Pleurisy Nursing Care Plans Diagnosis and Interventions
Pleurisy NCLEX Review and Nursing Care Plans
Pleurisy is a medical condition affecting the two layers of tissue called “pleura”, which act as a separator between the lungs and the chest wall. One of the layers lines the exterior of the lungs, while the other wraps around the inner chest wall.
There is a space between these two membranes, which has a thin sheet of liquid that acts as a lubricant. The smooth gliding action between these two layers enables the two-way breathing process of lung expansion and contraction. Pleurisy, also known as “pleuritis”, occurs when there is swelling and inflammation of the pleura. In addition to this, the fluid in the pleural space may thicken, causing the pleura to rub together.
These conditions manifest as a sharp chest pain called “pleuritic pain”, and can be worse during respirations.
Signs and Symptoms of Pleurisy
- Pleuritic pain – a sharp, stabbing chest pain that gets worse with breathing, coughing, or sneezing. This might also be worsened by moving the upper body, and may radiate to the shoulders or back.
- Shortness of breath or difficulty of breathing – the patient tends to have less respirations or perform shallow breathing as a response to the pain
- Fever, in some cases, especially when infection is the cause of pleurisy
- Cough, in some cases
Causes of Pleurisy
- Infection: The most common cause of pleurisy is infection. Several viruses that cause pleurisy include influenza or flu virus, cytomegalovirus (CMV), parainfluenza virus, and Epstein-Barr virus. Bacterial infections resulting to pleurisy are less common, and can be caused by streptococcus (related to pneumonia and throat infections), staphylococcus (related to skin infections and sepsis) or Mycobacterium tuberculosis. Fungal infection can also cause pleurisy.
- Trauma: Mechanical injury can result to pleurisy. The pleura can have swelling and inflammation when there is bruising or fracture of the ribs.
- Pulmonary embolism: A blood clot that blocks the lungs can cause reduced blood flow and oxygen levels in some parts of the lungs and eventually cause tissue death. This can also result to pleurisy.
- Pneumothorax: The buildup of air in the lungs following chest trauma or mechanical ventilation.
- Cancer: When a tumor grows in the pleural cavity, fluid buildup occurs, causing pleurisy and pleural effusion.
- Autoimmune disorders: Illnesses such as lupus or rheumatoid arthritis involve the immune system abnormally attacking healthy tissues.
- Certain medications with a side effect that manifests as a lupus-like condition, such as hydralazine, isoniazid, and procainamide.
- Chemotherapy and radiotherapy
Complications of Pleurisy
- Pleural Effusion: In cases when pleurisy is caused by a bacterial infection (such as tuberculosis) or a pulmonary embolism, an excessive buildup of fluid in the pleural cavity is evident. This is called pleural effusion, which is characterized by chest pain, shortness of breath, and cough. Treating the underlying cause of pleurisy usually resolves pleural effusion. If unresolved, surgical intervention such as putting a chest drain may be needed.
- Atelectasis: Pleurisy may eventually lead to the partial or total collapse of the lung due to fluid buildup in the alveoli.
- Empyema: Bacterial infections resulting to pleurisy may eventually develop pockets of pus in the pleural space known as empyema or purulent pleuritis.
- Imaging – chest X-ray, CT scan, or ultrasound
- Blood tests – to determine any bacterial, viral, or fungal pathogens, or any autoimmune disease
- Electrocardiogram (ECG) – to check if the chest pain is heart-related or pleurisy
- Thoracentesis – needle insertion to remove small amounts of pleural fluid from the lungs, and study a sample fluid to see the cause of pleurisy
- Thorascopy – the use of thorascope to view the thoracic cavity
Treatments for Pleurisy
- Antibiotics that are specific for bacteria-caused pleurisy
- Antifungals –for fungal-caused pleurisy
- If pleurisy is caused by a virus – antiviral may not be required as it can resolve on its own. The doctor may ask the patient to rest for a few days, with close monitoring.
- Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen are effective to relieve pleuritic pain
- In cases when NSAIDS are not helpful, paracetamol or codeine can be administered. Codeine can also help suppress cough.
