Capitol University
College of Nursing
PLEURAL EFFUSION
SUBMITTED TO:
(Clinical Instructor)
SUBMITTED BY:
RLE 7 GROUP 21
TABLE OF CONTENTS
I. Introduction………………………………………………..…………….…3
A. General objective…………………………………………………6
B. Specific objectives………………………………………………..6
C. Scope and limitations……………………………………………6
II. Assessment
IV. Pathophysiology
A. Narrative form…………………………………………………….24
B. Schematic Diagram………………………………………………26
V. Medical management
X. References ……………………….………………………………...……42
I. INTRODUCTION
3
Anteroposterior
upright chest
radiograph shows a
massive left-sided
pleural effusion
with contralateral
mediastinal shift.
Pleural effusion is excess fluid that accumulates in the pleural cavity, the
fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair
breathing by limiting the expansion of the lungs during inhalation.
Pleural fluid normally seeps continually into the pleural space from the
capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries
and lymphatic system. Any condition that interferes with either secretion or drainage of
this fluid leads to pleural effusion.
Pleural fluid may be (1) hemorrhagic (or bloody), such as when a tumor is
present or after trauma or pulmonary embolus with infarction; (2) chylous (or thick and
white), such as after lymphatic obstruction or trauma to the thoracic duct; or (3) rich in
cholesterol, such as in chronic, recurrent effusions caused by tuberculosis or
rheumatoid arthritis. If there is a high in WBC count and the pleural fluid is purulent, the
effusion is called emphysema. Emphysema of any volume requires drainage and
treatment of the infection.
If the pus is not drained, it may become thick and almost solidified or
loculated (containing cavities), a condition called fibrothorax.
A. GENERAL OBJECTIVE
B. SPECIFIC OBJECTIVES
1. Perform a thorough assessment and careful gathering of data that are clinically
significant and will be utilized as reliable cues for our care plans.
4. Design individualized nursing care plans based on nursing diagnoses that are
suitable and feasible to carry out.
5. Carry out nursing interventions that are effective, reality based, time-bounded,
achievable and beneficial for our client.
This study is limited only to the available records found on the patient’s
chart and the information being provided for by the family members present at the
patient’s room during the time of assessment. Other factors that will also be considered
7
as limitations to this study would include the short-duration of time given for ICU
rotation.
II. ASSESSMENT
Sex: Male
Height: NA
Weight: NA
Nationality: Filipino
Occupation: barber
Income: P1700/month
Admitting Diagnosis:
Pleural Effusion probably secondary to Pneumonia
B. ASSESSMENT TOOL
VITAL SIGNS:
Temperature: 36.7°c
Weight: NA
Height: NA
GENERAL DATA:
Source of information:
( - ) chest pain
Non asthmatic
9
Non diabetic
Non hypertensive
( - ) food/drug allergy
( - ) illness
FAMILY HISTORY:
( + ) HPN (paternal)
Single, barber
ACTIVITY-EXERCISE PATTERN
Pt.X pericordial area is flat; PMI is best heard at 5th ICS midclavicular line with
apical rate of 142bpm. Her peripheral pulse is symmetrical, palpable, and regular & her
capillary refill is 2sec. No pacemaker attached & hemodynamic monitoring but Chest
Thoracostomy Tube (CTT) is attached at the left mid-axillary line of the patient’s body.
Has O2 inhalation attached to patient’s nose upon assessment.
Pt. X ADL is in total dependence and mobility status is limited because of fear of
injury to the site of the CTT. Pt. X back & extremities has no deformities but ROM is
also limited. The spine is in the midline.
10
Prior to admission pt. X has no special diet. Does not have any supplement
rather than Ferrous sulfate.
Pt. X mouth & mucosa are pinkish; tongue is in the midline. Uvula is in the
midline & pinkish, tonsils are not inflamed. The trachea is in the midline with non-
palpable thyroids & minimal ROM on bed.
Pt. X skin general color is pallor, rough, firm, warm to touch. Patient has an
ongoing IVF of PNSS 940cc regulated at 30gtts/min. Patient has also a surgical wound
(suture) in the left mid-axillary line where Chest Thoracostomy Tube is attached with
drainage of 590 level in bloody color.
