pleural effusion ppt

Pleural Effusion

Presented By:Aguado, John Prose

Almarra, Edrianne Paul Antonino, Jelaine

Bacena, Dianne JamaicaMarpa, Ian Rafael

Marquez, CharmaineOng, Julie Ann

Taguba, Neilson JohnVillanueva, Irish

Saligumba, Emyl CyrilSoliven, Kathlene Chelo

Zacarias, AndreaIII-CN

Presented To:Dr. Concordia Eva Garcia RMT, RN, MD

~A Case Presentation~As a partial requirement for Medical-Surgical Nursing I

• 1st time to encounter

• Secondary illness

• Secondary to Tuberculosis

Why Pleural Effusion?

What is Pleural Effusion?

• It is the abnormal accumulation of fluid in the pleural space resulting from excess fluid production or decreased absorption .

• Normally, the pleural space approximately contains 1mL of fluid

Classifications of Pleural Effusion:

1. Transudative Effusion

2. Exudative Effusion

• Clear, pale yellow, watery substance

• Influenced by systemic factors that alter the formation or absorption of fluid

• Contains few protein cells

• Common causes: CHF and liver or kidney disease

Transudative effusions

• Pale yellow and cloudy substance• Influenced by local factors where fluid absorption is

altered (inflammation, infection, cancer) • Rich in protein (serum protein greater than 0.5)• Ratio of pleural fluid LDH and serum LDH is >0.6• Pleural fluid LDH is more the two-thirds normal upper

limit for serum• Rich in white blood cells and immune cells• Always has a low pH• Common causes: tuberculosis, pneumonia, cancer,

and trauma

Exudative effusions

Light’s criteria

Pleural fluid protein divided by serum protein is greater than 0.5. Pleural fluid LDH divided by serum LDH is greater than 0.6. Pleural fluid LDH is greater than two-thirds the upper limit of normal for the serum LDH. If none of these criteria is met, the patient has a transudative pleural effusion

StatisticsStatistics According to WHO:According to WHO:

The estimated prevalence The estimated prevalence of pleural effusion is of pleural effusion is 320 cases 320 cases per 100,000 peopleper 100,000 people in third in third world countries.world countries.

In developed countries the In developed countries the common causes of pleural common causes of pleural effusions in adults are effusions in adults are cardiac cardiac failure, malignancy and failure, malignancy and pneumoniapneumonia, whereas in , whereas in developing countries are developing countries are tuberculosis and parapneumonic tuberculosis and parapneumonic effusionseffusions are more prevalent. are more prevalent.

According to DOH:According to DOH:

The Philippines currently has The Philippines currently has 250,000 cases of Tuberculosis250,000 cases of Tuberculosis, as of , as of the year 2009. Pleural Effusion the year 2009. Pleural Effusion accounts to approximately accounts to approximately 38%38% of of patients with Tuberculosis. patients with Tuberculosis.

StatisticsStatistics

www.doh.gov.phwww.doh.gov.ph

NAME: Mrs. MADDRESS: Brgy CemboAGE: 42 y/oGENDER: FemaleBIRTHDATE: May 30, 1969RELIGION: Roman CatholicDATE OF ADMISSION: July 17, 2011MODE OF ADMISSION: Medicine Ward

BIOGRAPHICAL DATA

CHIEF COMPLAINT

“Nahihirapan akong huminga”, as verbalized by the client

History of Present Illness

• Four months prior to admission, the client experienced productive cough with greenish phlegm, and night sweats. She failed to seek for consultation because she believed that it was just an ordinary cough that is self-limiting.

• Three months prior to admission, the client still experienced productive cough (greenish phlegm) and night sweats. She also experienced fever (39C), chest tightness, and paroxysmal nocturnal dyspnea. She consulted a private doctor and was given Lagundi TID x 7days and Clarithromycin 500 mg BID x 7days. She had taken these drugs as prescribed by the physician. After a week, the patient still complains of the same symptoms. She failed to have a follow up check up due to lack of time


• Two months prior to admission, the client still manifested symptoms such as productive cough (greenish phlegm), persistent fever (39C) in the afternoon, and night sweats. The client now had anorexia and lost a total of 3 kg from her previous weight of 47 kg. She began to experience orthopnea of 2 pillows, easy fatigability and paroxysmal nocturnal dyspnea.


• She also began to complain of chest pain P: right thoraxQ: Sharp pain R: non-radiatingS: 4/10 T: upon deep inspiration, relieved after shallow breathing).


