Pleural Effusion Nursing Care Plan

What is a Pleural Effusion Nursing Care Plan Template?

A pleural effusion occurs when fluid accumulation in the space between the layers surrounding the lungs is abnormal, typically due to increased fluid production or reduced absorption. It can manifest independently or result from underlying conditions such as infections, cancer, or inflammatory issues. This condition significantly contributes to lung-related health issues. To classify the type of fluid buildup, medical professionals utilize the Light criteria, where the fluid is considered exudative if specific criteria are met:

• A higher ratio of protein in the pleural fluid compared to blood serum.
• Elevated levels of lactate dehydrogenase (LDH) in the pleural fluid relative to serum LDH.
• Pleural fluid LDH exceeds two-thirds of the upper normal limit for serum LDH.

Transudates, caused by changes in pressure within the pleural space, are often linked to conditions like heart failure, kidney disorders, liver cirrhosis, low albumin leading to malnutrition, or starting peritoneal dialysis. Exudates, on the other hand, result from infections (pneumonia, tuberculosis), cancer, inflammatory ailments (pancreatitis, lupus, rheumatoid arthritis), post-cardiac injury syndrome, chylothorax (lymphatic obstruction), hemothorax, or asbestos-related pleural effusion.

In its simplest form, pleural effusion involves an abnormal fluid collection surrounding the lungs, often originating from various conditions, and is classified based on specific criteria. Transudates and exudates differ in their underlying causes, impacting the fluid's protein and LDH levels, guiding diagnosis and treatment approaches.

A nursing care plan for pleural effusion is crucial in providing comprehensive care to individuals affected by this condition. Firstly, assessment plays a pivotal role. Nurses conduct thorough assessments to evaluate the patient's respiratory status, including monitoring breathing patterns, oxygen saturation levels, and lung sounds and assessing signs of distress. 

This assessment helps identify the effusion's severity and potential complications. Drainage and fluid management are crucial aspects of a pleural effusion management plan. Nurses may assist in or perform procedures such as thoracentesis, where excess fluid is drained from the pleural cavity using a needle or a chest tube. Monitoring the drainage and assessing the characteristics of the fluid are essential in determining the underlying cause and guiding further treatment.

How does it work?

Step One: Gather your resources

Pleural Effusion Nursing Care Plans are a valuable resource and essential to keep on hand. Make sure that you have a copy of the free printable PDF when the need arises by either clicking the “Download Template” or “Use Template” button or by searching “Pleural Effusion Nursing Care Plan” on Carepatron’s template library’s search bar on the website or app.

Step Two: Collate essential information

Once the patient has been diagnosed and assessed for abnormal lung health and functioning, utilizing the Pleural Effusion Nursing Care Plan Template to ensure all goals of care are met is seamless and easily accessible to relevant parties via Carepatron's centralized workspace.

Assessment, symptom management, and interventions can be collated within the single care plan and safely stored on a single database. The care plan allows for individualized treatment options. It acts as a scaffolding to ensure goals of care are met, and the next steps are recorded for future reference or distribution to other healthcare specialists who are part of the patient's care team.

Step Three: Store the chart securely

After reviewing the Pleural Effusion Nursing Care Plan and creating a viable and individualized plan for the patient, you need to secure the plan so that access is only granted to relevant parties.

Ensure this through Carepatrons HIPAA-compliant free patient records software. Here, all relevant medical records can be safely stored and collated for ease and security.

When would you use this template?

A Pleural Effusion Nursing Care Plan is essential in various scenarios where individuals are affected by this condition, some of which are outlined below:

Newly diagnosed patients

Individuals recently diagnosed with pleural effusion require education and support to understand the condition, its causes, and treatment options. A care plan helps them navigate this new diagnosis and treatment regimen.

Hospitalized patients

Those admitted due to respiratory distress, chest pain, or other symptoms related to pleural effusion need a structured care plan. Nurses play a vital role in managing drainage systems, administering medications, and monitoring for complications.

Chronic or recurrent cases

Patients with recurring or chronic pleural effusion require ongoing management and monitoring to prevent complications, reduce symptoms, and improve their quality of life.

Post-procedure care

Individuals who undergo procedures like thoracentesis (fluid drainage from the pleural cavity) or chest tube placement require specific post-procedure care to minimize risks of infection, monitor drainage, and manage discomfort.

Coexisting conditions

Patients with other medical conditions like heart failure, pneumonia, cancer, or kidney disease that contribute to or result from pleural effusion benefit from a comprehensive care plan that addresses the underlying conditions while managing the effusion.

Palliative care

For patients with advanced-stage disease, where the focus is on symptom management and improving quality of life, a tailored care plan addresses comfort, pain management, and emotional support.