ELIMINATION PATTERN
During admission pt. X defecates 1 time with yellow, slightly firm stool at medium
amount. Last bowel movement on January 13, 2010; and the day of assessment was
January 14, 2010. No incontinence & any method use to manage bowel movement
noted.
The abdomen is symmetrical but flat and normoactive without any abnormal
findings upon palpation. Pt. X usually urinates 1-2 times a day, appeared in yellow color
and has no problem in urinating. Patient also sweats minimally during afternoon but no
noted excessive perspiration.
SLEEP-REST PATTERN
Pt. X sleeps 7-8 hours at night. There were no histories of sleep disturbances of
the patient. Pt. X is always at the bed and easily drops to sleep.
COGNITIVE-PERCEPTION PATTERN
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Pt. X is conscious and calm upon assessment and disoriented to time. The head
is normocephalic with symmetrical facial movements & sunken fontanels. Hair is dry
with dandruff seen in the scalp. Pt. X eyelids are asymmetrical, with pink conjunctiva.
No lesions in the cornea & lens & anecteric sclera. Pupils are at equal size with 4mm in
diameter.
Pt. X external pinnae of ears is normoset with cerumen discharge & intact
tympanic membrane. The nasal septum is in the midline with pinkish mucosa & both
patent.
Pt. X feels fine about himself but I observed that he is not. Pt. X is depressed
about himself for being sick and hospitalized.
ROLE-RELATIONSHIP PATTERN
Pt. X lives with his mother, father and younger siblings. When it comes to the
feelings of his family members regarding her illness, pt. X mother felt so sad about her
son’s condition but she tries to understand the nature of the problem and accepts the
fact about the condition of her son. The mother also verbalized that her son needs
support about his present condition.
SKIN
- General color is pallor, rough, firm, and warm to touch.
NAILS
- His nails were pallor but it is firm and convex-shape.
HAIR
- Her hair is dry and black, with dandruff.
HEAD
- Normocephalic head and facial movements are symmetrical in size
- Sunken fontanels.
EYES
- He has no edema. Both eyes are coordinated with parallel alignment.
- Anicteric sclera and conjunctiva and no abnormal tears noted.
EARS
- Normal voice tones audible.
12
2. Yellowish about 10cc level + 110 water from bottle Jan. 15, 2010
3. Clear yellow about 190 cc level from previous bottle Jan. 16, 2010
13
C. LABORATORY RESULTS:
Gross Examination:
Volume: 10 ml
Color: yellow
Clarity: hazy
Microscopic Examination:
Segmenters: 15%
Lymphocytes: 85%
15
Mononuclear cells: -
Other types: -
Others:
Specific gravity: 1.005
Rivaltas Test: positive
Glucose: trace
January 7, 2010
Radiographic Report:
Chest in PA projections shows homogenous density occupying the lower 2/3 of
the left hemithorax eccentric upper border. Heart shadow is slightly deviated to
the right. No right parenchymal infiltrate. Right hemidiaphragm and its
corresponding sinuses are intact.
Impression:
Consider Pneumonia, Left w/ Pleural Effusion.
Suggest: UTS of the left hemithorax to determine the amount of fluid within the
pleural activity.
Impression:
16
Panugaling, Jonathan C.
27/M
Organism: No Growth
Comment: No growth after 72 hours incubation
Lungs
The lungs are paired elastic structures enclosed in the thoracic cage, which is an
airtight chamber with distensible walls. Ventilation requires movement of the walls of the
thoracic cage and of its floor, the diaphragm. The effect of these movements is
alternately to increase and decrease the capacity of the chest. When the capacity of the
chest is increased, air enters through the trachea (inspiration) because of the lowered
pressure within and inflates the lungs. When the chest wall and diaphragm return to
their previous positions (expiration), the lungs recoil and force the air out through the
bronchi and trachea. The inspiratory phase of respiration normally requires energy; the
expiratory phase is normally passive. Inspiration occurs during the first third of the
respiratory cycle, expiration during the latter two thirds.
