Conditions › Respiratory
Pleural Effusion Nursing Care Plan and Interventions
Pleural effusion nursing care supports breathing (head of bed up, oxygen as ordered) and prepares the client for thoracentesis: sitting up and leaning over a table. During drainage, stop and report chest pain, new shortness of breath or a drop in BP (coughing alone is common); afterward, watch for a pneumothorax.
Pleural effusion nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Ineffective breathing pattern | RR and SpO2 improve; less dyspnea. | |
| Risk for injury during and after thoracentesis | Procedure tolerated; no pneumothorax. | |
| Acute pain (pleuritic) | Reports pain at a tolerable level. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Pleural effusion: what it is
Fluid collects in the pleural space between the lung and the chest wall, leaving the lung less room to expand. 1,2
Normally that space holds only 10 to 20 mL of fluid.
Transudate vs exudate
Transudate: pressure or low protein pushes fluid out (heart failure, cirrhosis). Exudate: inflamed, leaky vessels (pneumonia, cancer, PE). 1
Heart failure is the most common cause of a transudate.
Assessment: what you will see
Cues: short of breath, pleuritic pain
Shortness of breath, sharp chest pain on breathing in, or both. A large effusion causes rapid, shallow breathing. 1
Small effusions may cause nothing and turn up by chance on a chest x-ray.
Exam: quiet and dull
Decreased breath sounds on that side, dullness to percussion, and absent tactile fremitus (no vibration felt as the client speaks). 1
A pneumothorax is quiet too, but hyperresonant. Fluid sounds dull; air sounds hollow.
Confirming it: x-ray, ultrasound
A chest x-ray shows fluid blunting the costophrenic angle. Bedside ultrasound is standard. Fluid from a thoracentesis helps find the cause. 1
The fluid sample sorts transudate from exudate, which points to the cause.
Complications and red flags
Empyema: pus in the pleura
Pus in the pleural space, most often a complication of pneumonia. It must be completely drained, by thoracentesis or a chest tube. 1
Empyema is the effusion you can't just watch: the pus has to come out.
After: watch for pneumothorax
New dyspnea, chest pain, falling SpO2 or quieter breath sounds on that side can mean air got in. Report it; imaging follows. 1,2
No symptoms? A routine x-ray usually isn't needed, unless air may have gotten in during the tap.
Priority: what the nurse does first
During drainage: when to stop
With large volumes (over about 500 mL), watch symptoms and BP. Stop the drainage for chest pain, dyspnea or low BP. 1
Coughing is common as the lung re-expands. New chest tightness or a falling BP is not.
Nursing interventions and treatment
Thoracentesis: positioning
Sit the client upright, leaning slightly forward with arms supported on an overbed table. This spreads the ribs. 1
Can't sit up, as on a ventilator? It can be done lying down with ultrasound or CT guidance.
Treat the cause, stop the return
Heart failure effusions often clear with diuretics. Recurrent, symptomatic ones: pleurodesis to seal the space, or an indwelling drain. 1
Pleurodesis instills an irritant such as talc so the two pleural layers stick together.
Keep studying pleural effusion in NurseLingo Pro
Everything for pleural effusion in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free med-surg practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for pleural effusion?
Common nursing problems for pleural effusion include ineffective breathing pattern; risk for injury during and after thoracentesis; acute pain (pleuritic). Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for pleural effusion?
With large volumes (over about 500 mL), watch symptoms and BP. Stop the drainage for chest pain, dyspnea or low BP.
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For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.