c. The physician must discover the underlying cause of the inflammation and
treat it. Along with the treatment of the primary cause, symptomatic treatment should
be utilized for the effects of the pleurisy. Applications of heat or cold may ease
discomfort. Analgesics should be used to decrease the pain. Anti-inflammatory drugs
are also useful in decreasing the painful inflammation of the pleura. Additionally, the
patient should be closely observed for signs indicating the development of pleural
2-42. PLEURAL EFFUSION
a. Pleural effusion is the collection of fluid in the pleural space. Normally, the
pleural space contains a small amount of lubricating fluid that allows the surfaces of the
visceral and parietal pleura to move without friction. When pleural effusion is present,
the patient will experience shortness of breath and rapid pulse. Decreased breath
sounds will be noted on auscultation of the affected lung.
(1) Pleural effusion is normally secondary to other disease processes.
When factors influencing formation and re-absorption of pleural fluid are altered, a
transudate occurs. A transudate is fluid with a relatively low content of protein, cells,
and cellular debris. The presence of transudate would indicate an underlying cause
such as congestive heart failure, renal failure, or ascites.
(2) Local inflammation within the pleura, in adjacent tissues, or beneath the
diaphragm will cause an exudate. An exudate is fluid characterized by a relatively high
content of protein, cells, and cellular debris. The presence of exudate is indicative of
tuberculosis, pneumonia, pulmonary viruses, or cancer.
b. Again, the physician must identify and treat the underlying cause in order for
the effusion to resolve. Large amounts of fluid should be removed in order to relieve the
dyspnea and discomfort felt by the patient. This can be done by needle aspiration
(thoracentesis) or by the insertion of chest tubes to drainage. Analgesics should be
used to reduce discomfort.
a. Atelectasis is defined as collapse of the lung. This means the collapse of an
alveolus or multiple alveoli. There are two different mechanisms that may cause
(1) Pressure on the lung that restricts normal lung expansion of the alveoli.
Whenever there is an overcrowding of the thoracic contents, the spongy lung tissue will
be the first thing to collapse as a result of the compression. Such pressure may be
caused by pleural effusion, pneumothorax, tumor growth, or an upwardly displaced
(2) Obstruction of a bronchus may restrict airflow to and from the
communicating alveoli. This may be caused by inhalation of a foreign body, but the