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Pleural effusion diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy

So if somebody has a pleural effusion, and this is what we’re
looking at right here, we’re looking at a set of
lungs with a pleural effusion, we’re going to know
that something is wrong based off of a couple
of signs and symptoms that we’ll collect from the patient. So just to kind of revisit
what a pleural effusion is, remember that we have our lung, right? Our lung sits in this sac, this is called our visceral pleura which is this darker
color pink that we have. And then on the outside of that, we have a lighter pink color and that sac or that membrane is actually called the parietal pleura. The effusion is the buildup
of fluid in between, and that’s our pleural space. And imagine what the
problem would be with this. What do you think a patient
would complain about if they had a buildup of
fluid in their pleural space? So we can see it’s really cramping up the available room of the lung. So some of the things that
they’re going to complain about is going to be some chest pain, right? Certainly chest pain. Especially as they are
trying to breathe in, as they’re trying to inhale, because there’s not enough
space for the lung to expand. And we call that pleurisy. And that’s when you have that chest pain when you’re trying to inhale. They might be having some
difficulty breathing. So that would be our dyspnea. We could even see that this
person has a dry cough. And I make a point to say dry cough, because the fluid that we have
accumulating in this space is really on the outside of the lung. It’s not on the inside
where our air space is, it’s on the outside. So that dry cough, we’re not bringing up anything, essentially because there’s
nothing to bring up. There’s nothing that we can clear. However our lungs are still going to try to compensate to make room by coughing, as if it could clear out something. So our first thing would
be the clues, right? Would be our clue. So I’m going to just
actually come over here and I’m going to write our clues and the clues really are
our signs and symptoms. So S-S. And that’s going to
lead us to believe that there is something going
on with this patient. So if we suspect, you know what, there’s something going
on in this guy’s lungs, we’ve really got to check this out. There’s a couple things that we can do. One of the early things that we can do is actually to do a chest x-ray. So we could do a chest x-ray and that really is just
looking at the lungs. So I’m drawing a box around the lungs. So you can imagine that this is a picture. And that would be a chest x-ray. And that’s going to
give us a visualization so we can see if there’s fluid in there. And here’s what a picture of
a chest x-ray might look like of a patient that had a pleural effusion. Now imagine this patient is
lying down on their side. So this would be a side
view of this chest x-ray. And what we can see is that
we’re able to see the ribs, and I kind of draw this out, and we can see that this is their heart or cardiac segment here, and then this would be part of their arm, this is their diaphragm, so on this side what
you’re looking at here, and let me just kind of
highlight this in a better color, on this side, this would be our normal lung. This is a normal space. So we see the darker color because that represents air space. But on this side, you see that there’s less air space. And we have a lot more of what looks like to be a more solid type of dense area and this dense area is
actually the effusion. So when you’re looking at a chest x-ray, you see that this is the
effusion that’s happening here. The reason why you see it on the side is because the patient
is lying on their side. So that’s gravity. If this patient were sitting straight up, then you would see the
fluid at the bottom. Just like if they were perhaps
lying on their other side, you would see the fluid lying
along the sternal border. So that’s something to look
out for in a chest x-ray. Another thing that we could do is we can do a CT scan. And both a chest x-ray and a CT scan will give us an image of the lungs. A CT scan is just going to
give us a little bit more of a detailed image. So we would do some diagnostics. Diagnostics, that’s what these fall under. Now in addition to that chest x-ray and that CT scan, we could do some further tests. Perhaps we think that this
person has an infection, so we want to do like a blood culture and the blood culture really is just taking a sample of the blood, so let’s say that this
is my blood drop here, taking a sample of the blood to figure out if there
is any type of infection that’s happening inside that blood and what we need to do
to kill that infection. But really, based off of that chest x-ray and based off of that CT scan, we should be able to see
if there is, in fact, fluid in the lung. So if there is now, well what do we do? So our first choice of a treatment, and let me get back my color here, would be to do a thoracentesis. And I’m writing these words down because they’re pretty big words, and they’re not something
that we use every day. So a thoracentesis, and what a thoracentesis is, is really going in to this space. So going in to this pleural space, and I’m going to pick a color
that we can see brightly. So let’s go with yellow. What we do is we take a needle and we insert the needle
into the pleural space and we can actually aspirate
or withdraw the fluid from that needle. And how that works is
we’ll insert the needle, so here’s my yellow needle
going into the pleural space, and we’re going to withdraw the fluid and the needle is attached to tubing and that tubing is either going to be connected to some kind of collection bag, so a collection bag to collect the fluid, or it could be connected
to a glass container. And that just really
depends on the facility and whoever is doing the procedure. So we can actually collect the fluid, so the fluid is going
to collect into the bag. And we want to make