• She now consulted a private doctor and was subjected for chest x-ray revealing pleural effusion of the right lung. The client had undergone thoracentesis and 450cc of fluids was collected from her right lung.


Normal CXR Right Pleural Effusion

Thoracentesis

• The patient was relieved from pain after the procedure and was sent home with stable vital signs. The patient was prescribed to take Acetylcystein 600 mg/tab TID, Paracetamol 500 mg/tab TID. She was advised to have a follow up chest x-ray after two weeks. The patient failed to have a follow up chest x-ray due to financial problem


• One month prior to admission, the patient still experienced productive cough, chest pain on deep inspiration (P: right thorax, Q: Sharp pain R: non-radiating, S: 7/10, T: upon deep inspiration, relieved after shallow breathing). The client still had anorexia and lost 4 kg from her previous weight of 44 kg.


• The patient consulted again a private MD. She was subjected again for chest x-ray and pleural effusion on the right lung was detected. Second thoracentesis was done and 1,000 mL of fluids was collected. She was relieved from pain after the procedure and was sent home with stable vital signs. The patient was advised to have a follow up chest x-ray after two weeks.


• Two weeks prior to admission, the patient again experienced productive cough and dyspnea, and easy fatigability. She was subjected to chest x-ray. Third thoracentesis was done and 800ml of fluid from the right lung was collected.

• The patient finally decided to be subsequently admitted to Ospital ng Makati.


Neurological System none

Cardiovascular System none

Respiratory System (+) dyspnea (+) paroxysmal nocturnal

dyspnea(+)chest pain (P-pain in right thorax during deep inspiration and movements Q- Sharp pain

R-Non-radiating S-7/10 T- relieved by shallow

breathing(+) orthopnea of 2 pillows

Integumentary System (+)night sweats

Endocrine System none

Urinary System none

Reproductive System none

REVIEW OF SYSTEMSREVIEW OF SYSTEMS

PAST MEDICAL HISTORY

• The client only had hospitalization in the past due to child delivery. The client has no known allergies to certain kind of foods and medication. She had no history of injury or falls. She had also completed her immunizations.

FAMILY HISTORY

The client has history of cancer, specifically; her mother has been diagnosed to have breast cancer while his father has been diagnosed to have prostate cancer.

GENOGRAM of Mrs. M’s Family:

Male prostate Ca

Female breast Ca

Deceased healthy

JoeTherese

Mary49

Maricar45

Mrs. M42

Mercy36

Mark38

Mr. Husband

Marj16

Jeff20

LEGEND:

Personal and Personal and Social HistorySocial History

Health Perception and Health Management Pattern:

Mrs. M described a healthy person as someone without an illness and still manages to do his/her daily activities. Mrs. M rated her general health status as 6/10, She added that she still has a positive outlook in life even though she has a disease.

With regards to self breast examination, the client is familiar with it but doesn’t have enough knowledge on how to perform it.

Mrs. M takes care of her body through bathing, trimming of fingernails, wearing of slippers at home, brushing teeth, and using deodorant.

The patient doesn’t smoke and doesn’t drink any alcoholic beverage.


Mrs. M lives in Brgy. Cembo with her husband and two siblings. Her family is renting a half of a bungalow house situated along a road. The house has two rooms with a wall that divides it. The wall is not touching the roof, leaving an open space between the two rooms. Mrs M. suspected that one of the family members living in the other side of the house has tuberculosis. She admitted that the air is polluted around their area because she can even inhale the smoke around their compound. Their house is poorly-ventilated and poorly-lighted.


Nutritional and Metabolic Pattern3-Day Diet Recall

August 30, 2011 August 29, 2011 August 28, 2011

Breakfast(7:30AM)

1 bowl of Arozcaldo1 glass of milk

1 glass of water

1 bowl of soup1 glass of milk

½ bowl of goto2pcs. Medium-sized

pandesal1 glass of milk

Lunch(12:30NN)

½ cup of steamed rice½ serving of menudo1 glass of orange juice

1 bowl champorado1 glass of water

½ bowl of ginataan2 slices of tasty bread1 glass of orange juice

2 glasses of water

Snack(3:00PM)

1 stick of bananaQ1 glass of water

- -

Dinner(7:00PM)

½ cup of steamed rice1 serving of pakbet2 glasses of water

1 glass of milk

½ cup of steamed rice½ serving of monggo

2 glasses of water

½ cup of steamed rice 1 pc. Lumpiang sariwa

1 glass of milk1-2 glass of water

Mrs. M is the one who prepares the food for her family before. Most of the time, she cooks Filipino dishes such as pork adobo & pork sinigang. Mrs. M does not forget to wash her hands everytime before she prepares the food.