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Pleura
The lungs and wall of the thorax are lined with a serous membrane called the
pleura. The visceral pleura cover the lungs; the parietal pleura lines the thorax. The
visceral and parietal pleura and the small amount of pleural fluid between these two
membranes serve to lubricate the thorax and lungs and permit smooth motion of the
lungs within the thoracic cavity with each breath.
Mediastinum
The mediastinum is in the middle of the thorax, between the pleural sacs that
contain the two lungs. It extends from the sternum to the vertebral column and contains
all the thoracic tissue outside the lungs.
Lobes
Each lung is divided into lobes. The left lung consists of an upper and lower lobe,
whereas the right lung has an upper, middle, and lower lobe. Each lobe is further
subdivided into two to five segments separated by fissures, which are extensions of the
pleura.
These are several divisions of the bronchi within each lobe of the lung. First are
the lobar bronchi (three in the right lung and two in the left lung). Lobar bronchi divide
into segmental bronchi (10 on the right and 8 on the left), which are the structures
identified when choosing the most effective postural drainage position for a given
patient. Segmental bronchi then divide into subsegmental bronchi. These bronchi are
surrounded by connective tissue that contains arteries, lymphatics and nerves. The
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subsegmental bronchi then branch into bronchioles, which have no cartilage in their
walls. Their patency depends entirely on the elastic recoil of the surrounding smooth
muscle and on the alveolar pressure. The bronchioles contain submucosal glands,
which produce mucus that covers the inside lining of the airways. The bronchi and
bronchioles are lined also with cells that have surfaces covered with cilia. These cilia
create a constant whipping motion that propels mucus and foreign substances away
from the lung toward the larynx. The bronchioles then branch into terminal bronchioles
then become respiratory bronchioles, which are considered to be the transitional
passageways between the conducting airways and the gas exchange airways. Up to
this point, the conducting airways contain about 150 ml of air in the tracheobronchial
tree that does not participate in gas exchange. This is known as physiologic dead
space. The respiratory bronchioles then lead into alveolar ducts and alveolar sacs and
then alveoli. Oxygen and carbon dioxide exchange takes place on the alveoli.
Alveoli
The lung is made up of about 300 million alveoli, which are arranged in clusters
of 15 to 20. These alveoli are so numerous that if their surfaces were united to form one
sheet, it would cover 70 square meters- the size of a tennis court. There are three types
of alveolar cells. Type I alveolar cells are epithelial cells that form the alveolar walls.
Type II alveolar cells are metabolically active. These cells secrete surfactant, a
phospholipid that lines the inner surface and prevents alveolar collapse. Type III
alveolar cell macrophages are large phagocytic cells that ingest foreign matter (eg.
mucus, bacteria) and act as an important defense mechanism).
The cells of the body derive the energy they need from the oxidation of
carbohydrates, fats, and proteins. As with any type of combustion, this process requires
oxygen. Certain vital tissues, such as those of the brain and the heart, cannot survive
for long without a continuing supply of oxygen. However, as a result of oxidation in the
body tissues, carbon dioxide is produce and must be remove from the cell to prevent
the build of acid waste products. The respiratory system performs this functions by
facilitating life sustaining processes such oxygen transport, respiration and ventilation,
and gas exchange.
Oxygen transport
Respiration
After this, tissue capillary exchanges blood enters systemic veins and travels to
pulmonary circulation. The oxygen diffuses from the alveoli from the blood. Carbon
dioxide diffuses from the blood to alveoli movement of air in and out of the airways
continually replenishes the oxygen and removes the carbon dioxide from the airways in
the lungs this whole process of gas exchange is called respiration.
Ventilation
During inspiration, air flows from the environment into the trachea, bronchi,
bronchioles and alveoli. During expiration, alveolar gas travels the same route in
reverse.
The pancreatic duct (also called the duct of Wirsung) runs the length of the
pancreas and empties into the second part of the duodenum at the ampulla of Vater.
