Pleurisy, Pleural Effusion, Chest Tubes, Atelectasis, and Pneumothorax

Pleurisy

• Definition: Inflammation of the pleura, the lining around the lungs.
• Location: Visceral and parietal pleura.
• Cause: Usually caused by pneumonia.
• Symptoms:
  • Pain: Very painful, similar to strained muscles from coughing.
  • Sharp pain: Especially when taking a deep breath, due to inflammation around the lung.
  • Radiating pain: Often radiates to the shoulder and abdomen; can be mistaken for a heart attack.
  • Shortness of breath: Due to reluctance to take deep breaths because of the pain.
  • Cough: Can occur.
  • Elevated temperature.
• Treatment:
  • Antibiotics: If caused by pneumonia.
  • Pain medication: To manage pain while allowing the patient to breathe adequately.
  • Oxygen: To address shortness of breath.
  • Heat: Apply heat to the affected area.
  • Splinting: Use a pillow or towel on the affected side to reduce sharp pain during breathing.
• Pleural Friction Rub:
  • Definition: A sound heard over the inflamed area.

Pleural Effusion

• Definition: Accumulation of fluid in the pleural space.
• Distinction from Pulmonary Embolism (PE): Ensure clarity when using the abbreviation PE.
• Cause: Usually occurs as a secondary problem due to other conditions.
• Causes
  • Tuberculosis (TB)
  • Pneumonia
  • Congestive Heart Failure (CHF)
  • Pancreatitis
  • Cirrhosis
  • Heart failure in general
  • Chronic kidney disease
  • Cancer. Especially in lung cancer patients
  • Empyema
  • Definition: Infected fluid in the pleural space.
  • Risk: Can develop from pleural effusion.
• Symptoms:
  • Shortness of breath: Due to restricted lung expansion.
  • Anxiety: Due to difficulty breathing.
  • Respiratory distress: In severe cases.
  • Nasal flaring: A sign of difficulty breathing.
  • Diminished breath sounds: On the affected side.
• Diagnosis: Chest X-ray.
• Treatment:
  • Thoracentesis: Needle inserted to drain fluid. Fluid is then cultured to inform on sensitivity and white count.
    • Patient placement: On the unaffected side.
  • Chest tube: May be necessary for excessive fluid or empyema.
  • Oxygen.

Chest Tube

• Function: Drains air or fluid from the pleural space.
• Drainage Mechanism: Gravity or suction.
• Canister Placement: Below the chest level, kept upright, and secured to the floor to prevent accidental spills.
• Water Reservoir: Contains sterile water; bubbling indicates a leak.
• Leaks: Not good, needs rapid intervention.
• Pain: Chest tube insertions and presence can be very painful.
• Output Monitoring: Accurate measurement of drainage is essential for determining when to remove the chest tube.
• Dressing: Secured with a large dressing.
• Sutures: Sutured to seal the whole thing.

Care for a Patient with a Chest Tube (Blue Box on 412)

• Checking the chest tube.
• Marking drainage.
• Assess for constant bubbling.

Atelectasis

• Definition: Collapse of alveoli, not the entire lung.
• Location: The alveoli.
• Impact: Prevents gas exchange.
• Cause: Often post-operative; mucus plug obstructs the airway.
• Risk Factors
  • Post operation
  • Hyperventilation
• Mucus plug: Thick mucus that clogs up the airway.
• Symptoms:
  • Difficulty breathing.
  • Anxiety.
  • Tachycardia.
  • Possible pleural friction rub.
  • Crackles.
  • Altered level of consciousness.
• Diagnosis: Chest X-ray.
• Intervention: Remove mucus, oxygen, intubation
• Treatment:
  • Mucus Removal.
  • Incentive spirometer.
  • Chest physiotherapy.
  • Bronchodilators.
  • Mucolytics.
  • Antibiotics: To prevent infection.
  • Early ambulation.

Pneumothorax

• Definition: Collapsed lung due to air or gas in the pleural space.
• Mechanism: Air builds up around the lung, preventing expansion.
• Causes:
  • Trauma: Penetrating chest wounds.
  • Severe coughing: Can cause fractured ribs.
  • Spontaneous: No known cause.
• Symptoms:
  • Decreased or absent breath sounds.
  • Sudden sharp pain.
  • Increased respiratory rate.
  • Increased heart rate.
  • Possible shift of mediastinum: In severe cases.
• Diagnosis: Chest X-ray and ABG to assess gas exchange.
• External Trauma: Sucking sound from chest wound.
• ABG:
  • pH: Decrease.
  • PaO_2: Decrease.
  • PaCO_2: Increase.
• Treatment:
  • Chest tube placement: To remove air from the pleural space.
  • Maintain airway, breathing, and circulation.
  • Position: High Fowler's.
    *Uneven breath sounds: Expected uneven breath sounds in a patient.