Mrs. M stated that she is not taking any vitamins since before.

The patient lost a total of 7 kg in her weight before hospital admission.

Nutritional and Metabolic Pattern3-Day Diet Recall

Elimination Pattern:

Regarding her defecation, she usually defecates once a day and the stool is dark brown in color and the consistency is solid. The patient doesn’t have any discomforts upon defecation. She seldom experiences constipation or diarrhea.

Regarding her urinary elimination pattern, Mrs. M frequently urinates (4-5x/day) because she is taking Furosemide every night. She stated that she doesn’t feel any discomfort or pain during micturition.

Activity-Exercise Pattern:

• Mrs. M is a high school teacher. She goes to school in the morning and goes home at 1:00 pm. She said that before she felt the symptoms of easy fatigability, she exercises during weekend morning for 30 minutes using a waist twisting disc. She also considers walking to her school for work as an exercise.

Sleep and Rest Pattern:

• Mrs. M had difficulty of sleeping in the hospital because she is not comfortable sleeping with the hospital environment and also, because of the pain she has been experiencing on the thoracostomy site upon trunk movements. She described the pain as sharp, and rated it as 7/10. During the interview, facial grimace is evident. She sometimes nods her head just to agree. She also speaks at a low-volume voice.

Sleep DiaryAugust 30, 2011 August 29, 2011 August 28, 2011

Hours of Sleep during Night

(12AM-5AM)5 hours

(11AM-4:30AM)5 1/2 hours

(12AM-4:30AM)4 1/2 hours

Hours of NapDuring

Afternoon

(1:30PM-3:00PM)

1 ½ hours

(4:30PM – 6:00PM)1 ½ hours

(1:00-3:00 PM)2 hours

Quality of Sleep

Continuous Continuous Not Continuous. Awakened at 3am due to pain on the thoracostomy site. Fell asleep after pain subsided.

Feeling upon waking up

Refreshed Refreshed Not Refreshed

PHYSICAL EXAMINATION

General Appearance: During the interview, the client is conscious and coherent. The client has evident facial grimace.

Anthropometric Measurement:

Weight: 40 kgHeight: 1.49 cmBMI: 18 AbnormalVital Sign:

Temperature : 39°C AbnormalCardiac Rate: 109bpm AbnormalRespiratory Rate: 26cpm AbnormalBlood Pressure: 100/70 Normal

PHYSICAL EXAMINATIONORGAN/ BODY

PART(S)METHODS

USEDFINDINGS SIGNIFICANCE

Head: Inspection normocephalic Normal

Skin: InspectionPalpation

Intact(+) dry skin

Warm to touchelastic skin turgor

NormalAbnormalAbnormalNormal

Eyes: Inspection White sclera(-) sunken eyeball(-) pale conjunctiva

(-) discharge

NormalNormalNormalNormal

Ears: InspectionPalpation

Bilaterally equal in size(-) lesions

(-) dischargeNo tenderness

NormalNormalNormalNorma

Nose: Inspection symmetric and straight(+) pink mucosal membrane

(-) deviated septum(-) discharge

(-) nasal flaring

NormalNormalNormalNormalNormal


ORGAN/ BODY PART(S)

METHODS USED

FINDINGS SIGNIFICANCE

Mouth Inspection (+) dry lipspinkish tongue

(-) lesionspink tonsils and buccal

mucosa

AbnormalNormalNormalNormal

Nails InspectionPalpation

(-) cyanotic nailbedscapillary refill more than

3secs.

NormalAbnormal

Neck InspectionPalpation

Symmetric and head centered

Thyroid gland moves upward upon swallowing

Trachea is midline(+) tender lymphnodes

NormalNormal.Normal

Abnormal

Thorax and Lungs InspectionPalpation

AuscultationPercussion

(-) Chest wall retractionsasymmetric Tactile fremitus

(absent on the right thorax)

asymmetric respiratory excursion (movement only

on the left thorax)asymmetric breathsounds

(absent breathsounds on the right)

(-) adventitious breath sounddull, flat sound over the right

thorax

NormalAbnormalAbnormalAbnormalNormal

Abnormal

Heart Auscultation (-) heart murmur Normal

Abdomen InspectionAuscultation

Flat abdomen(+) ascites

Normal bowel soundsNo bruit heard

NormalAbnormalNormalnormal

Extremities InspectionPalpation

Arms bilaterally symmetric(-) edema

(-) lesions or ulcerations(+) palpable distal pulse

NormalNormalNormalNormal

ORGAN/ BODY PART(S)

