
- Thoracentesis: leaning over table
- Respiratory Treatment: O2, hyperinflate & poss. mech. vent