I.

Introduction of the Disease:

Pleural Effusion is an accumulation of fluid in pleural space. Pleural fluid normally

seeps continually into the pleural space from the capillaries lining the parietal pleura and
is reabsorbed by visceral pleural capillaries and lymphatic system. Any conditions that
interferes with either secretions or drainage of this fluid leads to pleural effusion.

II. Objective:

• To enhance the nursing skills specially the prioritization of care and

interventions towards suitable healing of patient. It will focus on the proper
assessment of patient with pleural effusion, if fatal, its intensive care and
proper confinement of disease healing.

• To acquire knowledge about the cause and pathophysiology of pleural

effusion to gather correct information that will capitulate to a suitable
intervention to patient’s condition. To sufficiently correlate the cause and its
symptoms to proper care management.

• To listen and be non judgmental of patients concern which yield to a holistic

care and multi-faceted nursing interventions towards patients healing. To
better understands the value of lifestyle change by of lifestyle change by
giving

Health teachings to the patient and giving factors at which client would
weigh in the proper choice towards healthy lifestyle.
III.Demographic Data:

Name: Mahinay Jemema

Address: Quirino Ave. Magsaysay Novaliches, Quezon City

Age: 29 years old

Gender: Female

Birthday: January 22, 1981

Status: Married

Date of Admission: June 12, 2010

 Time of Admission: 8:30 am

Diagnosis: Pleural Effusion

HISTORY OF PRESENT ILLNESS

2 weeks prior to patient admission, patient experience cough productive of greenish sputum
accompanied by undocumented fever, decreasing appetite and progressive weight loss. She also had
minimal difficulty of breathing. She self medicated with a 2 does of amoccicilin 500 mg tab TID
and sabutamol neb, which provided partial relief. However few hours of patient experience
difficulty of breathing was severe unrelieved by any medication, consult and subsequent addmition.

GORDONS

Health Perception-health management pattern:

 Mahinay Jemema is a 29 years-old female that is dependent to his own decision and care.
Mahinay Jemama was not active to his daily routine. She cannot perform her daily routine that he is
usually doing when she is still not sick.

Nutritional metabolic pattern: (While confined)

Mahinay Jemema said she takes 1500cc of water a day, and takes 2 or 3 meals in a day with
a combination of 1-2 cups rice. She has poor appetite that sometimes she cannot consume her meal.
“Mahina talaga siya kumain” as verbalized by the husband. She was ordered to have a regular with
1320 kcal. She is also fond of drinking alcoholic beverages for 17 years and a smoker for 18 years.

Elimination pattern: (while confined)

She has a normal elimination pattern. She defecates one time a day with moderate amount,
soft stool, and light-brown in color. There was no problem on his urination; she can urinate 3-5
times per day.

.
Activity exercise pattern: (while confined)

The client stated that she has no sufficient energy to perfomerd desired activates. During
hospitalization she stated that she wants to rest all the time because she can’t be able to move
because of her CVP on her left arm. But she have had bathroom privileges after CVP line was been
removed.

Sleep-rest pattern: (while confined)

Patient Mahinay Jemema has a normal sleeping pattern and would sleep at most 6-8 hrs per
day, she was easily get distracted and awaken by any environmental stimuli, especially when taking
his medications. Watching TV makes him fall asleep.

Cognitive-perceptual pattern:
Patient was calm, responsive, conscious, well oriented with time and place and with normal
behavior of communication.

Role-relationship pattern: (while confined)

Patient is married, a good provider and was happy being with his family. She’s been wishing
that everybody is well, so that it would not add to his daily financial needs.
Sexuality and Reproductive Pattern

Patient Mahinay Jemema said that she is not so much active in his sexual patterns.

Coping-Stress Tolerance Pattern

Having this condition makes her challenge, and thinks that everything will be alright, though
she remains to be calm but he is a bit worried.

Value-Belief Pattern

She is a Roman Catholic and don’t believe in superstitious beliefs. She said, “God is our
savior and he is our creator, he has a plan for me”.

