Pleural effusion - Overview Alternative Names Fluid in the chest; Fluid on the lung; Pleural fluid Definition of Pleural

effusion: A pleural effusion is an accumulation of fluid between the layers of tissue that line the lungs and chest cavity. Causes, incidence, and risk factors: Your body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, the thin tissue that lines the chest cavity and surrounds the lungs. A pleural effusion is an abnormal, excessive collection of this fluid. Two different types of effusions can develop: Transudative pleural effusions are caused by fluid leaking into the pleural space. This is caused by elevated pressure in, or low protein content in, the blood vessels. Congestive heart failure is the most common cause. Exudative effusions usually result from leaky blood vessels caused by inflammation (irritation and swelling) of the pleura. This is often caused by lung disease. Examples include lung cancer, lung infections such as tuberculosis and pneumonia, drug reactions, and asbestosis. Symptoms: Chest pain, usually a sharp pain that is worse with cough or deep breaths Cough Fever Hiccups Rapid breathing Shortness of breath Signs and tests: During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness. The following tests may help to confirm a diagnosis: Chest x-ray Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancerous cells) Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs) Thoracic CT Ultrasound of the chest Treatment: Treatment may be directed at removing the fluid, preventing it from accumulating again, or addressing the underlying cause of the fluid buildup. Therapeutic thoracentesis may be done if the fluid collection is large and causing pressure, shortness of breath, or other breathing problems, such as low oxygen levels. Removing the fluid allows the lung to expand, making breathing easier. Treating the underlying cause of the effusion then becomes the goal.

I.

INITIAL DATABASE

A. General Data Patients initials: M.C. Address: Pasay Age: 64 Gender: M Birth Date: January 06, 1946 Birth place: Albay, Bicol Nationality: Filipino Dialect Spoken: Tagalog Civil Status: Married Educational Attainment: Elementary Undergraduate Occupation: Farmer Religion: Catholic Admission Date: September 01, 2010 Admission Time: 11:05 am B. Chief Complaint Nahihirapan siyang humunga. (difficulty of breathing) as verbalized by the patients wife C. History of Present Illness The patient had the first symptom last Tuesday August 31, 2010 when he had sharp chest pain that is worse with cough or deep breaths. He just rested for a while and this gave him temporary relief. On the next day, September 01, 2010 evening, the patient develops cough production of whitish phlegm. Persistence of symptoms prompted consult to the nearest hospital because the patient continue on experiencing difficulty of breathing, thus admitted at Pasay City General Hospital. D. Past Health History 1. Childhood Illness/es: mumps, chicken pox, measles 2. Adult Illness/es: Hypertension (2003) with Maintenance Medications 3. Immunization/s: 4. Previous Hospitalization/s: none 5. Operation/s: Tracheotomy - none 6. Injury/-ies: none 7. Medication/s: Metropolol 500mg OD 8. Allergy/-ies: none

E. System Review Gordons Functional Health Pattern 1. Health Perception-Health Management Pattern Prior to hospitalization, the client feels that his general health is good. According to him, eating enough food and taking medicinal plant are the most important things to keep him healthy. He does smoke. He usually consume 1 pack a day. He drinks alcohol occasionally. So far, he didnt had any accidents while at home or at work. During hospitalization, he feels unhealthy. he feels weak for she cant do her usual activities before. The experience of hospitalization made him realize that enough food and vitamins is not enough, thus have a well-balanced diet, exercise regularly and most especially have time for enough relaxation.During onset of coughing the patient verbalizes, Lagi na siyang ubo ng uboas verbalized by his wife. 2. Nutritional Metabolic Health Pattern Prior to hospitalization, the patient usually eats 2-3times a day. He typically eats chicken, fish and consumes 1-2 cups of rice. There are times she skip meals because of hectic schedule. His daily fluid intake is about 5-7 glasses of water. He drinks hot coffee every morning then usually water at lunch and dinner. He doesnt have any eating discomfort and she usually has a good appetite. Whenever He has a wound, it heals well, taking about 2-3 days to heal. He experiences dryness of her skin at times. He doesnt have any dental problems. During hospitalization, the patient is on Low Salt Low Fat Diet. He has poor appetite that sometimes he cannot consume his meal. hindi siya masyadong nakakakain ng maayos as verbalized by his wife. He still does experience any eating discomfort. He does experience skin dryness anymore. She doesnt have any bony prominences, lesions and color changes. His oral mucous membrane is pinkish without any lesions. His teeth are complete, properly aligned, slight yellowish and without dental caries. He doesnt wear dentures. he has an ongoing # 2 D5W 500cc + Vitamin B-Complex X 10 at 400 cc level infusing well at her right metacarpal vein.

