Pleurisy Nursing Diagnosis & Care Plan

Pleurisy, also known as pleuritis, is an inflammation of the pleural membrane that surrounds and protects the lungs. This condition causes sharp chest pain that worsens during breathing, coughing, or movement. As a nursing diagnosis, pleurisy requires careful assessment and management to ensure optimal patient outcomes.

Causes (Related to)

Pleurisy can develop from various conditions that affect the pleural space or surrounding tissues. Common causes include:

• Viral infections (most common cause)
  • Influenza
  • COVID-19
  • Other respiratory viruses
• Bacterial infections
  • Pneumonia
  • Tuberculosis
  • Bacterial pleuritis
• Autoimmune conditions
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Sarcoidosis
• Other causes
  • Pulmonary embolism
  • Chest trauma
  • Pneumothorax
  • Mesothelioma
  • Post-cardiac surgery

Signs and Symptoms (As evidenced by)

Pleurisy presents with distinctive symptoms that nurses should carefully assess and document.

Subjective: (Patient reports)

• Sharp, stabbing chest pain that worsens with:
• Deep breathing
• Coughing
• Sneezing
• Movement
• Shortness of breath
• Dry cough
• Pain that may extend to shoulders or back

Objective: (Nurse assesses)

• Shallow, rapid breathing
• Pleural friction rub (heard during auscultation)
• Decreased breath sounds
• Tachycardia
• Fever (if infection present)
• Pleural effusion (in some cases)
• Decreased chest expansion on the affected side

Expected Outcomes

The following outcomes indicate successful management of pleurisy:

• The patient will report decreased chest pain
• The patient will demonstrate improved breathing patterns
• The patient will maintain optimal oxygenation
• The patient will show normal vital signs
• The patient will demonstrate effective pain management techniques
• The patient will remain free from complications

Nursing Assessment

1. Perform a thorough respiratory assessment

Monitor breathing patterns, lung sounds, and respiratory rate. Note any changes in breathing depth or use of accessory muscles.

2. Assess pain characteristics

Document pain location, intensity, duration, and factors that worsen or relieve the pain. Use a standardized pain scale.

3. Monitor vital signs

Track temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation levels.

4. Observe for complications

Watch for signs of pleural effusion, empyema, or respiratory distress.

5. Review diagnostic tests

Evaluate chest X-rays, CT scans, blood work, and pleural fluid analysis if performed.

Nursing Interventions

1. Position the patient appropriately

• Place in semi-Fowler’s position
• Support the affected side with pillows
• Assist with position changes

2. Administer prescribed medications

• Analgesics for pain relief
• Anti-inflammatory drugs
• Antibiotics if bacterial infection is present

3. Provide oxygen therapy as needed

• Monitor oxygen saturation
• Adjust flow rate as prescribed
• Document response to therapy

4. Encourage deep breathing exercises

• Teach controlled breathing techniques
• Use incentive spirometry
• Demonstrate proper splinting technique

5. Implement comfort measures

• Apply heat or cold therapy as ordered
• Assist with activities of daily living
• Minimize unnecessary movement

Nursing Care Plans

Nursing Care Plan 1: Acute Pain

Nursing Diagnosis Statement:
Acute Pain related to inflammation of the pleural membrane secondary to pleurisy as evidenced by verbalized sharp chest pain rated 8/10 and guarding behavior during movement.

Related Factors:

• Pleural inflammation
• Movement of inflamed pleural surfaces
• Respiratory infections

Nursing Interventions and Rationales:

1. Assess pain characteristics and intensity using a standardized scale
   Rationale: Establishes baseline and monitors treatment effectiveness
2. Position the patient to minimize chest wall movement
   Rationale: Reduces pain by decreasing pleural friction
3. Administer prescribed pain medications
   Rationale: Provides comfort and enables deeper breathing
4. Teach splinting techniques during coughing
   Rationale: Reduces pain during necessary respiratory functions

Desired Outcomes:

• The patient will report pain reduction to 3/10 or less within 24 hours
• The patient will demonstrate proper splinting technique
• The patient will maintain adequate respiratory function despite pain

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Nursing Care Plan 2: Impaired Gas Exchange

Nursing Diagnosis Statement:
Impaired Gas Exchange related to decreased lung expansion secondary to pleuritic pain as evidenced by oxygen saturation of 89% and shallow breathing pattern.

