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INTRODUCTION Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluidfilled space

that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. Diagnosis Pleural effusion is usually diagnosed on the basis of medical history and physical exam, and confirmed by chest x-ray. Once accumulated fluid is more than 300 ml, there are usually detectable clinical signs in the patient, such as decreased movement of the chest on the affected side, stony dullness to percussion over the fluid, diminished breath sounds on the affected side, decreased vocal resonance and fremitus(though this is an inconsistent and unreliable sign), and pleural friction rub. Above the effusion, where the lung is compressed, there may be bronchial breathing and egophony. In large effusion there may be tracheal deviation away from the effusion. A systematic review (2009) published as part of the Rational Clinical Examination Series in the Journal of the American Medical Association (JAMA) showed that dullness to conventional percussion was most accurate for diagnosing pleural effusion (summary positive likelihood ratio, 8.7; 95% confidence interval, 2.233.8), while the absence of reduced tactile vocal fremitus made pleural effusion less likely (negative likelihood ratio, 0.21; 95% confidence interval, 0.120.37). Treatment Treatment depends on the underlying cause of the pleural effusion. Therapeutic aspiration may be sufficient; larger effusions may require insertion of an intercostal drain (either pigtail or surgical). When managing these chest tubes, it is important to make sure the chest tubes do not become occluded or clogged. A clogged chest tube in the setting of continued production of fluid will result in residual fluid left behind when the chest tube is removed. This fluid can lead to complications such as hypoxia due to lung collapse from the fluid, or fibrothorax, later, when the space scars down. Repeated effusions may require chemical (talc, bleomycin, tetracycline/doxycycline), or surgical pleurodesis, in which the two pleural surfaces are scarred to each other so that no fluid can accumulate between them. This is a surgical procedure that involves inserting a chest tube, then either mechanically abrading the pleura or inserting the chemicals to induce a scar. This requires the chest tube to stay in until the fluid drainage stops. This can take days to weeks and can require prolonged hospitalizations. If the chest tube becomes clogged, fluid will be left behind and the pleurodesis will fail. Pleurodesis fails in as many as 30% of cases. An alternative is to place a PleurX Pleural Catheter or Aspira Drainage Catheter. This is a 15Fr chest tube with a one-way valve. Each day the patient or care givers connect it to a simple vacuum tube and remove from 600 cc to 1000 cc of fluid. This can be repeated daily. When not in use, the tube is capped. This allows patients to be outside the hospital. For patients withmalignant pleural effusions, it allows them to continue chemotherapy, if indicated. Generally the tube is in for about 30 days and then it is removed when the space undergoes a spontaneous pleurodesis.

DEMOGRAPHIC DATA GENERAL DATA Name: Mr. V Sex: female Address: #73 Hereford ST. Proj. 8 Quezon City. Birthday: December 20, 1950 Age: 63 Place of birth: Quezon City Civil Status: Married Nationality: Filipino Religion: Roman Catholic Occupation: House wife Educational Attainment: College Undergraduate Date of Admission: December 17, 2011 Chief complaint: Dyspnea Diagnosis: Pleural Effusion Admitting diagnosis: Pleural Effusion Final diagnosis: Pleural Effusion CLIENT HISTORY PAST HISTORY According to my client. She said that in her childhood. she had been hospitalization in case of appendicitis. She also been diagnose of Diabetes. She always eat sweets food like lecheplan. PRESENT HISTORY The patient diagnose is pleural effusion. Then the day prior to admission the patient feels difficulty of breathing. So his husband took her in east ave medical center on December 17. FAMILY HISTORY Her mother died in cancer in lymph nodes. Because of smoking. Her father don't have andy disease like her. She has 4 children 3 were died. Because of premature.

Vital Signs Assessment Date taken: February 21, 2012. Vital Signs Temperature Technique Inspection (thermometer via axilla) Actual findings 36.9C Interpretation and Analysis Normal range: 36.5 37.5 Normal finding. Its within the normal range. (Kozier) Normal range: 60-100 beats per minute Finding is within the normal range.(Kozier) Respiration Inspection of 26 cycles per minute Normal range: 12-20 abdominal breathing cycles per minute Auscultation 130/70 Normal range: 120/80 mmhg (kozier).

Cardiac rate

Palpation of radial pulse

98 beats per minute

Blood pressure

OBJECTIVES General Objectives: This case study focus on the advancement of our knowledge, enhancing our skills and improving our attitude in managing and administering the extensive range of nursing intervention to our client with Pleural Effusion in order to understand the general objective of the study, the following are intended to be done specifically: Specific Objective: To know and understand the concept regarding Pleural effusion and enumerate different causes, signs and symptoms, possible diagnostic exams, and nursing management regarding Pleural Effusion To establish rapport and gain the trust of the patient and family members in the course of the case study. To gather pertinent data from different sources such as clients history, physical assessment, medical records and interviews from family members and the client. To collate and analyze different data prioritizing actual and potential problems related to the clients condition. To be able to understand the pathophysiology of the underlying disease.

ANATOMY AND PHYSIOLOGY

HEMATOLOGY/ COMPLETE BLOOD COUNT INDICATION: This was requested to check on the patients general health status and to evaluate conditions such as inflammation, infection, hydration and blood loss. DATE: November 15, 2011 RESULTS TEST WBC NORMAL VALUE 5-10x10/mL RESULT 12.2 INTERPRETATION

Normal: An elevation of the WBC ( Leukocytosis ) usually identifies infection, tissue inflammation or

necrosis. A decrease in the WBC (leucopenia) co destruction of the cells. A person with leucopenia increased risk for infection.

indicates a decrease in production or an increase

Neutrophils

0.45-0.65%

0.85

Increased neutrophil count is due to high level of placed on the body. (Fundamentals of Nursing, K p.759)

Lymphocyt es

0.25-0.50

0.12

Decreased lymphocytes count is caused by weak immunity system or infections that may lead to

immunodeficiency diseases. ( Albas Medical Tech

Hgb

Male : 140170gm/l

193gm/l

Hemoglobin is the oxygen carrying capacity of the

Decreased hemoglobin indicates low oxygen circu hemorrhage and mild anemia. ( Fundamentals of

which decreases oxygen supply to the cell. It indic

Hct

Male : 0.40-0.50

0.58

Kozier p.759) Decreased value of hematocrit indicates hemorrh (Fundamentals of Nursing, Kozier p.759)

MCV

80-100l

103.9

Normal: Mean Corpuscular Volume (MCV) measu

average concentration of hemoglobin in red blood MCH 27-31 33.6

Mean Corpuscular hemoglobin (MCH), increased means macrocytic anemia.

MEDICAL AND SURGICAL MANAGEMENT

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