sure that we collect it because we want to test it later to figure out what type of fluid it is. Is it transudative or is it exudative. And that’s going to give us an idea of kind of where it came from. Now what we do with thoracentesis, we actually are going to
have the patient sit upright. So this patient is going
to be sitting upright on the edge of their bed, so it’s done in their room, and they’re going to be kind of draped over the bedside table. So that’s what I’m
drawing here is the table. They’re going to have their hands draped over the bedside table, and their arm, and we’re actually going to enter into that pleural space
from behind the patient. So the patient’s awake for this, right? We’re definitely going
to give them something so they feel comfortable, so they’re not going to experience pain. And we also do this ultrasound guided. So I’m writing US guided. And that’s important, that way we can see exactly where we’re going because we don’t want to hurt the patient or any of the tissue. And so what we’ll do
with the thoracentesis, just extract all that fluid, collect it and test it. Other things that we can do, these would be more invasive procedures, but other things we can do, we can do something called a pleurodesis. Pleurodesis. Now if somebody has
recurrent pleural effusions, meaning it’s happening over
and over and over again, we can do something called a pleurodesis. And what that is, is that we’re going to go
into that same pleural space, and let’s use this lung, and what we’re going to do is we’re going to introduce
some type of medication or some type of irritant. And that’s really going to cause
irritation inside of there. And the goal is, is that irritation is going to cause some sort of tissue damage essentially. And as the tissue heals, and you see me scribbling in the space, as the tissue heals, scar tissue is going to develop, and these two membranes, these two pleuras, right? We have our visceral and
we have our parietal, they’re going to adhere together, they’re going to stick together, and what that does, is that that closes out this potential space that we had in here, and if we can close out
that potential space, well then we take away the chances of having a pleural effusion. Again, this would be for somebody that really has a recurrent issue with this pleural effusion. Now sometimes this can
actually reverse itself. So meaning that the spaces can separate and you might end up with
a pleural effusion again. So this is a pretty invasive procedure that we do for those that really
suffer from it very often. Now another thing that we can do, that’s more invasive as well, would be a pleuroperitoneal shunt. And as the term suggests, we would actually put in
some type of drainage device into the pleural space, and where we have this pleural effusion. So you see where I have my needle, where I did my thoracentesis, we can put in a shunt. So imagine now that this needle has turned into a drainage device. And we can have this actual shunt, we can have it redirect. So I’m going to follow it somewhere else. We can have it redirect
into our peritoneal space. And when we talk about
our peritoneal space, we’re really talking about the space that’s in our abdominal cavity. So let’s pretend this
is our abdominal cavity. And the fluid that’s in here, the fluid that’s in the pleural space will empty into this peritoneal cavity and it will be absorbed and
excreted out through there. So our thoracentesis would be
our first line of treatment as far as to get rid of the fluid, and then pleurodesis
or peritoneal shunting, pleuroperitoneal shunting, those would be more invasive procedures for someone that really has been suffering from this a lot. Now when you’re dealing with
things like pleural effusion, we always want to treat
the underlying cause. So if there’s an infection, think about giving antibiotics for it. If there’s a malignancy, something that’s cancerous like a tumor, that perhaps is causing a blockage in the lymphatic system, so we can’t drain fluid properly
and that’s how we got it, well then we want to treat the malignancy. So chemotherapy might
be appropriate as well. Now it’s really, really important that we treat a pleural effusion. Now why? Let’s go back to our image here. If we leave a pleural effusion untreated, over time it can turn into an empyema. So let’s write that word down. I’m going to write it
in a different color. It can become an empyema. So now you see where we’re
building up a vocabulary of some big words. Now an empyema essentially is an infection of this fluid. And what happens is that early on empyema is going to turn
into pus-like, right? So I’m going to start drawing
some other colors in here. It’s going to get pus-like and it’ll be easy flowing early on, but if we leave it alone, this infection is going to
cause an inflammatory response And as such we can end up with scar tissue in our lung area, and around all of our pleural spaces here, pleural membranes. We’ll end up with scar tissue. And it can start to, you see how it’s making these rooms, it can start to loculate, which means that they’re
kind of blocking off areas of this pleural effusion. And as these are loculated, or kind of put into their own rooms, their own cavities, they’re going to become less fluid-like and more hard. And it’s going to become like
cottage cheese consistency. And as that happens, we call that organizing. Because it’s organizing
into this new form, not organizing like clean, that’s not what’s happening. And once they’ve loculated
and they’ve organized, well now it’s really hard to get to. It’s difficult to drain and
it’s difficult to treat. And this infection can actually spill over into our blood vessels, and cause some serious damage. Because remember, we actually have blood vessels, right? That run all along our lungs and if this infection gets into contact, and I’m just going to
draw some blue ones too, if this infection gets into
contact with our blood vessels, it can get into our circulatory system and we can become septic. So treating it early on is a
very important thing to do.