The common bile duct usually joins the pancreatic duct at or near this point. Many
people also have a small accessory duct, the duct of Santorini, which extends from the
main duct more upstream (towards the tail) to the duodenum, joining it more proximal
than the ampulla of Vater.
• the splenic artery supplies the neck, body, and tail of the pancreas.
Venous drainage is via the pancreaticoduodenal veins which end up in the portal
vein. The splenic vein passes posterior to the pancreas but is said to not drain the
pancreas itself. The portal vein is formed by the union of the superior mesenteric vein
and splenic vein posterior to the neck of the pancreas. In some people (some books say
40% of people), the inferior mesenteric vein also joins with the splenic vein behind the
pancreas (in others it simply joins with the superior mesenteric vein instead).
Nerves
light staining circles (islets of endocrine secretes hormones that regulate blood
Langerhans) pancreas glucose levels
Endocrine
There are four main types of cells in the islets of Langerhans. They are relatively
difficult to distinguish using standard staining techniques, but they can be classified by
their secretion:
The islets are a compact collection of endocrine cells arranged in clusters and
cords and are crisscrossed by a dense network of capillaries. The capillaries of the
islets are lined by layers of endocrine cells in direct contact with vessels, and most
endocrine cells are in direct contact with blood vessels, by either cytoplasmic processes
or by direct apposition. According to the volume The Body, by Alan E. Nourse, in the
Time-Life Science Library Series, the islets are "busily manufacturing their hormone and
generally disregarding the pancreatic cells all around them, as though they were located
in some completely different part of the body.
Position
The heart is a hallow organ positioned left of the center in the chest cavity within
the pericardial cavity. The base of the heart is located superiorly in and the apex is
directed downward and leftward and formed by the lateral tip of the left ventricle
The essential function of the heart is to pump blood to various parts of the body.
The mammalian heart has four chambers: right and left atria and right and left
ventricles. The two atria act as collecting reservoirs for blood returning to the heart while
the two ventricles act as pumps to eject the blood to the body. As in any pumping
system, the heart comes complete with valves to prevent the back flow of blood.
Deoxygenated blood returns to the heart via the major veins (superior and inferior vena
cava), enters the right atrium, passes into the right ventricle, and from there is ejected to
the pulmonary artery on the way to the lungs. Oxygenated blood returning from the
lungs enters the left atrium via the pulmonary veins, passes into the left ventricle, and is
then ejected to the aorta. In the frontal view of the heart shown below, the right atrium is
in blue, the left atrium in yellow, the right ventricle in purple, and the left ventricle in red.
The chambers are semi-transparent so that the valves, drawn in white, can be seen.
The large valve in the foreground is the tricuspid valve that prevents backflow
from the right ventricle to the right atrium. The small round valve you see near the top is
the pulmonary valve, where the pulmonary artery comes out of the right ventricle.
The inner edge of the tricuspid and the mitral valves end in filamentous
connective tissue (chordae tendineae). These are attached to small columns of muscle
(papillary muscles) arising out of the inner surface of the ventricles. As the pressure
builds in the ventricles, the valves snap shut, and the papillary muscles prevent the
valves from blowing into the atrium and opening.
23
The pumping action starts with the simultaneous contraction of the two atria. This
contraction serves to give an added push to get the blood into the ventricles at the end
of the slow-filling portion of the pumping cycle called "diastole." Shortly after that, the
ventricles contract, marking the beginning of "systole." The aortic and pulmonary valves
open and blood is forcibly ejected from the ventricles, while the mitral and tricuspid
valves close to prevent backflow. At the same time, the atria start to fill with blood again.
After a while, the ventricles relax, the aortic and pulmonary valves close, and the mitral
and tricuspid valves open and the ventricles start to fill with blood again, marking the
end of systole and the beginning of diastole. It should be noted that even though equal
volumes are ejected from the right and the left heart, the left ventricle generates a much
higher pressure than does the right ventricle.
One thing that distinguishes the heart from other muscles is that the heart muscle
is a "syncytium," meaning a meshwork of muscle cells interconnected by contiguous
cytoplasmic bridges. Thus, an electrical excitation occurring in one cell can spread to
neighboring cells. Another defining characteristic is the presence of pacemaker cells.
