EFFUSION PLEURAL

System Respirasi
 Group 4 :

1. Sofia Erfiani
2. Fitriah Nurul H.
3. Yessi Elita Okinawati
4. Shinta Putri Gitayu
5. Abdul Chafid Muzaki
6. Ayu Rahma Widhiya A.
7. Haris Tirta Kusuma
 DEFINITION
Effusion pleura is a condition in which fluid accumulates in the
pleural cavity (Simanjuntak, 2014).
Effusion Pleura is collection of fluid in the pleural space,
located between the visceral and perietal surface is the
primary disease is rare but usually a disease secondary to
other diseases (Smletzer & Bare, 2002).
 CLASSIFICATION
Pleural effusion by Morton (2012) is divided into 2 :
1. Effusion pleural transudate
Constitute ultrafiltrate plasma, indicating that the
pleura is not affected by the disease. Fluid accumulation
caused by systemic factors affecting the production and
absorption of pleural fluid such as (congestive heart failure,
atelectasis, cirrhosis, nephrotic syndrome and dyalisis
peritoneum).
2. Pleural effusion exudate
This caused by fluid leakage past the broken
capillaries and into the pleural lung coated or into the
nearest lungs.
 ETIOLOGY
1. INFECTION
a) Tuberculosis
b) Non tuberkulosi :
- Pneumonia ( the pneumonia effusion )
- Mushroom
- Parasite
- Virus
2. NON INFECTION
a) Hipoproteinemia
b) Neoplasm
c) Abnormality circulation / failed heart
d) Embolism lung
e) Atelectasis
3. TRAUMATIC (HEMOTORAX)
 MANIFESTATION CLINICAL
According Nurarif and Kusuma (2015), the clinical manifestations of pleural
effusion is as following:
1. Presence heap fluid result patient experience crowded breath.
2. Presence symptom from disease which causes pleural effusion as fever, shiver,
and painful chest pleurisy (pneumonia).
3. Deviation trachea, namely tracheal keep away the place that sick could
happen if happen cumulation fluid pleural significant.
4. Examination physical in circumstances lie and sit will different, because fluid
will move the place.
5. Part that sick will less move in breathing, fremitus weakened (conjecture and
vocals), on percussion found area deaf.
6. They found triangle gerland, that is area that on percussion dim timpani in part
on line ellis damoiseu.
7. Triangle grocco-rochfusz, that is area deaf because fluid push mediastinum to
the other side, on auscultation area this found vesicular weakened with ronkhi.
8. On beginning and end disease audible crepitations pleural.
 EXAMINATION DIAGNOSTIC
a. Chest X-ray : Surface fluid that there in cavity pleural will shape shadow
as curve, with surface area lateral more high of the part medially.
b. Torakosentesis : aspiration fluid pleura (torakosentesis) useful as means for
diagnostic nor therapeutic.
c. Cytology : Examination cytology to fluid pleural very important for
diagnostic disease pleura, especially when found pathological or
domination cell-cell certain.
d. Bacteriology : Usually fluid pleural sterile, but sometimes could contain
microorganisms, moreover when the liquid is purulent.
e. Pleural biopsy : Examination histology one or some example network
pleural could showing 50-75% diagnosis cases pleurisy of tuberculosis
and tumor pleural.
f. Approach on effusion that no undiagnosed : analysis to fluid pleura do
one time sometimes no could uphold diagnosis. so that recommended for
be repeated back to diagnosis into clear.
 COMPLICATION
According to Mansjoer (2001), A complication of pleural effusion
is as follows :
1. Infection >> Infection constitute process invasive by
microorganism.
2. Fibrotoraks >> Effusion pleura the form exudate that no
addressed with drainage that good will happen adhesions
fibrous between pleural parietal and visceral.
3. Atalektasis >> Atalektasis is an imperfect lung development
caused by emphasis due to effusion pleura.
4. Fibrosis lung >> Fibrosis lung constitute circumstances
pathological Where there network bundle lung in amount that
excessive.
 MANAGEMENT
Management on effusion pleural including : (Nurarif and Kusuma, 2015)
1. Bed rest
Aiming for lower needs oxygen.
2. Thorakosistesis
Drainage fluid if effusion pleural inflict symptom subjective as painful, dyspnea
and etc. If cstreams effusion many need in remove soon for prevent increasing
edema lung.
3. Antibiotic
Administration antibiotic do if proven there presence infection.
4. Pleurodesis
On effusion because malignancy and effusion recurrent other, be given drug
(tetracycline, calc, and biomisin) through hose intercostal for imbed second
layer pleural and prevent fluid accumulated back atalektasis that linger.
NURSING CARE
Diagnosis:
1. The lack effectiveness pattern breath b / d reduction expansion
lung.
2. Imbalance nutrients less from needs body b / d metabolism
body increase
3. Risk infection b / d invasive measures: drainage.
4. Painful b / d interruption of network continuity.
5. Disruption pattern sleep b / d discomfort or painful.
6. Intolerance activity b / d weakness.
 INTERVENTION