METHODS USED

FINDINGS SIGNIFICANCE


Contraptions:• IV on Right Hand (PNSS 1L x 8hrs)

• CTT on Right Thorax at 8th ICS connected to a one-bottle water seal system

• With Foley Catheter

MEDICAL AND NURSING DIAGNOSES

Medical Diagnosis: Pleural Effusion secondary to PTB

Nursing Diagnoses: • Ineffective Breathing Pattern r/t decreased lung volume

capacity• Acute Pain r/t accumulation of fluid in the pleural space and

rubbing of thoracostomy tube to the lungs• Imbalanced Nutrition: less than body requirement r/t inability

to ingest adequate nutrients• Hyperthermia r/t disease process• Sleep Deprivation r/t Paroxysmal nocturnal dyspnea • Risk for fluid volume deficit related to administration of

diuretic drugs• Risk for Injury related to thoracentesis• Risk for infection r/t presence of ctt

Pathophysiology

Inhalation of TB Bacilli

Tubercle Formation (Primary Infection)

Exposure to Air Pollutants

Exposure to TB

Formation of Granuloma

Living in Poorly-lighted and

overcrowded house

PTB

Productive cough, Fever 39C, Anorexia,

weight loss, easy fatigability

AFB (+)

Vigorous inflammatory response associated with an exudation of white blood cells and proteins.

Increase WBC count(16.6 x 10^9 mm/ L)

Increase Monocyte count(0.13 g/L)

Mycobacterial antigens enter the pleural space

Not early detected

subpleural caseous focus in the lung ruptures into the pleural space

PTB

Vigorous inflammatory response associated with an exudation of white blood cells and proteins.

Increase pulmonary interstitial fluid

PLEURAL EFFUSION(Accumulation of fluid in

the pleural cavity)

Low serum albumin level:

25 g/LChanges in

permeability of capillaries

Intense inflammation obstructs the lymphatic pores in the

parietal pleura

Decrease in lymphatic drainage

PLEURAL EFFUSION(Accumulation of fluid in the

pleural cavity)

Irritation of sensory nerves in the parietal pleura during deep

inspiration

Increase in intra-alveolar & intra-pleural pressure

Dyspnea, Pleuritic chest pain, Orthopnea, Paroxysmal

nocturnal dyspnea

Decrease lung expansion

Decrease breath sounds, stony dull sound when

percussed

Dyspnea, Increase RR

Decrease respiratory excursion

Lung collapse

CXR: Opaque densities on the right

lower lobe& blunting of

costophrenic angle

Prolonged pleural effusion

Risk for infection of pleural fluid

Empyema

LABORATORY & DIAGNOSTIC TESTS

Complete Blood CountProcedure/Item Abnormal

flagsResult Units Reference

Range

Hemoglobin 16 g/DL ( 13.0 – 18.0 )

Hematocrit 45 % ( 40.0 – 52.0 )

RBC 5 Mil/mm^3 ( 4.70 – 5.40 )

WBC *High 16.6 /mm^3 (4-11 x 10^9)

Neutrophils 0.77 g/L (0.50-0.70)

Lymphocytes 0.39 g/L (0.20-0.40)

Monocytes *High 0.13 g/L ( 0.02 – 0.05 )

Eosinophils 0.03 g/L ( 0.02-0.04 )

Basophils -- /mm^3 ( 10 – 100 )

Arterial Blood GasesResult Normal Range

pH 7.48 7.35-7.45

PCO2 47 35-45mmHg

HCO3 23 22-26mmHg

PaO2 88 80-100%

Significance: The patient has respiratory alkalosis. This may be due to rapid & shallow breathing.

Procedure/Item

Abnormal flags

Result Units Reference Range

Albumin *Low 25 g/L ( 34 - 50 )

AST (SGOT) 35 u/L ( 15 - 37 )

ALT (SGPT) 33 u/L ( 30 - 65 )

Alkaline Phospha

tase

143 u/L (50-165)

Acid-fast Bacillus (AFB)

(July 20, 2011) Specimen: Sputum Result: AFB (+)

Gram Stain

(August 20, 2011) Specimen: Pleural Fluid Result: Smear shows no presence of

gram (-) bacilli.

