Page 1587 - Saunders Comprehensive Review For NCLEX-RN

inspiration
2. Progressive dyspnea with decreased movement of the
chest wall on the affected side
3. Dry, nonproductive cough caused by bronchial
irritation or mediastinal shift
4. Tachycardia
5. Elevated temperature
6. Decreased breath sounds over affected area

7. Chest x-ray film that shows pleural effusion

and a mediastinal shift away from the fluid if the
effusion is more than 250 mL
C. Interventions
1. Identify and treat the underlying cause.

2. Monitor breath sounds.
3. Place the client in a Fowler’s position.
4. Encourage coughing and deep breathing.
5. Prepare the client for thoracentesis.
6. If pleural effusion is recurrent, prepare the client for
pleurectomy or pleurodesis as prescribed.
D. Pleurectomy
1. Consists of surgically stripping the parietal pleura
away from the visceral pleura
2. This produces an intense inflammatory reaction that
promotes adhesion formation between the 2 layers
during healing.
E. Pleurodesis
1. Involves the instillation of a sclerosing substance into
the pleural space via a thoracotomy tube
2. The substance creates an inflammatory response that
scleroses tissue together.
XIII. Empyema
A. Description
1. Collection of pus within the pleural cavity
2. The fluid is thick, opaque, and foul-smelling.
3. The most common cause is pulmonary

infection and lung abscess caused by thoracic surgery
or chest trauma, in which bacteria are introduced
directly into the pleural space.
4. Treatment focuses on treating the infection, emptying
the empyema cavity, re-expanding the lung, and
controlling the infection.
B. Assessment
1. Recent febrile illness or trauma
2. Chest pain

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