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Pleural Effusion Nursing Guide

The content for this course was created by Annette Brownlee RN, BSN

Pleural Effusion Overview

This course is intended as a Quick Reference for pleural effusion and will cover an overview as well as nursing considerations utilizing the nursing process.

Pleural Effusion Etiology and Epidemiology

Pleural effusion is the accumulation of excess fluid in the pleural space. The pleura are membranes that line the lungs and support breathing and reduce friction during respiration. There is normally a small amount of fluid in the intrapleural space for lubrication. There are two layers of pleura, the visceral pleura and the parietal pleura. The parietal pleura is the outer membrane. It lines the chest wall and diaphragm. The visceral pleura is the inner membrane that covers the surface of the lungs and hilum.

The cause of the pleural effusion depends on the type of fluid found. The two categories of pleural fluid are transudative and exudative. Transudative has a pleural fluid/serum protein ratio that is less than 0.5 and is typically caused by a condition like heart failure where the body’s processes for forming and absorbing the pleural fluid are compromised. Transudative pleural effusion causes include (Cleveland Clinic, 2018):

  • Heart failure
  • Pulmonary embolism
  • Cirrhosis
  • Open heart surgery

Exudative fluid contains protein and has a pleural fluid/serum protein ratio more than 0.5 and is often caused by infection. Exudative pleural effusion causes include:

Pleural effusion is common. It affects 1.5 million people in the U. S. annually (Rachana & Rudrappa, 2021). Pleural effusion is found in up to 55% of individuals with pulmonary embolism (Jany & Welte, 2019). Other causes of pleural effusion include:

  • Radiation therapy
  • Tuberculosis
  • Autoimmune disease
  • Chest trauma
  • Infection
  • Asbestos
  • Meig’s syndrome
  • Ovarian hyperstimulation syndrome
  • Medications including nitrofurantoin (Marcrobid®), amiodarone (Nexterone®), methotrexate (Trexall®), clozapine (Clozaril®), and phenytoin (Dilantin®), and beta- blockers (Jany & Welte, 2019)
  • Lung cancer, breast cancer, and lymphoma

Pleural Effusion Diagnosis

The diagnosis of pleural effusion is made by a thorough history intake and physical examination by the healthcare provider. Signs and symptoms of pleural effusion include (Cleveland Clinic, 2018):

  • Dry, nonproductive cough
  • Dyspnea
  • Orthopnea
  • Pain
  • Diminished breath sounds, pleural rub
  • Tachypnea

Diagnostic tests that may be ordered include:

  • Pleural fluid analysis
  • Chest X-ray
  • Ultrasound
  • CT scan

Pleural Effusion Management

Management and treatment of pleural effusion will depend on the cause and severity. Treatments may include:

  • Obtain ordered lab work and imaging
  • Monitor vital signs
  • Medications as ordered
  • Assess and stabilize airway, breathing, and circulation
  • Monitor pain level
  • Monitor surgical wound/drain site, if present, for signs and symptoms of infection
  • Monitor pleural fluid drainage and output if drain is present
  • Provide a calm environment
  • Initiate fall precautions

Pleural Effusion Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for pleural effusion are listed below.

Assessment

Assessment includes:

  • Lung sounds
  • Level of consciousness
  • Vital signs
  • Pain
  • Signs and symptoms of infection at surgical/drain site
  • Anxiety
  • Respiratory distress

Nursing Diagnosis/Risk For

  • Ineffective breathing pattern related to pain evidenced by:
    • Difficulty breathing including dyspnea, tachypnea, and orthopnea
    • Low oxygen saturation
    • Use of accessory muscles or nasal flaring
    • Cyanosis
  • Excess fluid volume related to compromised regulatory mechanisms, evidenced by:
    • Dyspnea, tachypnea, orthopnea
    • Imaging
    • Diminished lung sounds in bases or pleural rub
  • Acute pain related to fluid accumulation, evidenced by:
    • Verbalization of pain
    • Facial grimacing
    • Bracing
    • Shallow breathing, tachypnea
  • Anxiety related to inability to take deep breaths, evidenced by:
    • Restlessness
    • Agitation
    • Verbalization
  • Activity intolerance related to pain or poor oxygen supply, evidenced by:
    • Low oxygen saturations
    • Poor pain management
    • Increased coughing with exertion

Interventions

  • Monitor vitals
  • Monitor pain
  • Maintain adequate ventilation and oxygenation
  • Monitor lung sounds
  • Administer medications
  • Provide non-pharmacological comfort and pain reduction measures
  • Provide non-pharmacological anxiety reduction measures
  • Monitor surgical wound/drain site, if present, for infection
  • Monitor drain output if present
  • Provide calm environment
  • Educate and assist individual to brace/splint when breathing

Expected Outcomes

  • Returns to baseline vitals
  • Reports that pain is controlled
  • Achieves wound healing
  • Prevents infection
  • Demonstrates effective coping
  • Verbalizes decrease in breathing difficulty

Individual/Caregiver Education

  • Condition, treatment, and expected outcomes
  • Side effects of antibiotics, if prescribed
  • Side effects of pain medications, if prescribed
  • Signs and symptoms of pleural effusion
  • Notify healthcare provider or seek immediate medical care for:
    • Increased pain with breathing
    • Fever
    • Difficulty breathing
    • Signs of infection including redness, tenderness, and pus at drain/surgical site
  • Recommended follow-up with healthcare provider

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Additional Information

Content Release Date

6/11/2024

Content Expiration

12/31/2025

Course Contributor

The content for this course was created by Annette Brownlee RN, BSN

Annette Brownlee is an SME Writer for the Post-Acute Care team. She has a Bachelor of Arts in advertising from Michigan State University and a Bachelor of Science in nursing from the University of Northern Colorado. Annette has worked in skilled nursing and home health. Her most recent experience includes being a Staff Development Coordinator and Infection Preventionist.

References

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