Dx 1 The lack effectiveness pattern breath b / d reduction expansion lung

Objectives & Expected Outcomes Intervention

NOC NIC
1. Respiratory Status : Ventilation 1. Place patient for maximizing ventilation
2. Respiratory status : Airway breathing.
patency 2. Identification patient will the need
3. Vital sign status installation tool Street breath artificial.
3. Make physiotherapy chest if need.
Expected outcomes : 4. Set intake fluid.
1. Demonstrate sound breath that 5. Monitoring respiration and status O2.
clean, no there is cyanosis and 6. Preserve Street breath patent maintain
dyspnea. position patient.
2. Show Street breath the patent. 7. Monitir Flow O2.
3. TTV in span normal. 8. Monitoring TTV.
9. Monitor frequency, rhythm breath.
10. Identification cause change sign vital.
Dx 2 Imbalance nutrients less from needs body b / d metabolism body increase

Objectives & Expected Outcomes Intervention

NOC NIC
1. Nutritional status : Nutrient 1. Knowledge presence allergy food.
intake 2. Collaboration with expert nutrient for
2. weight control determine amount calorie and nutrients which
in heal & condition patient.
Expected outcomes : 3. Instruct patient for increase protein and
1. Presence enhancement weight vitamin c,
body corresponding premises 4. Reassure diet in eat contain high fiber for
aim. prevent constipation.
2. Weight body ideal 5. Give food that selected (already consulted
corresponding with high body. with expert nutrient.
3. Capable identified needs 6. Teach patient how make record food daily.
nutrients. 7. Monitor amount nutrients and contents replyri.
8. Give information about needs nutrients.
Dx 3 Risk infection b / d invasive measures: drainage

Objectives & Expected Outcomes Intervention

NOC NIC
1. Immune status 1. Wash hand before and after action nursing.
2. Knowledge : Infection control 2. Use APD.
3. Risk control 3. Preserve environment aseptic for installation
tool or injection.
Expected outcomes : 4. Change location iv peripheral and central line
1. Client free from sign and and dressing corresponding hint.
symptom infection. 5. Increase intake nutrients.
2. Describe process transmission 6. Monitor sign symptom systemic infection and
disease. local.
3. Show behavior life healthy. 7. Use technique isolation.
8. Give care skin on area epiderma.
9. Inspection condition wound.
10. Instruct patient for drink antibody
corresponding recipe.
11. Teach the patients family about signs of
infection.
Dx 4 Painful b / d interruption of network continuity
Objectives & Expected
Intervention
Outcomes
NOC NIC
1. Pain level 1. Make assessments painful in comprehensive
2. Pain control including locations, characteristics, duration,
3. Comfort level frequency, quality and factor presipitas.
2. Observation reaction nonverbal from
Expected outcomes : inconvenience.
1. Capable control painful. 3. Use technique communication therapeutic for
2. Report that painful knowing experience painful patient.
diminish with use 4. Knowledge culture that influence responses painful.
management painful. 5. Evaluation experience painful time past.
3. Capable recognize flavor 6. Choose and do handling painful (pharmacology,
comfortable after painful non pharmacology and inter personal).
diminish. 7. Knowledge type and source painful for determine
intervention.
8. Specify locations, characteristics, quality, and level
painful before administration drug.
9. Check instructions doctor about type drug, dose,
and frequency.
10. Check history allergy.
Dx 5 Disruption pattern sleep b / d discomfort or painful
Objectives & Expected Outcomes Intervention
NOC NIC
1. Anxiety reduction 1. Determination effects medications to
2. Comfort level pattern sleep.
3. Pain level 2. Explain importance sleep that adequate.
3. Amenities for maintain activity before
Expected outcomes : sleep (read).
1. Amount hour sleep within the 4. Create environment that comfortable.
normal limit of 6-8 hour/day. 5. Collaboration administration drug sleep.
2. Pattern sleep, quality in limit 6. Discuss with patient and family about
normal. technique sleep patient.
3. Capable identified case case that 7. Instruct for monitors sleep patient.
increase sleep. 8. Monitor eat time and drink with time
sleep.
9. Monitor or record needs sleep patient
every day and hour.
Dx 6 Intolerance activity b / d weakness
Objectives & Expected
Outcomes
NOC
1. Energy conservation
2. Activity tolerance
3. Self care : ADLs
Expected outcomes :
1. Participate in activity physical
without be accompanied
enhancement TD, pulse, and
RR.
2. Capable do activity one
heart-to-day (adls) in
independent.
3. TTV in span normal.
Intervention
NIC
1. Collaborate with power rehabilitation medical in plan
program choppi that right.
2. Help client for identified activity that capable in do,.
3. Help for choose activity consistent that corresponding with
ability physical, psychology and social.
4. Help for identified and get source that be required for
activity that desirable.
5. Help for get tool help activity as seat wheel, crick.
6. Help patient or family for mengidantifikasi deficiency in
activity.
7. Help patient for develop motifasi self and strengthening.
8. Monitor responses physical, emotion, social and spiritual.
Thank You