Medical Surgical Pleural Effusion & Thoracentesis #3

Question

A client enters the emergency department with difficulty breathing, chest pain during inhalation and a fever. Assessment by the nurse revealed dull resonance on percussion with diminished breath sounds in the left lower lobe. Based on the nurse’s assessment findings, which diagnosis is most likely?

Answers

  1. Pleural effusion
    • Rationale:

      This answer is correct because the client is exhibiting key signs of pleural effusion which are chest pain during inhalation, dull resonance on percussion, and diminished lungs sounds in the lower lobes. The client has a fever, which indicates some type of infection, most likely pneumonia. Pleural effusion is typically the result of pneumonia or heart failure.

  2. Pleurisy
    • Rationale:

      This answer is not correct because in pleurisy, the sound heard on auscultation of the lungs is friction that is generated by the rubbing of the two inflamed layers of the pleura with each breath. This is called a pleural friction rub.

  3. Pneumothorax
    • Rationale:

      This answer is not correct because the nurse heard dull resonance on percussion. A client with a pneumothorax will have hyperresonance, indicating high air inside the lungs.

  4. Deviated trachea
    • Rationale:

      This answer is not correct because with a deviated trachea, the client will be coughing and wheezing. Also, dull resonance will not be percussed since the cause of a deviated trachea is caused by a tension pneumothorax.

Overview

Pleural effusion is when there is more than 15 mL of fluid build up between the lungs and chest cavity. Key signs include chest pain during inhalation, diminished breath sounds on lower lung bases and dull resonance on percussion.

Explanation

Learning Outcomes

Pleural effusion happens as a result of heart failure or pneumonia, from fluid build up in the pleural space, the area between the lungs and chest cavity. This results in decreased gas and oxygen exchange and atelectasis, which can place the client in acidosis from the buildup of CO2. Key signs include chest pain during inhalation, diminished breath sounds on lower lung bases, and dull resonance on percussion. Pleurisy is when the pleura becomes inflamed, causing sharp chest pain and a pleural friction rub on auscultation. Pneumothorax is when high air is trapped inside the lungs and the client will have hyperresonance on percussion. A deviated trachea is caused by a tension pneumothorax. The client will demonstrate coughing and wheezing.

Test Taking Tip

Remember the differences between pleural effusion and pneumothorax. Pleural effusion is when there is fluid inside the lung space and there will be dull resonance on percussion. Pneumothorax is when there is high air in the lung space and there will be hyperresonance.

Video Rationale