3. Elimination Pattern Prior to hospitalization, the client defecates once a day or twice at times. Arawaraw siyang dumudumi, kadalasan after ng breakfast, the wife stated. He voids at about 5-6 times a day and described her urine as yellowish and aromatic. He doesnt use laxatives and doesnt experience any discomfort during defecation and urination. He doesnt experience excessive perspiration that much and doesnt have odor problems. During hospitalization, she seldom defecates. Isang beses lang akong dumumi at konti lang hindi tulad ng dati, the client verbalized. She described it as formed, round and brownish to dark brown. She urinates frequently, Di ko mabilang kung ilang beses ako umiihi basta naiihi ako kada inom ko ng maraming tubig. She described it as yellowish to clear and still aromatic. She doesnt experience excessive perspiration and still have no any odor problems. She doesnt have body cavity drainage or suction.

4. Activity-Exercise Pattern Prior to hospitalization, the patient has sufficient energy in doing his desired and required activities. His main exercise is walking 1 meter going to the farm from their house. For spare time, he loves hanging out with his friend and has a cockpit. During hospitalization, the patient feels weak and doesnt have sufficient energy. He always ask for assistance in doing his activities of daily living because hes anxious he might fall down. Patient was advice to refrain from doing strenuous activity because of his condition. Nahihirapan siyang huminga as verbalized by the wife.

5.

Sleep-Rest Pattern Prior to hospitalization, the patient feels she always lack rest, Maaga siyang gumising araw-araw. stated by his wife. He usually sleeps at 12 mn and wakes at 5:30 am. He doesnt have difficulty in falling asleep or going back to sleep but sometimes he experiences nightmares and early awakenings. His regular hours of sleep is 4-5 hours. During hospitalization, the patient feels not well rested, Nahihirapan din siyang huminga. He was easily get distracted and awaken by any environmental stimuli, especially when taking his medications.

6. Cognitive-Perception Pattern Prior to hospitalization, The patient sometimes had poor hearing ability but hes not wearing hearing aids, minsan talaga mahina na ang pandinig niya siguro dala na din ng katandaan the wife stated but hes not wearing hearing aids. he doesnt wears eyeglasses. Some important decisions of him are made easily. During hospitalization, the patient is not comfortable because of the difficulty of breathing that she is experiencing right now.

7. Self Perception-Self Concept Pattern Prior to hospitalization, the patient describe himself as a loving father and grandfather person. He feels good about himself. oo proud ako sa knya although alam nating walang perfect diba? Pero masasabi ko proud yan sa mga anak niya at loving asawa. Masayahin pa siya his wife said. The thing that makes her angry is when his children and grandchildren done wrong. She never felt of losing hope because she is a very positive person. During hospitalization, the patient describes herself as unhealthy person. She does worry about her physical changes and she wants to go back to her original daily activities. She feels annoyed and anxious when her nose is congested.the patient still feels happy and very thankful seeing his family taking care of him.

8. Roles-Relationship Pattern Prior to hospitalization, the patient lives together with his wife. The patient is in a nuclear family, patient has 2 sons and 2 daughter and had 3 grandchildren. Masaya naman ako sa pamilya ko, minsan nagkakaproblema pero nareresolba naman dahil sa tamang desisyon the wife verbalizes when I ask him if he is happy having a family like he had now. His children had their own family. The patient does not have any social group or organization but he has lots of close friends. His income is sufficient for their needs.

During hospitalization, the patients family is worried about the condition of my client. His close friends feel sad about her hospitalization. Sometimes, he feels lonely because he didnt see her friends and family frequently. The patient and his family is having their best time in expressing their love more especially now that the patient, their father, husband is experiencing a trial in his health.