PHYSICAL ASSESSMENT

ASSESSMENT FINDINGS
ASSESSMENT DATA

SKIN

Color Fair

Temperature 36 º C

Turgor Good skin turgor

Texture Moist skin

Lesion (-) Lesions/Rash

Integrity Intact
 Others

NAILS

Color Pinkish

Texture Smooth

Shape Concave

Others

HAIR

Color Black

Texture Coarsely dry

Distribution Evenly distributed

Quantity Moderate

Others

HEAD

Shape Round

Size Normocephalic

Configuration Symmetrical

Headache None

ASSESSMENT DATA
EARS

Hearing Good

Tinnitus None

Vertigo No vertigo

Earaches No earaches

Infection No infection

Discharge’s No discharges

NOSE AND SINUSES

Frequent colds None

Nasal stiffness None

Nose bleed None

Sinus trouble Sinuses are non tender

MOUTH & THROAT

Condition of teeth Incomplete teeth

Bleeding gums No bleeding

Tongue Tongue is at midline,

Throat Throat Non-tender

Hoarseness None

Mucous membrane Pinkish

ASSESSMENT DATA ASSESSMENT FINDING

NECK

Symmetry Symmetrical

Condition of trachea Thyroid in the midline

Lymph nodes (-) nonpalpable

 (-) nonpalpable

LUNG

Symmetry Symmetrical

Shape A:P diameter 1:2

Respiratory movements Asymmetrical, use of accessory muscles

# of breath 24cpm

AUSCULTATION:

Character of respiration (+) rales/crackles sounds on upper lung

HEART AND NECK VESSELS:

Apical Pulse

Apical/Radial pulse data (-) murmurs

Blood pressure 90/60

Pulse pressure

Any special procedure

Done

ASSESSMENT DATA ASSESSMENT FINDING

ABDOMEN:

Symmetry Symmetrical
Skin Lesion none

Masses (-) Masses

Bowel Sounds Normoactive bowel sounds

Tenderness none
HEAD AND NECK:

Facial muscle symmetry Symmetrical

Swelling None

Scars None

Discoloration None

Weakness (+) Weakness

ROM can turn head from side to side

Posterior neck cervical spine Non-tender

Muscle spasm (-) Spasm

Crepitus (-) Crepitus heard

MUSCULOSKELETAL SYSTEM:

Posture

abnormal postures aren’t present

Muscle Strength 4/5

 I. Anatomy and Physiology:

Pleural effusion Chest x-ray of a pleural effusion. The arrow A shows fluid layering
in the right pleural cavity. The B arrow shows the normal width of the lung in the cavity.

The pleural cavity is created between the 4th and 7th week of embryologic development and is
lined by the splanchnopleurae and somatopleurae. These embryonic components of visceral and
parietal pleurae develop different anatomic characteristics with regard to vascular, lymphatic, and
nervous supply. Both pleurae have two layers: a superficial mesothelial cell layer facing the pleural
space and an underlying connective tissue layer. Various ultrastructures of the pleura show a close
relationship to the basic functions of the pleural membranes, such as local inflammatory response
and maintenance of the pleural fluid.
 The latter function is especially important in the mechanical coupling of the lung and chest wall.
The fluid in the pleural space transmits transpleural forces involved in normal respiration, and the
maintenance of the optimal volume and thickness is regulated closely. Fluid is filtered into the
pleural space according to the net hydrostaticoncotic pressure gradient. It flows downward along a
vertical pressure gradient, presumably determined by hydrostatic pressure and resistance to viscous
flow. There also may be a net movement of fluid from the costal pleura to the mediastinal and
interlobar regions. In these areas, pleural fluid is resorbed primarily through
Precipitating lymphatic stomata on
Factors:
Predisposing Factor
the parietal pleural surface.
Lifestyle, environmental
Age, gender

Inflammation of airways wheezing

Increased mucus Bronco constrict- Bronchial

Bronchial edema
secretion ion spasm

. PATHOPHYSIOLOGY Dsypnea, cold and

clammy skin,
Worsening of obstruction diaphoresis

Accumulation of fluids caused by over secretion

Multiplication of growth of organism

Inflammation in the epithelial wall

Fluid filled alveoli/lobar compartment

Shallow Excess fluid Rupture of inflamed endothelial cells

breathing, accumulated
RR in space Mismatch of ventilation and perfusion
increase pericardial

Mismatch of ventilation and dyspnea

perfusion
Pleural
effusion
Hypoxemia

Hypoxia
Medical Surgical Management

Expectorants and antimicrobial agents to relieve dyspnea and infection

Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain
control.