- Chest drain –If pleurisy is associated with pleural effusion, a tube is inserted into the pleural space to drain excess fluid
- Smoking cessation – smoking causes irritation to the lungs
Pleurisy Nursing Diagnosis
Nursing Care Plan for Pleurisy 1
Nursing Diagnosis: Acute Pain related to pleurisy as evidenced by chest pain rating of 8 out of 10 on pain scale
Desired Outcome: The patient will report a decrease of pain level to 0 upon discharge
|Pleurisy Nursing Interventions||Rationales|
|Assess the patient using a 0-10 pain rating scale for intensity, as well as characteristics and location of pain (sharp, dull, crushing, etc.)||To assist in creating an accurate diagnosis and treating the underlying cause of pain.|
|Administer the prescribed pain medications and assess response at least 30 minutes after drug administration.||To alleviate the pain and to monitor the efficacy of pharmacological pain relief.|
|Educate patient on deep breathing exercises and relaxation techniques.||Deep breathing exercises can avoid ineffective shallow breathing which is common a response of a patient who has pleuritic pain. Relaxation techniques relieves stress and lowers energy demands.|
Nursing Care Plan for Pleurisy 2
Nursing Diagnosis: Ineffective Breathing Pattern related to bacteria-caused pleurisy as evidenced by shortness of breath and cough
Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation of above 96%, and verbalizes ease of breathing.
|Pleurisy Nursing Interventions||Rationales|
|Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.|
|Administer the prescribed antibiotic medications.||To treat bacterial infection, which is the underlying cause of the patient’s pleurisy.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
|Assist the patient to change positions as tolerated. Encourage the patient to lie on the affected side if possible.||According to Gate Control Theory of Pain, non-painful sensations such as putting pressure by lying on the affected side can reduce pain perception.|
Nursing Care Plan for Pleurisy 3
Nursing Diagnosis: Anxiety related to chest pain secondary to pleurisy as evidenced by restlessness, irritability, hyperventilation, and verbal report of worrying about his/her condition
Desired Outcome: The patient will be able to verbalize decreased reports of anxiety, with noted relaxation of mood and outlook.
|Pleurisy Nursing Interventions||Rationale|
|Assess the patient’s anxiety levels, particularly the manifestations, triggering factors and compounding features.||Proper assessment of the patient’s anxiety levels will provide crucial information for the healthcare team. Knowing the manifestations of the patient’s anxiety will enable the healthcare provider to properly and effectively address the condition. Triggering factors and compounding features will assist the team and the patient in formulating effective strategies for managing anxiety. It is also helpful to take note that sources of a patient’s anxiety may come from fear and uncertainty of prognosis, treatment, and recovery, loss of independence, and changes in defined roles.|
|Ensure using a calm and non-threatening tone when speaking with the patient. Take note to maintain eye contact when interacting with the patient, answering concerns as calmly and honestly as possible. Practice open communication when dealing with anxious patients.||A calm and non-threatening tone when speaking with the anxious patient will promote a calm and supportive environment. Maintaining eye contact ensures that the patient’s concerns are heard and understood by the healthcare provider. Communicating openly with an anxious patient establishes trust, thus ensuring for compliance with treatment goals.|
|Show support to the patient through the following: Use of presenceUse of therapeutic touch, with permissionAllowing verbalizationDisplay of calm demeanor||Utilizing the aforementioned methods of showing support (i.e., use of presence, therapeutic touch, verbalizations, and a calm demeanor) will promote trust and communication with the patient, thereby allowing for further expression of patient concerns or clarifications that is crucial for the therapeutic regimen.|
|Receive, without judgment, the patient’s defenses towards anxiety and pain. Do not engage, dare, or argue with the patient.||The patient’s reaction to anxiety can sometimes be uncalled for and may put off the care team. However, unruly behavior may be entirely be brought by stressful situations and should not be taken personally. Maintaining professional decorum at all times will make the patient feel less threatened, therefore allowing for self-introspection of disorderly behavior.|
|Use brief and simple language when interacting with the anxious patient.||Patients experiencing anxiety attacks, especially those having moderate to severe forms, are least likely to understand and comprehend information on such states. Utilizing brief statements on simple language will help the patient understand the instructions of the caregiver.|
|Decrease stressful stimuli by ensuring and maintaining a quiet and peaceful environment. Remove “intimidating” equipment away from the patient.||An anxious patient may have increased levels of anxiety when in the presence of noisy conversation, excessive background noise and unknown equipment. Removing such distractions allows for better patient compliance with the prescribed treatment regimen.|
|Encourage the patient to verbalize anxiety episodes. Analyze with the patient provoking factors or situations that increase anxiety.||Open discussion of factors that trigger anxiety can assist the patient and the care team on how to effectively and efficiently handle these episodes. It helps establish a realistic approach for the patient’s condition, thereby applying appropriate interventions as it happens.|