Educational support

Families and caregivers of individuals with pleural effusion also benefit from education and guidance on how to support their loved ones, manage devices or medications, and recognize signs of complications.

What do the results mean?

The results of a Pleural Effusion Nursing Care Plan reflect the care's effectiveness and impact on the patient's well-being and health outcomes. Here's what different outcomes might indicate:

Symptom improvement

Reduction in symptoms such as shortness of breath, chest pain, or coughing suggests the effectiveness of the interventions implemented. It indicates that the management plan is helping alleviate the discomfort caused by the pleural effusion.

Stabilization or reduction in fluid accumulation

Monitoring the fluid volume in the pleural space through imaging or drainage measurements shows whether the interventions successfully manage the effusion. Stable or reduced fluid levels indicate positive progress.

Improved respiratory function

Assessing lung sounds, oxygen saturation, and respiratory rates helps determine if the patient's breathing has improved. Enhanced respiratory function suggests that the care plan positively impacts lung capacity and efficiency.

Management of underlying conditions

If the pleural effusion results from an underlying condition like heart failure or infection, improving or stabilizing these conditions indicates effective management of the root cause.

Decreased complications

Fewer complications such as infections or pleural thickening signify successful prevention measures and effective care in minimizing potential adverse outcomes related to the effusion or its management.

Patient education and engagement

Patient understanding and engagement in self-care, including proper drainage techniques (if applicable), medication adherence, and lifestyle modifications, indicate successful education and empowerment through the care plan.

Enhanced Quality of Life

Improvement in overall comfort, reduced anxiety related to the condition, and an increased ability to perform daily activities suggest an improved quality of life resulting from the care plan's interventions.

These outcomes collectively demonstrate the impact and efficacy of the Pleural Effusion Nursing Care Plan. Positive results signify effective management, improved patient well-being, and a step toward better health outcomes. 

Conversely, any lack of progress or deterioration in symptoms might necessitate a reassessment of the care plan to address any potential shortcomings or changes in the patient's needs.

Research & evidence

Pleural effusion presents a broad spectrum of potential causes, with common culprits including congestive heart failure, cancer, pneumonia, and pulmonary embolism. A delayed diagnosis of its root cause can significantly elevate both morbidity and mortality rates, exemplified by instances where a parapneumonic effusion progresses to pulmonary empyema. 

Non-malignant pleural effusions frequently signal a poor prognosis in patients dealing with cardiac, renal, or hepatic failure, with respective one-year mortality rates of 57%, 46%, and 25% (Walker et al., 2017). Additionally, several rare diseases, mostly exudative in nature, are associated with pleural effusion. 

For instance, systemic lupus erythematosus sees a 30–50% prevalence of pleural effusion, termed "polyserositis," while diseases like granulomatosis with polyangiitis, rheumatoid arthritis, and Langerhans-cell granulomatosis also commonly present with pleural effusion (Anevlavis et al., 2012). A substantial portion (21%) of idiopathic and familial pulmonary hypertension cases exhibit pleural effusion, primarily unilateral (Tang et al., 2009). 

Pulmonary embolism serves as a frequent yet unexplained cause of pleural effusion, present in 20–55% of cases. The severity of the embolism and the occurrence of pulmonary infarction align with the frequency of pleural effusion in these instances. Despite the relatively small effusion volume, patients often experience severe dyspnea (Choi et al., 2017). The importance of a multifaceted nursing care plan that covers multiple conditions at once to provide a clear overview is key. 

References

Anevlavis, S., Tzouvelekis, A., & Bouros, D. (2012). Mechanisms of Pleural Involvement in Orphan Diseases. Respiration, 83(1), 5–12. https://doi.org/10.1159/000335128 

Choi, S. H., Cha, S.-I., Shin, K.-M., Lim, J.-K., Yoo, S.-S., Lee, S.-Y., Lee, J., Kim, C.-H., Park, J.-Y., & Lee, D. H. (2017). Clinical Relevance of Pleural Effusion in Patients with Pulmonary Embolism. Respiration, 93(4), 271–278. https://doi.org/10.1159/000457132 

Tang, K., Robbins, I. M., & Light, R. W. (2009). Incidence of Pleural Effusions in Idiopathic and Familial Pulmonary Arterial Hypertension Patients. Chest, 136(3), 688–693. https://doi.org/10.1378/chest.08-0659 

Walker, S. P., Morley, A. J., Stadon, L., De Fonseka, D., Arnold, D. T., Medford, A. R. L., & Maskell, N. A. (2017). Nonmalignant Pleural Effusions. Chest, 151(5), 1099–1105. https://doi.org/10.1016/j.chest.2016.12.014