CYTOPATHOLOGY

(August 20, 2011) Specimen: Pleural Fluid Pathologic Diagnosis: Negative for

malignant cells

Chest X-ray

(July 14, 2011) Impression: Consider

moderate pleural effusion; right

Right Lateral Decubitus: Evidence of minimal pleural fluid

Chest X-ray

Right Lateral Decubitus

CT-SCAN of Chest

Result: PTB with organizing Pneumonia, Superior and postero-medial right lower lobe with right hilar lymphadenopathies and right pleural effusion.

CT – MRI

(August 11, 2011) Findings: Mediastinal lymphadenopathies Right pleural effusion with thick

pleural density Heart not enlarged Pulmonary Fibrosis in Left Lower

Lobes

COURSE IN THE WARD AUGUST

31,2011 Wednesday

(6:00AM – 2:00 PM)

Patient received lying on bed, awake, calm and coherent Patient was febrile Patient was ambulatory Has an IVF of 1L PNSS at 31-32 gtts/min for 8 hours infusing well Patient’s vital signs were taken and recorded Temperature: 39°C Cardiac Rate: 109bpm Respiratory Rate: 22cpm Blood Pressure: 100/70

Tepid sponge bath was done to lower hyperthermic state Endorsed elevated temperature to the nurse-in-charge Bed rails were raise to promote patient’s safety Instruct the significant other how to do the tepid sponge bath if fever is

present Intake and output strictly monitored Intake Output Oral- 400 mL Urine- 500 mL IV- 500 mL Chest tube – 60mL Total - 900mL Total - 560mL No. of stool – 0• Checked thoracostomy tube for leak, kinks, patency and output. Noted fluctuations in every inspiration on the drainage bottlez Secured bottle lower than the client (under the bed).

Drug Study

Drug Name Classification Action Dosage/Frequency Nursing responsibilities Evaluation

Generic:Acetylcysteine

Mucolytics Breaksdown the link that binds mucus together

Liquifies mucus

Makes cough more productive

600 mg PO q4 Evaluates client’s respiratory status (respiratory rate, depth, rhythm)Check sputum for color, consistency and amount.If bronchospasm occurs, stop the treatment and notify the physician.Instruct patient to notify prescriber immediatelyabout nausea, rash, or vomiting.

Warn patient about acetylcysteine’sunpleasant smell; reassure him that it subsidesas treatment progresses.

To decrease mucus viscosity, urge patientto consume 2 to 3 L of fluid daily unlesscontraindicated by another condition.

Evaluate the effectiveness of Acetylcysteine through assessing the respiratory status of the client and amount of sputum expectorated.


Generic Name:Pyrazinamide + Ethambutol

Anti-TB Agents Inhibits cell action of Mycobacterium tuberculosis

Bacteriostatic

400mg + 275mg PO

Take it continously and never skip doses to avoid multi-drug resistance.

Monitor Vision of patient. Ethambutol causes optic neuritis.

Examine patients at regular intervals and question about possible signs of toxicity: Liver enlargement or tenderness, jaundice, fever, anorexia, malaise, impaired vascular integrity

Report to physician onset of difficulty in voiding. Keep fluid intake at 2000 mL/d if possible.

Evaluate effectiveness of medication through observing the clients coughing and coping mechanism with the drug


Generic Name:Rifampicin

Antituberculosis agent

Inhibits DNA and RNA polymerase activity

Cell death

300 mg PO OD Administer on an empty stomach, 1 hr before or 2 hr after meals.Administer in a single daily dose.Give with meals because it causes gastric irritation.Prepare patient for the reddish-orange coloring of body fluids (urine, sweat, sputum, tears, feces, saliva); soft contact lenses may be permanently stained; advise patients not to wear them during therapy.arrange for follow-up visits for liver and renal function tests, CBC, and ophthalmic examinations.Advise client to avoid omission of dose to prevent drug resistance

Evaluate effectiveness of medication through monitoring hemoptysis production, liver fxn test and CXR


Generic:Piperacillin + Tazobactam

AntibioticBinds to bacterial cell membrane and inhibits beta-lactamase

Cell lysis

4.5 g/ml TIV q6 Perform skin test before giving the initial dose.Assess client for allergy to penicillin. Check C&S result.

Monitor client for 30 mins when given parenterally; administer epinephrine if anaphylaxis occurs.

Do not mix aminoglycosides with penicillin in the same IV infusion – deactivates aminoglycoside

Check for CBC result and Monitor for hemorrhagic manifestations because high doses may induce coagulation abnormalities.


