Pleural effusion is the build-up of excess fluid in the area surrounding the lungs known as the pleural cavity. This excessive build up of fluid impairs normal breathing in an individual. The normal anatomy of the respiratory system consists of two airways, namely, the superior and the inferior airways. The former is composed of the infraglottic, glottic and supraglottic regions, while the latter encompasses the bronchi, bronchial generations, and trachea. A series of segments and lobes are present in the lungs, that aid in the breathing process. Every lung is enclosed by a pleural cavity, which is a potential fluid filled space between the parietal pleura and the visceral pleura. The right lung is divided into three lobes by two fissures, while the left lung is divided into two lobes by a single fissure (Faull & Blankley, 2015). Every lung consists of an apex, a base, lobes, surfaces and various borders that all have vital roles in the respiration process.
Normal physiology of respiration entails the proper functioning of the lungs and other associated organs such as the diaphragm. The pulmonary pleurae, consists of two layers, and contain a pleural fluid within a small cavity that exists between the layers. This fluid provides lubrication between the different surfaces, thereby preventing trauma. It also facilitates the expansion of the lungs which helps in filling them with air during breathing.
Computer tomography, chest radiography, and ultrasonography are some of the modalities used in the detection of pleural effusions. The initial test is the determination of the effusion as exudate or transudate. Numerous pleural fluid tests are used in such observations. Thoracentesis is a standard procedure that examines the pleural fluid appearance for signs of turbidity.
Pleural effusion is often caused by the leakage of fluid from a neighboring organ. Congestive heart failure is one such cause of buildup of bodily fluids into the pleural space. Pulmonary embolism that involves the blockage of an artery is another cause of this ailment. Additionally, infections such as pneumonia are also significant contributors to the condition. Autoimmune medical conditions such as lupus can also be involved. Other diseases that cause pleural effusion include emphysema, pleurisy, fever, lymphoma, and pneumothorax.
Pleural effusions can be categorized as transudative and exudative. The former is due to the leakage of fluid into the pleural space through an increase in pressure on the different blood vessels (West & Stanley, 2011). The latter is caused by the blockage of blood vessels, tumors, lung injuries and inflammations. Alzheimer’s is a common disease that produces side specificity of pleural effusion. Bilateral effusion is a form of transudative effusion that increases capillary permeability and thus results in a higher rate of reabsorption. Left-sided effusion is different from the right-sided one because the latter is malignant.
Subpulmonic effusions are when the plueral fluid accumulates between the diaphragm and the lung base and are visible only on erect projections. Blunting of costrophrenic angles usually occurs due to pleural effusion. The meniscus sign is a membrane that houses gaseous matter in the body and is present in tumors, granulomatous infections, and lung abscesses. Chest radiographs indicate that a total opacification of hemithorax involves the blockage of the trachea, which may be caused by a mucous plug or endotracheal tubes which alter the tracheal position. Loculated effusions are often caused by pleural inflammation. It is a form of exudative effusion that enables the formation of a fibrotic scar tissue. Such accumulation prevents the smooth flow of fluid between the fissures and the poor drainage results in an unhealthy condition. Fissural pseudotumors are collections of various fluids such as fat and mucous within pleural fissures,which resemble tumors. Laminar effusions are linear occurrences on the chest wall. They are also visible on the costophrenic angle. Hydropneumothorax refers to the occurrence of both fluid and air within the pleural cavity. This extension is found on the hemithorax too. It is an abnormal phenomenon that leads to complications for the patient.
Provision of care to patients with malignant pleural effusions demands a proactive approach that emphasizes palliative care. Reduction of the pain experienced by patients is the main goal for such care. Immunotherapy is a common treatment method that examines the positioning of the patient to hasten pain relief. One should be aware of the various levels of anxiety experienced by the patient because such mood alterations affect the treatment (West & Stanley, 2011). An important technical factors that should be considered by a caregiver is the proper drainage of the patient’s catheter. This procedure entails the use of appropriate tools and supplies. Thoracentesis is a vital treatment option and caution should be taken on the type of local anesthesia. The patient should also be awake during the procedure for him/her to report symptoms that may arise. Drainage of the fluid ought to be done slowly. It should also be done intermittently to avoid further complications. Alternatively, the patient can be made to lie down sideways to allow the movement of the fluid. The caregiver is then supposed to conduct a chest X-ray that would reveal the presence of pleural effusion. A stethoscope can also be used to measure the volume of breath sounds especially on the part of the chest most affected by the disease. For example, a friction rub is vital in such a scenario because the heart would gain contact with the fluid area and expose the extent of the inflammation. It is important for the processes outlined above to be done in a conducive environment that does not worsen the situation. Detection of any other alarming symptoms should be seriously noted for further tests to enable doctors make the right diagnosis.
Faull, C., & Blankley, K. (2015). Palliative care. Oxford, UK: Oxford University Press.
West, B. S., & Stanley, D. R. (2011). Lung cancer treatment. New York, NY: Nova Science Publishers.
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