Pleural Disorders - Exam 2 Flashcards
What is the pleura? ______ is attached to the chest wall. _____ covers the lungs, blood vessels, bronchi and nerves
the serous membrane lining the thorax (chest wall) and enveloping the lungs
parietal= attached to the chest wall
visceral= covers the lungs, blood vessels, bronchi and nerves
Which pleura has nerve endings?
parietal pleura
What is the pleural cavity? What is the pleural fluid?
the thin serous fluid-filled (potential space) between the two pulmonary pleura
fills the pleural space/cavity; helps the two layers of pleura glide smoothly past each other during breathing
Is pleural fluid normally seen on imaging?
pleural fluid is NOT normally seen on imaging, only if there is a problem
What is pleurisy? What is pleural effusion?
Pleurisy - Inflammation of the pleura that causes sharp pain with breathing
Pleural Effusion - Excess fluid in the pleural space
What medications can lead pleurisy?
procainamide, hydralazine, and isoniazid
What AI disorders lead to pleurisy? What GI disorders lead to pleurisy?
lupus (SLE), rheumatoid arthritis,or scleroderma
pancreatitis, peritonitis, cholecystitis
a localized, sharp, stabbing, fleeting pain that is worsened by inspiration, sneezing or coughing
What am I?
What does it radiate towards?
pleurisy
radiation of pain to ipsilateral scapula may occur if diaphragmatic pleura is affected
What will you hear on PE in pleurisy?
pleural friction rub and decreased breath sounds
If CT is indicated, what kind do you need to order?
chest CT with contrast or CT angiography
Name 3 reasons you would want to admit a pt for pleurisy
hypoxemic (O2 sat of <90%)
parenteral pain control is needed
underlying etiology requires hospitalization
What is the tx for pleurisy?
NSAIDs!! indomethacin 25 mg BID-TID (short course - < 7-10 d)
cough suppressant (codeine, dextromethorphan, tessalon perles)
What does using cough suppressant put you at risk for?
pneumonia due to build up on airway secretions that are NOT coughed out due to cough suppressant
What is a pleural effusion? How much fluid is normal?
a collection of fluid in the pleural space resulting from a disruption in the normal pleural homeostasis
leaves 5–15 mL of fluid in the normal pleural space (1 teaspoon or 1 tablespoon)
What are the 5 pathophys processes that account for most pleural effusions?
What is the pathophsy behind transudate fluid?
A fluid that passes through a membrane (capillary wall), which filters out all the cells and much of the protein, yielding a watery solution. A transudate is a filtrate of blood caused by an imbalance in hydrostatic and colloid osmotic pressure
What is the pathophys behind exudative fluid?
A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues. The altered permeability of blood vessels permits the passage of large molecules and solid matter through their walls
transudate want to think ?????
exudate want to think ?????
transudate think imbalance in pressure
exudate think inflammation or infection
**______ falls under both transudate and exudate
pulm embolism
What are the 3 MC s/s of a pleural effusion?
dyspnea, cough and pleuritic chest pain
a small pleural effusion will present like ???
a large pleural effusion will present like ????
small= less symptoms with normal physical exam
larger= more symptomatic with abnormal physical exam findings
What are 2 important questions to ask you pt when considered about a pleural effusion?
When did it start? has it gotten worse?
What are 3 things that will be DECREASED over the area that has the pleural effusion?
Diminished or absent breath sounds
Dullness to percussion
Decreased tactile fremitus
also have diminished or delayed chest expansion on the side with the effusion
What is a common CXR finding with pleural effusion?
blunting of the costophrenic angle is evident if there is > 175 ml (appx 6 oz) of fluid present
What is a helpful diagnostic imaging for pleural effusions?
CXR first then chest CT
CT is helpful when determining the underlying pathology
What are the 2 treatment options for pleural effusions?
observation vs thoracentesis
What are the indications for pleural effusion observation?
benign cause (overt CHF, viral pleurisy, recent thoracic or abdominal sx)
small amount of pleural fluid and there is a secure clinical diagnosis
What is the correct needle placement in a thoracentesis in a supine or posterior position? upright or seated?
supine/posterior: Midaxillary line between the 7th and 9th rib insert needle just superior to rib to avoid neurovascular bundle
upright/seated: midscapular line between the 7th and 9th rib insert needle just superior to rib to avoid neurovascular bundle