Generic: Furosemide

Loop diuretic Acts in loop of Henle, proximal and distal tubule

Inhibits Na and Cl reabsorption

10 mg/mL TIV q8 Monitor for adequate intake and output and potassium loss.

Monitor client’s weight and vital signs esp BPMonitor for signs and symptoms of hearing loss, which may last from 1 to 24 hrs.

Teach client to take Furosemide early in the day to decrease nocturia.

Teach client to report any hearing loss or signs of gout.monitor for S/s of hypokalemia; such as muscle weakness and cramps

Monitor for sideeffects such as dizziness, lightheadedness, or fainting spells, Signs of dehydration or low electrolytes,

Evaluate effectiveness of Furosemide through frequently monitoring urinary output.

http://bsnurse.com/?p=1115

Drug Name Classification

Action Dosage/Frequency

Nursing responsibilities

Evaluation

Generic Name:Cefixime

third-generation cephalosporin antibiotic

Binds to PBPs

Inhibits bacterial cell wall synthesis

Death of Bacteria

200 mg PO Assess for infection at beginning of and throughout therapy.

Ask patient for allergies to penicillin or cephalosporins.

Perform skin test before the initial administration.

Obtain specimens for culture and sensitivity before initiating therapy.

Observe patient for signs and symptoms of anaphylaxis ( rash, pruritus, laryngeal edema, wheezing)

Evaluate the effectiveness of medicine

Drug Name Classification Action Dosage/Frequency


Evaluation

Generic Name:Tramadol

Opioids/analgesic binds to µ-

opiate receptors and inhibits reuptake of norepinephrine and serotonin

reduces intensity of pain stimuli sponse to pain.

50mg/2mL TIV Assess onset, type, location, and duration of pain.Effect of medication is reduced if full pain recurs before next dose. Assess drug history especially carbamazepine, CNS depressant medication, MAOIs.Review past medical history, especially epilepsy or seizures.Assess renal or hepatic function laboratory values.Give without regards to mealsMonitor pulse and blood pressure.Assist with ambulation if dizziness or vertigo occurs.

Evaluate effectiveness of medication through monitoring vital signs of client and assessing pain recurrence.

Drug Name Classification Action Dosage/Frequency


Evaluation

Generic Name:

Streptokinase

Thrombolytic enzyme Produces

plasmin

Breaks down fibrin

Dissolves blood clots

250,000 units intrapleurally

Continuous monitoring of HR and rhythm throughout thrombolytic administration.

Vital observations : record 15 minutely for at least 1 hour from onset of infusion until stable.

Notify physician if allergic reactions may include fever increased liver enzymes, reduced renal function, polyarthralgia, polyarthritis and rash.

Evaluate effectiveness of Streptokinase through checking for blood in the chest tube drainage.


Generic Name:Paracetamol

Anti-pyretic inhibiting the

hypothalamic

heat-regulating centre.

Inhibits fever

300g TIV Check vital signs of the client esp temperature.

Inspect IM and IVinjection sitesfrequently for signs of phlebitis.

Report onset of loose stools or diarrhea

Monitor I&O rates and pattern:

Evaluate effectiveness of Paracetamol through monitoring a decrease in the temperature of the client.

DISCHARGE PLANNING

• Medication: After handling the patient for one day, we advice the client and significant others that the client should continue the prescribed medications as follows: Rifampicin 300 mg PO OD, Pyrazinamide + Ethambutol 400mg + 275mg PO as ordered by the doctor.

• Exercise: We have encouraged the client to perform mild exercise such as jogging for 30 minutes each day after the woundcompletely healed.

• Treatment: • Health Teaching: Teach the client to avoid omission of doses of

antituberculosis drugs such as Rifampicin, Pyrazinamide and Ethambutol. We have advised the client to expect reddish to orange color of urine, sweats, etc. We have advised the client to seek for consultation if she experienced blurring of vision and jaundice.

• We also taught the client that Mycobacterium Tuberculosis is killed by heat and sunshine that’s why appropriate lighting and ventilation of the house is important.

• Out-Patient Follow-up Care: Advised the client for a follow up check up and for chest xray.

• Diet: We advised the client to increase intake of protein to increase healing of wound brought about by chest tube thoracostomy. We also advised to take 8-10 glasses of water everyday to avoid dehydration.

pleural effusion ppt

Documents

pleural effusion accounts

pleural space

ratio of pleural fluid

serum ldh

absorption of fluid

fluid absorption

chest xray

protein serum protein