36 thoughts on “Pleural effusion diagnosis and treatment | Respiratory system diseases | NCLEX-RN | Khan Academy

  1. Thanks.. i have one in one x ray.. I'm scare … left side.. now I'm feeling cough and pain in ribs.. doctor appointment is soon.. let see what happens ! Thanks for the information. ..

  2. Very helpful. Thanks i am looking forward to see more videos by you… Thanks a lot…you explain it very well and very easy to understand. Good luck! 

  3. i had a Xray done my lungs and heart came back fine, is it possible to miss? because iv had nearly all the symptoms for about a week now and after a few deep breaths i could curl up and cry.

  4. can tuberculosis cause pleural effusion or the other way? and can anti tb drugs medication manage pleural effusion? tnx more power to ur channel.

  5. Damn.
    I'm wondering if a pleural effusion can be caused by very-hard coughing as associated with asthma and/or COPD. And, is thoracentesis always required for elimination of the fluid? Can they not instead administer a powerful diuretic like Lasix instead?

  6. My friend has had this fluid removed and due to poor facilities in Zambia they can't seem to know the cause or the source. How can I help him?

  7. so quick question. just for clarification purpose. would you say that empyema is like pneumonia? or whats the difference? just the way it began?

  8. For sometime ago, i have been coughing heavily. can that cause pleurisy? now im suffering from one. can anti-bio-tic and anti-inflammatory cure it? some body help please

  9. Seems like my infusion has fluid as soon as I start doing chores I get pains in my chest and feel faint. Plus trouble breathing.ive had mine for 3months now. It's fing horrible. Mines reoccurring all the time it's frightening. Kemp kills your body cells.

  10. If someone has empyema or malignant pleural effusion, pleuroperitoneal shunt is no option…..what the fuck …lady You must be carefull when saying these things…

  11. Thank you this video is by far the best one I’ve seen x. I have this. Often. Over the years x. You are so clear. Amazing xxxx. Bless you xx.

  12. Sir,
    Me qaiser khan suffering from plural have been taken out the water by injecting needle but by doing after ultra sound there are some (loctation) word can be wrong the doctor is saying that some kind of thread have been appeared they said it can be removed by medicine aftr course of nine month,the medicine are
    Myrin-p forte

  13. Sir,
    Me qaiser khan suffering from plural have been taken out the water by injecting needle but by doing after ultra sound there are some (loctation) word can be wrong the doctor is saying that some kind of thread have been appeared they said it can be removed by medicine aftr course of nine month,the medicine are
    Myrin-p forte

  14. Very Helpful, as I am currently experiencing the awful pleurisy pain and I am probably going to need Thoracentisis myself…learned a lot Thanks!

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