PLEURISY
It is a clinical term to describe Pleuritis (Inflammation of the pleura, both parietal and visceral).
Causes
Pulmonary diseases - pneumonia (bacterial, viral), TB, Pulmonary infarction, embolism, embolism, pulmonary abscess, upper respiratory tract infection and pulmonary neoplasm.
Pathophysiology
Pulmonary disease
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Inflammation of the pleura
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Stimulates nerve endings
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Pain
Clinical Manifestations
1. Chest pain becomes severe, sharp and knifelike on inspiration
a. May be minimal or absent when breath is held
b. May be localized or radiate to shoulder or abdomen
2. Intercostal tenderness.
3. Pleural friction rub-grating or leathery sounds.
4. Evidence of infection, fever, malaise, increased WBC count
Diagnostic Evaluation
- Chest X-ray shows pleural Thickening
- Sputum examination-indicates infectious
- Examination of pleural fluid obtained by thoracentesis for smear and culture
- Pleural biopsy may be necessary to rule out other conditions
Medical Management
- Treatment of the underlying primary disease (pneumonia, infarction). Inflammation usually resolves when the primary disease subsides
- Pain relief prescribed analgesics and applications of heat or cold will provide symptomatic relief. Indomethacin, an anti-inflammatory drug, may give pain relief while allowing the patient to cough effectively. If pain is severe, a procaine intercostal block may be required.
Complication
Severe Pleural effusion.
Nursing Management
Assess patients level of pain, Observe for signs and symptoms of pleural effusion, (dyspnea, pain, decreased local excursion of chest wall)
Assist the patient to find a comfortable position that will promote aeration, lying on affected side decreases stretching of the pleura and therefore the pain decreases
Instruct patient in splinting chest while taking a deep breath or coughing
Administer or teach self-administration of pain medication as ordered
Application of heat, muscle relaxation and imagery - relief of pain
Assist with intercostals nerve block if indicated
Evaluate patient for signs of hypoxia thoroughly when anxiety, restlessness and agitation before administering sedatives
