References:
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 19, pp. 553–554)
- Saunders Comprehensive Review for the NCLEX-RN Examination, 9th Edition, ISBN 978-032-37-9530-2, by Linda Anne Silvestri, Angela E. Silvestri, and Jessica Grimm (Ch. 51, p. 692)
Pleurisy (pleuritis) refers to inflammation of both layers of the pleurae (parietal and visceral).
- Etiology: Pleurisy may develop in conjunction with pneumonia, lung abscess, or an upper respiratory tract infection, TB, or collagen disease; after trauma to the chest, pulmonary infarction, or PE; in patients with primary or metastatic cancer; and after thoracotomy.
- Clinical Manifestations: the key characteristic of pleuritic pain is its relationship to respiratory movement. Deep breathing, coughing, and sneezing all worsen the pain. The pain that appears is localized to the inflamed area, often only on one side and on the lower lobes. It is described as severe, sharp, knifelike pain. It may radiate to the shoulder or abdomen. The pain may become minimal or absent when the patient holds their breath. Later, as pleural fluid develops, the pain decreases.
- Upon assessment, shallow breathing and asymmetric excursion may be found due to splinting.
- Diagnostic Findings: initially, a pleural friction rub can be heard with a stethoscope. Later on, the sound disappears as the accumulation of fluid separates the inflamed pleural surfaces. Chest x-rays, sputum analysis, and thoracentesis can help obtain a specimen of pleural fluid for examination, and, less commonly, a pleural biopsy.
- Medical Management: The objectives of treatment are to discover the underlying condition causing the pleurisy and to relieve the pain. Additionally, watching for the development of pleural effusion (shortness of breath, pain and re-positioning to reduce pain, and decreased chest wall excursion) is also important.
- Analgesics and topical application of heat or cold can help provide symptomatic relief. An NSAID may provide pain relief while allowing the patient to take deep breaths and cough more effectively. If pain is severe, an intercostal nerve block may be required.
- Nursing Interventions: offer suggestions to enhance comfort—turning frequently (lying on the affected side) or using a pillow splint in order to reduce pleural movement.