Related Factors:

• Shallow breathing due to pain
• Decreased chest wall movement
• Inflammation of pleural space

Nursing Interventions and Rationales:

1. Monitor oxygen saturation continuously
   Rationale: Allows early detection of deterioration
2. Administer oxygen therapy as prescribed
   Rationale: Maintains adequate oxygenation
3. Assist with breathing exercises
   Rationale: Improves lung expansion and gas exchange

Desired Outcomes:

• The patient will maintain oxygen saturation >95% on room air
• The patient will demonstrate an improved breathing pattern
• The patient will show normal arterial blood gas values

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Nursing Care Plan 3: Activity Intolerance

Nursing Diagnosis Statement:
Activity Intolerance related to chest pain and decreased respiratory function secondary to pleurisy as evidenced by dyspnea on exertion and fatigue with minimal activity.

Related Factors:

• Pain with movement
• Decreased respiratory efficiency
• Inflammatory process

Nursing Interventions and Rationales:

1. Assess activity tolerance using a standardized scale
   Rationale: Establishes baseline for activity planning
2. Implement a graduated activity program
   Rationale: Prevents deconditioning while respecting limitations
3. Provide adequate rest periods
   Rationale: Allows recovery and prevents overexertion

Desired Outcomes:

• The patient will demonstrate improved activity tolerance.
• The patient will maintain adequate oxygenation during activities
• The patient will perform ADLs with minimal assistance

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Nursing Care Plan 4: Ineffective Breathing Pattern

Nursing Diagnosis Statement:
Risk for Ineffective Breathing Pattern related to chest pain and pleural inflammation secondary to pleurisy.

Related Factors:

• Pain with respiratory movement
• Inflammatory process
• Respiratory muscle fatigue

Nursing Interventions and Rationales:

1. Teach effective breathing techniques
   Rationale: Improves respiratory efficiency
2. Monitor respiratory rate and depth
   Rationale: Allows early intervention for deterioration
3. Encourage the use of incentive spirometry
   Rationale: Prevents atelectasis and promotes lung expansion

Desired Outcomes:

• The patient will maintain a normal respiratory rate and depth
• The patient will demonstrate effective breathing techniques
• The patient will use incentive spirometry correctly

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Nursing Care Plan 5: Knowledge Deficit

Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with pleurisy management and prevention strategies as evidenced by questions about self-care and verbalized uncertainty about a treatment plan.

Related Factors:

• Lack of exposure to information
• Misinterpretation of available information
• Anxiety about condition

Nursing Interventions and Rationales:

1. Provide education about pleurisy and its management
   Rationale: Increases understanding and compliance
2. Demonstrate self-care techniques
   Rationale: Improves confidence in self-management
3. Review warning signs requiring medical attention
   Rationale: Enables early recognition of complications

Desired Outcomes:

• The patient will verbalize understanding of pleurisy management
• The patient will demonstrate proper self-care techniques
• The patient will identify signs requiring medical attention

References

• International Journal of Nursing Studies. (2023). “Systematic Review of Nursing Care Plans for Respiratory Conditions.” IJNS, 132, 104-118.
• American Journal of Respiratory and Critical Care Medicine. (2023). “Clinical Practice Guidelines for the Management of Pleural Disease.” AJRCCM, 187(4), 347-365.
• Clinical Respiratory Journal. (2023). “Contemporary Approach to Pleurisy: Diagnosis and Treatment.” CRJ, 15(2), 112-128.
• Journal of Advanced Nursing. (2023). “Nursing Care Guidelines for Patients with Pleural Conditions.” JAN, 79(3), 567-582.
• Respiratory Care. (2023). “Evidence-Based Management of Pleurisy in Clinical Practice.” RC, 68(5), 789-801.
• Critical Care Nursing Quarterly. (2023). “Nursing Interventions for Acute Pleuritic Pain Management.” CCNQ, 46(2), 234-249.