Pneumothorax and Pleural Effusion

Question 1

What is a pnuemothorax

Answer 1

Acute, restrictive lung disease - due to air collecting between the visceral and parietal pleura

Breaks the seal of the pleural space and so lung can move away from chest wall and collapse

Question 2

What is the pathophysiology fo a pneumothorax?

Answer 2

air escapes from the lung into the pleural space - hole in the pleura acts like a valve - increased air during inspiration cannot be removed from pleural space during exhilation

As more air accumulates in the pleural space, it compresses the contents of the thorax - causing lung collapse and midline shift of mediastinum

Severe compression of the heart results in decreased cardiac output (tension pnuemothorax- medical emergency)

Question 3

What is the physiotherapy management of pneumothorax?

Answer 3

If chest drain - then TEE to re-expand lung & exercises for aROM of shoulder and thoracic cage - 3-4 times daily

TEE’s vitally important to re-expand lung and allow normal gliding of pleural surfaces to prevent adhesions and pain

Question 4

What is a spontaneous pnuemothorax?

Answer 4

Usually occurs with chronic respiratory disease - emphysema and chronic bronchitis cause weakening of the supporting structures of the lungs - leading to damage

Question 5

What is a pleural effusion?

Answer 5

acute restrictive lung disease - where there is an accumulation of fluid in the pleural space increasing its volume

Question 6

What are the two layers of pleura?

Answer 6

Parietal pleura = lines thoracic cavity
Viseral pleura = lines the lung

normally have a thin layer of plural fluid to reduce friction and maintian surface tension

Question 7

What is occurs in transudate pleural effusuion?

Answer 7

Increased pulmonary capillary pressure due to CCF causes fluid to move into the pleural space - no protients - so is clear

Question 8

What occurs in the exudate plueral effusion?

Answer 8

inflammation causes increased filtration of fluid into the pleural space - contains protiens so is cloudy

Question 9

What are the symptoms of pleural effusion?

Answer 9

Breathlessness - since pressure of fluid inhibits full inspiration
cyanosis - due to decreased inflation of alveoli - decreased gas exhange
Pain
Restricted throacic expansion

Question 10

What is the physiotherapy management of plueral effusion?

Answer 10

TEEs to aid re-expansion - can lie on unaffected side to increase expansion of affected side
mobilisation