These are specialized muscle cells that can generate action potentials rhythmically.
IV. PATHOPHYSIOLOGY
A. NARRATIVE FORM
Microorganisms that produce pneumonia can end up in air sacs in several ways.
In some cases, people inhale microorganisms (which are present in tiny droplets) when
they are near someone already infected. Spread in hospitals and nursing homes often
occurs this way. More common among older people, however, is the presence of
bacteria in their throat (colonization). These bacteria may remain there harmlessly or
suddenly cause pneumonia if mucus or food is inhaled into the airway (aspiration)
instead of passed into the esophagus. When aspiration occurs, the food or mucus can
make its way into the lungs, carrying the bacteria from the throat along for the ride.
Rarely, microorganisms from elsewhere in the body reach the lungs by traveling through
the bloodstream. These are usually blood borne microorganisms that enter the
pulmonary circulation and are trapped in the capillary bed, becoming a potential source
of pneumonia.
o pH 7.60-7.64
o Protein content less than 2% (1-2 g/dL)
o Fewer than 1000 WBCs per cubic millimeter
o Glucose content similar to that of plasma
o Lactate dehydrogenase (LDH) less than 50% of plasma
o Sodium, potassium, and calcium concentration similar to that of the
interstitial fluid
B. SCHEMATIC DIAGRAM
Inflammation
27
Exudates
SIGNS AND SYMPTOMS:
Dyspnea Complication:
chest pain Atelectasis
decreased tactile fremitus Pleural Effusion Infection
diminished or absent breath sounds hypoxemia
pleural friction rub during both inspiration and expiration
dry nonproductive cough
shortness of breath
Treated Not treated
NURSING DIAGNOSIS
Subjective Cue:
Objective Cue:
- Dyspnea on exertion
- Pursed-lip breathing
- Nasal flaring
After 4-5 days of Nursing Care, the patient will be able to establish a
normal/effective respiratory pattern.
29
NURSING INTERVENTION
Independent:
Dependent:
Collaborative:
EVALUATION
The patient was able to participate and perform deep breathing exercises and
verbalizes understanding about the relaxation techniques when the patient has
dyspnea.
The goal in not yet met since the patient still has pneumonia and needs for
further evaluation.
30
NURSING DIAGNOSIS
Acute Pain related to inflammatory process of the Pleural Effusion due to infectious
process from pneumonia.
Subjective Cue:
“Sakit akong dughan duol sa bangag didto sa nay tubo”, as verbalized by the
patient.
Objective Cue:
After 3-4 days of Nursing Care, the patient will experience controlled pain
regarding the draining of the pleural fluid.
NURSING INTERVENTION
Independent:
R> Pain is a subjective experience & cannot be felt by others but can be
objective when assessed in scale of 0-10
Dependent:
R> To maintain acceptable level of pain. Given with Tramadol every 8 hours
50mg via IVTT route.
EVALUATION
The patient reported relief or controlled pain from pain scale of 6/10 to 4/10 after
given with the medication in given intervals. Also used relaxation techniques and
followed treatment regimens.
NURSING DIAGNOSIS
Risk for Infection related to, damaged tissue integrity due to insertion of CTT.
Objective Cue:
- Has attached Chest Thoracostomy Tube on the left mid-axillary line noted
After 2-3 days of Nursing Care, the will maintain an infection free environment
from harmful pathogens.
NURSING INTERVENTION
Independent:
Dependent:
Discuss importance of not taking antibiotic or using left over drugs unless
specifically instructed by the health care provider.
EVALUATION
Providing a clean environment for the patient was given in order to prevent
infection from the damaged tissue due to CTT draining of pleural fluid. The surgical
dressing was not advised to be replaced since the chest was totally covered or no
openings were noted for risk of infection.
Provision of clean clothes was given in order to prevent infection of the CTT site.