|Support the patient in developing coping skills for anxiety episodes such as relaxation, deep breathing exercises, visualizations, use of self-reassuring statements.||Non-pharmacologic coping skills are helpful tools, in conjunction with medications, in dealing with anxiety. Discovering coping skills that work and are applicable for the patient ensures a variety of ways on how the patient will handle anxious episodes.|
|Describe and expound to the patient all of the activities in the patient’s care. Ensure using non-medical terms when explaining procedures to the patient. Advise the patient in advance, if possible, of the planned treatment regimen, ensuring to validate the patient’s understanding.||Anxiety may arise from impulsiveness and ambiguous situations, especially in giving treatment. Explaining, in advance, all of the procedures and treatment that will be given to the patient will ensure reduced anxiety levels and full participation in the therapeutic regimen. This gives increased coping skills for the patient for they know what to expect from the treatment they are receiving.|
Nursing Care Plan for Pleurisy 4
Nursing Diagnosis: Fatigue related to respiratory effort secondary to pleurisy as evidenced by exhausted appearance and inability to do activities of daily living.
Desired Outcome: The patient will be able to participate and accomplish activities of daily living to the optimal capacity appropriate for the individual.
|Pleurisy Nursing Interventions||Rationale|
|Assess the patient’s level and narrative of fatigue. Take note of the clinical manifestations, aggravating factors, and compounding features that relate to the patient’s fatiguability.||Proper assessment of a patient’s fatigue is necessary for planning and implementing an effective therapeutic regimen. Recognizing the features of a patient’s fatigue episodes, factors that worsen or improve these episodes will help the healthcare team formulate a personalized care regimen for the patient. One way of gauging a patient’s fatigue is the use of a numerical scale. This allows the healthcare team to measure the effectiveness of therapy to apply the necessary improvements as needed.|
|Recognize and measure the patient’s ability to perform personal activities such as: Activities of daily livingInstrumental activities Demands of daily living||Fatigue can affect the patient’s role and responsibilities in society. Recognizing the activities that the patient can and cannot tolerate will help the care teamwork around therapies appropriate for the individual.|
|Measure and gauge the patient’s outlook regarding their fatigue, their eagerness for relief of it, and support system by their family and significant others.||Knowing the patient’s motivation to improve their health will promote active participation in formulating, employing, and evaluating treatment regimens for the patient’s fatigue. Knowing the patient’s support system will help the patient cope with the challenges of his condition.|
|Observe the patient’s reaction to activities, such as any differences in the patient’s vital signs (i.e., heart rate, blood pressure, respiratory rate)||Tolerance levels of an individual vary and will have an impact depending on their current state of health, disease progression, nutritional condition, type and amount of medical condition was subjected to.|
|Recognize and assess the patient’s sleeping and resting patterns. Take note of the quantity, quality, and any alterations in the patient’s thought processes.||Issues of a patient regarding their sleeping and resting patterns can add up to their fatigue. Furthermore, factors such as emotional distress, drug side effects, etc. can further compound a patient’s fatigue.|
|Limit external sources of unnecessary stimuli, particularly on times of planned rest and sleep periods.||External stimuli such as vivid lighting, visitors, distracting sounds, and physical clutter on the patient’s surroundings can disrupt their sleeping patterns and may contribute to the patient’s fatigue.|
|Assist the patient in developing a schedule for rest and activities of daily living. Highlight the need for frequent rest periods.||Enforcing a schedule for sleep, rest and activities will help the patient to cope during episodes of fatigue. Furthermore, it balances the patient’s energy levels so that he can plan out activities efficiently and effectively.|
|Educate the patient on ways in conserving energy levels. Seek the professional help of an occupational therapist as needed.||The occupational therapist is a healthcare team member who specializes in assisting patients in recovering their lost independence in doing activities of daily living. Because of the associated challenges for the patient and caregivers, the occupational therapist can support their knowledge and skills to be able to cope with handling fatigue through various energy conversation techniques (i.e., the delegation of tasks, priority setting, etc.)|
|Recognize energy conservation techniques such as distributing activities into segments, which are convenient and within the capacity of the patient. Support the patient when moving or when doing self-care as needed.||The associated weakness and fatigue, felt by the patient, oftentimes hinders the patient in accomplishing activities of daily living. The healthcare provider being near to assist the patient ensures that these tasks are done, and safety is maintained all throughout.|
Nursing Care Plan for Pleurisy 5
Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with the disease process secondary to pleurisy as evidenced by the inability to comply with the treatment regimen.