Surgical Intervention

Restriction of tumor, lobe, or lung.

Therapeutic Interventions.

• Oxygen through nasal cannula based on level of dyspnea.

• Total parenteral nutrition for malnourished patient who is unable or unwilling to eat .

• Removal of the pleural fluid (by thoracentesis or tube thoracostomy) and instillation
of sclesrosing agent to obliterate pleural space and fluid recurrence.

Nursing Management

1. Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in
upper body (from superior vena cava syndrome).

2. Teach breathing retraining exercise to increase diaphragmatic excursion and reduce work of
breathing.

3. Augment the patient’s ability to cough effectively by splinting the patient’s chest manually.
4. Instruct the patient to inspire fully and cough two to three times in on breath.

5. Provide humidifier or vaporizer to provide moisture to loosen secretions.

6. Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely
dyspneic patient to sleep in reclining chair.

7. Encourage the patient to conserve energy by decreasing activities.

8. Ensure adequate protein make such as milk, eggs, oral nutritional supplements and chicken,
fowl and fish of other treatments are not tolerated – to promote healing and prevent edema.

9. Advice the patient to eat small amounts of high-calories and high protein foods frequently,
rather than three daily meals.

10. Suggest eating the major meal in the morning if rapid satiety is the problem.

11. Consider alternative pain control method’s such as biofeedback and relaxation methods, to
increase the patient’s sense of control.

DISCHARGE PLAN

M- Medication

• Medication includes Kalium Durule, NaCl, clindymizine and sabutamol neb. These
medicines are taken depending on severity and kind of pleural effusion.

E- E xercise

• Teaching breathing retaining exercise to increase diaphragmatic excursion and reduce work
of breathing.

• Teach relaxation techniques to reduce anxiety with dyspnea.

• Augment the patient’s ability to cough effectively by splinting the patient’s chest manually.

T- Treatment

• Follow strict compliance to treatment regimen given to improve condition especially

medications, diet and lifestyle.
 H- Health Teachings

• Keep a list of your medicines: Keep a written list of the medicines you take, the amounts
and when and why you take them. Bring the list of your medicines or the pill bottles when
you see your caregivers. Do not take any medicines, over the counter drugs, vitamins, herbs
or food supplements without first talking to caregivers.

• To decrease your pain; when coughing, hold a pillow over your chest where the pain is.

• Quit smoking. Do not smoke and do not allow others to smoke around you. Smoking
increases your risk of lung infections such as pneumonia. Smoking also makes it harder for
you to get better after having a lung problem. Talk to your caregiver if you need help
quitting smoking.

• Drink enough liquids and get plenty of rest. Be sure to drink enough liquids every day. Most
people should drink at least 8(oz.) Cups of water a day. This help to keep your air passages
moist and better able to get rid of germs and other irritants. You may feel like resting more.
Slowly start to do more each day. Rest when you feel it is needed.

Exercise your lungs. The discomfort of pleural effusion may cause you to avoid breathing as
deeply as you should. Coughing and deep breathing can help prevent a new or worsening
lung infection. Take a deep breath and hold the breath as long as you can then push the air
out of your lungs with a deep, strong cough. Take 10 deep breaths in a row every hour that
you are awake. Remember to follow each deep breathe with a cough.

O- Out patient

• Compliance to home medication regimen.

D- Diet

• Ensure adequate protein intake such as milk, eggs, oral nutritional supplements, chicken,
and fish if other treatments not tolerated.

• Advice patient to eat small amounts of high-calorie and protein foods frequently rather than
three daily large meals.