pleural conditions

Pleura

The membranes surrounding the lungs and lining the chest cavity.

Visceral pleura

Pleural layer that covers the lungs.

Parietal pleura

Pleural layer that lines the chest wall.

Pleural space

Space between the visceral and parietal pleura.

Pleuritis (pleurisy)

Inflammation of the pleura that causes sharp chest pain when the pleural surfaces rub together during breathing.

Pleural friction rub

Scratchy or grating sound heard on auscultation when inflamed pleural surfaces rub against one another.

Manifestations of pleurisy

Sharp, knife-like chest pain that worsens with inspiration or coughing; a pleural friction rub may be heard.

Nursing management of pleurisy

Treat the underlying cause, manage pain with prescribed medications, promote effective breathing, and monitor for pleural effusion.

Pleural effusion

Abnormal accumulation of fluid in the pleural space that compresses the lungs, limits expansion, and may decrease breath sounds.

Transudate

Fluid that crosses relatively intact capillary walls, commonly associated with pressure or fluid-balance problems such as heart failure or volume overload.

Exudate

Protein-rich fluid that leaks into tissues or a cavity due to inflammation, infection, or other disease processes.

Empyema

Accumulation of thick, purulent infected fluid in the pleural space, often associated with bacterial pneumonia or a lung abscess.

Causes of pleural effusion

Heart failure, TB, pneumonia, nephrotic syndrome, connective tissue disease, pulmonary embolism, tumors, pancreatitis, and cirrhosis with ascites.

Thoracentesis

Procedure that removes fluid from the pleural space for diagnostic testing or to relieve symptoms such as dyspnea.

Chest tube

Tube inserted into the pleural space to drain air, fluid, or pus and help restore the pressure needed for lung expansion.

Nursing management of a chest tube

Assess respiratory status, monitor drainage amount and characteristics, and observe the drainage system for abnormal bubbling or changes.

Tidaling

Normal fluctuation of fluid in a chest drainage system with breathing, as described in the notes.

Continuous bubbling in a chest drainage system

A finding that may indicate an air leak and requires assessment.

Priority with a large pleural effusion

Monitor for respiratory distress and hypoxemia; significant fluid accumulation may displace the trachea away from the affected side.