Physical Examination of Pleural Effusion

1) Health Status

Need to review the level of consciousness, how the patient's general appearance, facial expressions during the examination, the patient's attitude and behavior toward nurses, how the mood of patients to determine the level of patient anxiety and tension. There should also be measured height and weight of patients.

2) Respiratory System

Inspection in patients with pleural effusion, a sick form of convex hemithorax, horizontal ribs, widened space between the ribs, decreased respiratory movement. Furtherance of the mediastinum toward the contra lateral hemithorax is known from the position of tracheal and cardiac ictus. Respiratory rate tended to increase and examination usually dyspneu.

Vocal Fremitus decreased primarily for the amount of pleural effusion fluid> 250 cc. In addition to palpation of the chest wall movements were also found on the left chest pain.

Percussive sound dim to be sensitive depending on the amount of liquid. If the liquid does not fill the pleural cavity, there is the upper limit of the liquid form of curved lines with the lateral end of the medical patient in a sitting position. This line is called the line "Ellis-Damoiseaux". The line is most obvious in the front of the chest, is less clear in the back.

Sound Auscultation of breath decreases until it disappears. In the sitting position more liquid upwards thinner, and behind it there is compression atelectasis of the lung parenchyma, may be found auscultation signs of compression atelectasis around the upper limit of the liquid. Coupled with the sign "i - e" that is, if the person is asked to utter the words "i", then it will sound "e" nasal, called egofoni.

3) Cardiovascular System

On inspection to note the location of ictus Cordis, normally located in the ICS - 5 on linea medio clavicularis left border of 1 cm. This examination aims to determine the presence or absence of cardiac enlargement. Palpation to calculate the frequency of the heart (health rate) and be aware of the depth and irregular heart beat or not, should also examine the thrill of vibration ictus Cordis. Percussion to determine the limit of the heart where the cardiac region sounded dull. It aims to determine is there any heart or left ventricular enlargement. Auscultation of heart sounds to determine I and II single or gallops and is there a third heart sound that may be symptoms of heart trouble and is there any murmurs that indicate the presence of increased blood flow turbulence.

4) Digestive System

At the inspection need to be considered, whether the abdominal bulge or flat, edge protruding belly or not, the umbilicus prominent or not, but it also needs to be in inspection whether or not there lumps or masses.

Auscultation to listen to the voice in which intestinal peristalsis normal values ​​5-35 times per minute. On palpation should also be noted, is there any abdominal tenderness, is there a mass (tumor, feces), abdominal skin turgor to determine the degree of hydration of the patient, whether the liver is palpable, whether the lien is also palpable. Tympanik normal abdominal percussion, the mass of solid or liquid will cause a dull sound (liver, ascites, vesika urinarta, tumors).

5) Neurological System

On inspection of the level of awareness needs to be studied, In addition to GCS examination is also required. Is there composmentis or somnolence or comma. Pathological reflexes, and how the physiological reflex. Additionally sensory functions also need to be studied such as hearing, sight, smell, touch and taste.

6) Musculoskeletal System

At the inspection should be noted there peritibial edema, palpation at both extremities to determine the level of peripheral perfusion and capillary refil time with a survey. By inspection and palpation examination of muscle strength were compared between the left and right.

7) Integumentary System

Inspection of the general condition of skin hygiene, presence or absence of color in the skin lesions, on examination with pleural effusion will usually be visible cyanosis as a result of failure of oxygen transport system. On palpation should be checked on the warmth of the skin (cold, warm, fever). Then the skin texture (smooth-rough-soft) as well as skin turgor to determine the degree of hydration of a person.

Physical Examination of Pleural Effusion

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Nursing Assessment of Pleural Effusion - Patterns of Health Functions

Nursing Assessment of Pleural Effusion

Provision of Nursing Care is a therapeutic process that involves cooperation relations with clients, families or communities to achieve optimal health levels (Canpernito, 2000.2).

Nurses need the scientific method in the therapeutic process of the nursing process. The nursing process is used to assist nurses in nursing practice in a systematic in addressing nursing problems that exist, where the four components influence each other, namely: assessment, planning, implementation and evaluation form a chain.

Patterns of Health Functions

1) Health Perception and Health Management

The existence of medical and hospital care affect the change in perceptions about health, but it sometimes raises an incorrect perception towards health maintenance. The possibility of a history of smoking, drinking alcohol and drug use can be a predisposing factor of disease onset.

2) Nutritional Metabolic Pattern

In the assessment of nutritional and metabolic patterns, we need to take measurements of height and weight to determine the patient's nutritional status, but also need to be asked eating and drinking habits before and during the hospital, patients with pleural effusion will experience a decrease in appetite as a result of shortness of breath and an emphasis on abdominal structures. Increased metabolism will occur due to the disease process. patients with pleural effusion are generally weak state.

3) Elimination Pattern

In the assessment of the pattern of elimination need to be asked about bowel habits before and after in hospital. Because the patient's general condition is weak, the patient will be more bed rest so that it will cause constipation, but due to digestion on the structure of the abdomen causes a decrease in the peristaltic muscles of the digestive tract.

4) Activity and Exercise Pattern

Due to shortness of breath, tissue oxygen demand will be less satisfied and examination will quickly experience fatigue on minimal activity. Besides, patients will also reduce its activity due to chest pain. And to meet the needs of its most ADL needs of patients assisted by a nurse and family.

5) Sleep Rest Pattern

The presence of chest pain, shortness of breath and increased body temperature will affect the fulfillment of needs sleep and rest, in addition to changes in environmental conditions of a quiet home environment into the hospital environment, where many people are walking around, noisy, and so forth.

6) Role-Relationship Pattern

As a result of illness, patients will experience a change in role, eg a housewife patient, the patient can not perform its function as a mother who must care for their children, taking care of her husband. In addition, the role of patients in the community is also changing and all that affects the patient's interpersonal relationships.

7) Self-Perception-Self-Concept Pattern

Patient's perception of themselves will change. Patients who had been healthy, suddenly experienced pain, shortness of breath, chest pain. As a layman, the patient may be assumed that the disease is dangerous and deadly disease. In this case the patient might lose a positive image of himself.

8) Cognitive-Perceptual Pattern

Sensory function of patients had no change, so does the thinking process.

9) Sexuality and Reproduction

For patients who do not know the process will experience stress and illness may be a lot of patients ask nurses and doctors who cared for him or anyone who may be more to know about his illness.

10) Coping-Stress Tolerance Pattern

Sexual needs of patients in this case sexual intercourse would be disturbed for a while because the patient was in hospital and his physical condition was weak.

11) Value-Belief Pattern

As a religious patient will be closer himself and always pray to God.

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