DRUG STUDY
NURSING
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS
DRUG ORDER INDICATIONS RESPONSIBILITIES/
ACTION OF THE DRUG
PRECAUTIONS
Generic name: A second – generation Treatment of History of Antibiotic – associated Question for history of
Cefuroxime cephalosporin that susceptible infections anaphylactic reaction colitis and other supr allergies, particularly
binds to bacterial cell due to group B to penicillins or infections may result cephalosporins,
membranes and streptococci, hypersensitivity to from altered bacterial penicillins. Assess
Brand name: inhibits cell wall pneumococci, cephalosporins. balance. oral cavity for white
Ceftin synthesis staphylococci, H. patches on mucous
Influinzae, E.coli. Cautions: renal membranes, tongue,
Classification: Therapeutic Effect: impairment, history of monitor bowel activity
Antibiotic Bactericidal GI disease (especially and stool consistency
ulcerative colitis, carefully; mild GI
antibiotic – associated effects ,may be
Dosage: colitis), concurrent tolerable, but
750 mg use of nephrotoxic increasing severity
medications. may indicate onset of
antibiotic associated
colitis. Monitor I&O,
renal function reports
Route: for nephrotoxicity. Be
IVTT alert for
superinfection: severe
Frequency: genital/anal pruritus,
q8h severe mouth
soreness, moderate to
severe diarrhea.
35
NURSING
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS
DRUG ORDER INDICATIONS RESPONSIBILITIES/
ACTION OF THE DRUG
PRECAUTIONS
Generic name: An analgesic that Management of Acute alcohol Seizures have been Check the prescribed
Tramadol binds to mu-opioid moderate to intoxication, reported in patients medication for 3 time
hydrochloride receptors and inhibits moderately severe concurrent use of receiving tramadol on the first encounter,
reuptake of pain. centrally acting within the before and after
norepinephrine and analgesics, hypnotics, recommended dosage withdrawing the med
Brand name: serotonin reduces the opioids, or range. Overdose R> so that the
Ultram intensity of pain psychotropic drugs, results in respiratory medicine is properly
stimuli reaching hypersensitivity to depression and checked according to
sensory nerve opioids. seizures. Tramadol the doctor’s
Classification: endings. may not have prescription.
Analgesic prolonged duration of
Therapeutic Effect: action and cumulative Give first health
Alters the perception effect in patients with teaching before giving
Dosage: of and emotional hepatic or renal the patient.
50mg response to pain. impairment. R> to make the patient
prepare and know
what to expect
NURSING
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS
DRUG ORDER INDICATIONS RESPONSIBILITIES/
ACTION OF THE DRUG
PRECAUTIONS
Generic name: Paracetamol exhibits For treatment of mild No known Nausea, allergic The medication should
Paracetamol analgesic action by to moderate pain and contraindications. reaction, skin rashes, be given in IVTT.
peripheral blockage of fever. acute renal tubular R> this is according to
Brand name: pain impulse necrosis. the doctor’s order.
- generation. It
produces antipyresis Potentially Fatal: Very Assess patient for any
by inhibiting the rare, blood dyscrasias drug allergy to the
Classification: hypothalamic heat – (e.g., medicine.
Analgesics and regulating center. Its thrombocytopenia, R> to determine if the
Antipyretics weak anti- leukopenia, patient is allergic to
inflammatory activity neutropenia, drug
is related to inhibition agranulocytosis); liver
Dosage: of prostaglandin damage. Intruct the patient/
300mg synthesis in the CNS. give first health
teaching before giving
the patient.
Route: R> to make the patient
IVTT prepare and know
what to expect
Frequency:
PRN
37
HEALTH TEACHING
The patient with Pleural Effusion needs to be given attention especially if the
patient has experienced pain in the site if CTT, had dyspnea, chest pain, nonproductive
cough.
Management:
3. Implement a plan of care that is teaching the client to do deep breathing exercise
since the client has shortness of breath.
5. Explain to the significant others the limitation of the patient’s mobility due to
attached chest thoracostomy tube.
6. Explain tests and procedures to the patient, including thoracentesis, and answer
questions he has.
7. Before thoracentesis, tell the patient to expect a stinging sensation from the local
anesthetic and a feeling of pressure when the needle is inserted. Instruct him to tell you
immediately if he feels uncomfortable or has trouble breathing during the procedure.