|Pleurisy Nursing Interventions||Rationale|
|Determine the patient and caregiver’s knowledge of pleurisy, its associated complications, and the appropriate treatment plan.||Different individuals learn in a variety of ways. Likewise, the processing of newly acquired information varies from person to person. Determining the knowledge base of the patient and his caregiver regarding pleurisy can reveal strengths and weaknesses of teaching and will serve as the basis of the teaching plan.|
|Review with the patient and caregiver of the current condition of the disease, including the normal lung function.||Educating the patient and caregiver of the normal lung function and the deviations associated with pleurisy enforces understanding of the situation and the significance of compliance with the therapeutic regimen.|
|Recognize the needs of the patient regarding self-care and accomplishment of activities of daily living. Also, explore the needs of the caregiver in assisting the patient to accomplish these tasks.||Due to the nature of respiratory conditions being slow to resolve, (i.e., pleurisy), addressing these challenges is the priority. Providing instruction can improve the patient and caregiver’s coping skills in managing their needs, and likewise will reduce anxiety and unnecessary stress.|
|Recognize potential needs of the patient in their home setting.||Since respiratory conditions take time to resolve (i.e., pleurisy), continuing the patient’s therapy after hospital discharge is oftentimes warranted. Ensuring the availability of out-patient resources and support care teams outside the hospital should be prioritized in order to comply with patient therapies.|
|Ensure that instructions are provided in written and verbal form.||Fatigue can affect the patient’s ability to process and absorb information. Varied ways of relaying information, such as written or verbal, will serve as a guide for the patient and caregiver in order to comply with the treatment regimen.|
|Emphasize the significance of complying and continuing with effective respiratory exercises (i.e., deep breathing exercises, coughing practices).||The patient is at risk from developing relapse of pleurisy at 6 to 8 weeks post hospitalization. Therefore, respiratory exercises such as deep breathing and coughing are helpful tools in aiding the patient’s lungs to recover. These exercises strengthen and practice the lungs towards improving respiratory function following pleurisy.|
|Reinforce the importance of compliance with the prescribed antibiotic therapy.||A complete course of antibiotic therapy is necessary for the full recovery of the patient from pleurisy. Interruptions and non-compliance with dosing schedules may result in failure in recovery and the occurrence of rebound disease.|
|Reiterate to the patient and caregiver the significance of smoke cessation.||Tobacco smoking acts on the lung parenchyma by damaging the cilia that line the respiratory tract. This in turn irritates the latent mucosa, thereby compromising the body’s natural defense. Ensuring that the patient and caregiver understand this information will help them with compliance with the treatment regimen.|
|Plan the phases necessary to promote health and well-being through the following: Balanced rest and activityAn adequate diet rich in macro and micronutrientsAvoidance of opportunities for infections such as crowded places, flu season, etc. Compliance with follow-up check-upsObtaining vaccinations as needed, especially for high-risk patients||Reiterating these steps towards attaining the highest possible health and well-being will increase the patient’s natural defenses, thus limiting reinfections that will be detrimental to the patient’s health.|
|Instruct the patient and caregiver of the danger signs of worsening health condition such as: Increasing difficulty in breathingAssociated chest pain Prolonged fatigueUnexplained weight lossFever and chillsTenacious coughingMental disturbances||Timely and accurate evaluation of worsening clinical manifestations ensures the application of appropriate interventions and reduction of possible complications. This also reinforces a sense of responsibility and control for the patient and caregiver to better manage the disease.|
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Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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