9. Sexuality- Reproductive Pattern The patient had a good sexual relationship with his wife. He and his wife has two sons and two girl. Hindi na active ang sexual relationship namin dahil matatanda na din kami e. the wife verbalized During hospitalization, the patient answers are still the same. 10. Coping Stress Tolerance Pattern The patient's big changes life is when he was diagnosed of having an pleural effusion, because he have to adjust to almost everything he used to do not just to her own life but also to her friends and families life that made her become bothered so much. They just continue to love and take care of one another. During hospitalization, the patient is just doing his best to still enjoy life and treasure everything he has for this moment.

11. Values Beliefs Pattern The patient is a Roman Catholic and for her and her family, their relationship to God is very important. They are regularly attending the mass and goes to church every Friday. During hospitalization, the patient and families prayer is very important and according to them that is their very weapon. He lifts up everything to god and as will do all the best for his health to come back to its good condition.

F. Family assessment NAME L.C RELATION Wife AGE 60 SEX Female OCCUPATION Housewife EDUCATIONAL ATTAINMENT High school Graduate

G. Heredo-familial illness Maternal: Hypertension Paternal: Diabetes

H. Developmental History THEORIST Erik Erikson AGE 64 TASK Integrity vs. Despair PATIENT DESCRIPTION Patient is recovering from his past experiences. He looks back on his life with happiness and contentment, feels fulfilled that his life was meaningful and made a contribution to other especially to his love ones, seeing her children as successful individuals. He accept death as his completion to his life as everybody else. The patient is so much comfortable with his sexuality, and is at a healthy relationship with his wife. His drives have been satisfied that is why he has a meaningful sexual relationship towards her wife. The patient knows and feels that he had done his very best to be the father and husband he had set before entering the family life. For him, as a formal operational thinker, he solves problem as thinking first why such problem arises then solves it in a more systematic manner in a way that he set things first before deciding. As a father, it is a significant factor for him to be a best model for his children and to other people. In his age he knew to act as what he know that is true and right not just because for his own protected identity but for setting his self as his children's model being a good individuals. For him, the feeling of others is very important that acting without thinking is not a good thing to implement in living in this world. The patient as a catholic has a strong faith in God, especially to what he is experiencing right now. But he knew that these things are just trials set by God and he believes that with his great faith and love for God, he would still be spending his life, with sense of happiness, together with his family.

Sigmund Freud

64

Genital Stage

Jean Piaget

64

Formal Operational Stage

Lawrence Kohlberg

64

Level 3: Post Conventional Stage 6: Universal Ethical Priciple Orientation

James Fowler

60

Stage 6: Conjunctive Faith

I. Physical Examination BP 140/90 mmHg RR 26cpm PR -107 bpm Temp. 37.3

Regional examination: Skin veins are visible skin dry and warm to touch poor skin turgor body temperature of 36.5C absence of discoloration Nail absence of clubbing Poor capillary refill = 3 sec absence of cyanosis

Head and Face Normocephalic absence of lesions absence of tender areas, masses and deformities Eyes Ears eyes are parallel to each other eyebrows are symmetrical sclera is dirty white PERRLA good eye convergence

no discharge absence of lesions symmetrical to the face same color as face no deviations

Nose symmetric and same color as the face absence of exudates absence of nasal flaring Mouth & Pharynx lips is brownish in color absence of exudates absence of lesions buccal mucosa is pinkish in color

 absence of swelling in the gums and teeth no dentures tongue and uvula is in midline Neck absence of lesions symmetrical and proportion to the body trachea is in midline absence of tenderness Thorax & Lungs chest contour is symmetrical no presence of lumps or masses no retractions chest excursion is symmetrical Asymmetrical, use of accessory muscles 26cpm (+) rales on upper lung lields Decrease breath sounds on left lung field Heart absence of vein engorgement full & equal pulses Pulse rate: 107 Blood Pressure: 140/90 mmHg 5 auscultatory areas identified