8. If the patient developed pleural effusion because of pneumonia or influenza, tell him to
seek medical attention promptly whenever he gets a chest cold.
9. Teach the patient the signs and symptoms of respiratory distress. If any of these
develop, tell him to notify his physician.
10. Fully explain the drug regimen, including adverse effects. Emphasize the importance of
completing the prescribed drug regimen.
LEARNING EXPERIENCE
As part of the learning process, there are things that you need to discover
yourself and need to explore in order to fulfill the things that you are curious about. And
I have learned something from this. Although there are hard times and mistakes that we
may encounter, there is only one thing that you can appreciate more which is the
experience. I have learned that through this individual case study, I was able cope
myself in doing the requirement alone without the assistance of anybody, which makes
me feel joyous since this is a tough thing to make a case study. I have learned from this
case the hardship and the joy of fulfilling the requirement and it is a one way step of
developing my skills in doing the case study.
I realized that one should work hard amidst of your limits and accomplish
the things that you are ought to do. Not by just passing a requirement but also learning
from it as part of you dream to become an effective nurse in the future. One must have
focus and not to left the things unappreciated for nurses deals with the lives of many
individuals and thus must be accountable for the patient’s life in alleviating the pain,
restoring the health, etc as possible it may be.
Lastly, as a student nurse, I have learned and kept in mind the most
important thing to do for our patient and that is not to get mistakes in rendering care for
our patient for one slip could end up the life of your patient and that could be your
hardest thing that could happen for you and the patient’s family of losing one’s life in just
a minor mistake. So I guess that I should practice myself to seek for perfection in giving
care to patients and diminish the faulty errors in the clinical area when you are on duty.
DISCHARGE PLAN
M-MEDICATION
Explain the purpose, dosage, schedule, and route of administration of any prescribed
drugs, as well as side effects to report to the physician or nurse.
Instruct the watcher to refer any abnormalities about the pt. to the nurse or physician to
prevent complications. (The patient is not yet discharged and there were no PO meds
given in the hospital except for IVTT meds).
E-EXERCISE
The patient is advised to take rest after discharge in order to prevent injury and to
regain strength. The site of effusion needs proper attention and careful not to be
strained. The patient is not advised to do hard and stressful work yet he can still take
walking exercise that he is capable of doing.
T-TREATMENT
Patient is advised to consult his physician if he cannot afford the treatment. It is best
that the health care provider is aware so that he can make adjustments. Instruct
significant others to monitor patients condition.
H-HEALTH TEACHINGS
Teach the significant others on the simple pathology and physiology of the disease to
help them understand and to clarify misconceptions of the disease. Discuss the possible
causes of the disease, prognosis, and describe the disorder. Demonstrate to significant
others the proper wound care, administration of medicines and how to care for the
patient. Explain the effects of the treatment of the patient and what to do when side
effects occur. Aware the patient and significant others the importance of knowing the
40
Do’s and Don’ts while the effusion is still present. Determine the patient’s expectations
to alleviate fear and anxiety.
OUT-PATIENT CHECK-UP
Follow-up with the patient's primary care physician or a pulmonary specialist within 2-3
days is advisable, especially if thoracentesis is deferred.
If early follow-up seems unlikely, the patient should be given clear instructions to return
to the ED in 2-3 days for reevaluation.
Patient is instructed to have a regular check up in the hospital if there are any signs of
complications of risks and if there is also improvement or progress regarding his case.
DIET
Instruct patient’s family, significant other to follow recommended diet provided by her
dietician if any.
SPIRITUAL
Patient’s family is very religious that is why we always continue to encourage him to
remain that faithful and strong to God. Continue praying and reading the bible and never
forget that during times of difficulties, God carries our burden. It is about putting our trust
in him and never giving up.
DOCTOR’S ORDER
41
CTT drainage
reading
REFERENCE:
www.wisegeek.com
www.wikipedia.com
www.emedicine.medscape.com
Black & Hawks. Medical – Surgical Nursing Clinical Management for Positive
Outcomes. Saunders Elsevier 8th edition.