Breast not done Abdomen umbilicus is centered when palpated, patient verbalized a bloated sensation on the epigastric region flat abdomen 2 bowels sounds heard per minute tympanic all over positive tenderness

Extremities absence of lesions or scars upper and lower extremities are symmetrical Genitals not done

 Rectum & Anus not done Neurologic exam Coherent II. PERSONAL/SOCIAL HISTORY Habits: farming, and sometimes hanging out with his family or friends Vices: cigarette smoking and alcohol drinking Lifestyle: Sedentary Educational attainment: elementary undergraduate Travel: She went to Subic last January for vacation Social Affiliation: None Rank/Order in the Family: Father Travel: None Clients Usual Day Like: The client usually wakes up around 5AM. The client walks around the neighborhood then after eats his breakfast. The client usually chats with his family or friends. The client eats lunch around 12 NN and takes a nap after. Then eats dinner at 7PM. The client usually goes to sleep around 10PM. III. ENVIRONMENTAL HISTORY

The client lives in a place that is very accessible to important landmarks like: Church, Malls, School, Market and Hospitals. Their garbage is collected regularly. Most of their clients neighbors are friendly to her. They drink mineral water. The clients place is a residential type with enough ventilation. Their garbage is collected regularly every Monday, Wednesday and Friday. Most of the clients neighbors are friendly to him. IV. OB/GYNE HISTORY N/A

V. PATHOPHYSIOLOGY THEORETICAL BASE

Non-Modifiable: Age, gender

Modifiable: Lifestyle, environmental

Inflammation of airways

wheezing

Bronchial edema

Increased mucus secretion

Broncoconstrict -ion

Bronchial spasm

Worsening of obstruction

Dsypnea, cold and clammy skin, diaphoresis

Accumulation of fluids caused by over secretion

Multiplication of growth of organism Inflammation in the epithelial wall Fluid filled alveoli/lobar copartment Shallow breathing, RR increase Excess fluid accumulate d in spaceperica rdial Rupture of inflamed endothelial cells Mismatch of ventilation and perfusion Mismatch of ventilation 10 and perfusion hypoxia hypoxemia dyspnea

Pleural effusion

CLIENT BASE

Non-modifiable: 64 Male

Modifiable: Smoker drinkerl

Inflammation of airways

wheezing

Bronchial edema

Increased mucus secretion

Broncoconstrict -ion

Bronchial spasm

Worsening of obstruction

Dsypnea, cold and clammy skin, diaphoresis

Accumulation of fluids caused by over secretion

Multiplication of growth of organism Inflammation in the epithelial wall Fluid filled alveoli/lobar copartment Shallow breathing, RR increase Excess fluid accumulate d in spaceperica rdial Pleural effusion Rupture of inflamed endothelial cells Mismatch of ventilation and perfusion 11

VI.

LABORATORY RESULTS

dyspnea

Arterial Blood Gas Analysis Site: Brachial Laboratory (test) PH paCO2 paO2 HCO3 O2 Saturation B.E. Normal Value S.I. Unit 7.35- 7.45 35-45mmHg 80-100mmHg 22-26mEq/L 97% +_2mEq/L Date&Time: 09/01/10 11:25am Result Interpretations S.I. Unit 7.34 NORMAL 56.6 mmHg 143 mmHg 30.6 mEq/L 99.0% 3.1 mEq/L HIGH HIGH HIGH HIGH HIGH

BLOOD CHEMISTRY Date & Time: 09/02/10 09:15am Laboratory (test) ULDL Cholesterol LDL Cholesterol Normal Value S.I. Unit 0.318-0.772 mmol/L Up to 3.8umol/L Result S.I. Unit .38 2.52 Interpretations LOW NORMAL

Laboratory (test) Glucose FBS Uric Acid Triglycerides Cholesterol

Normal Value S.I. Unit 4.22-6.10 mmol/L 202.00-416.00 umol/L 0.46-1.71mmol/L 3.90-5.20 mmol/L 12

Result S.I. Unit 7.22 630.08 0.84 3.98

Interpretations HIGH HIGH HIGH NORMAL

HDL

0.91-1.68 mmol/L

1.08

NORMAL

13

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