Pleuritis, commonly known as pleurisy, can be an agonizing experience for patients. That sharp, stabbing sensation with every breath is more than just a discomfort—it is a clinical sign that the delicate layers surrounding the lungs are inflamed.
In this comprehensive guide, we break down the pathophysiology of pleuritis and the essential nursing interventions required for effective recovery.
What is Pleuritis? (The Affected Organ)
Pleuritis is the inflammation of the pleura, the serous membrane that surrounds the lungs and lines the thoracic cavity.
The pleura consists of two layers:
- The Visceral Pleura: Covers the surface of the lungs.
- The Parietal Pleura: Lines the inner chest wall.
In a healthy state, these layers glide smoothly over one another during respiration. When inflamed, they rub together like sandpaper, causing intense pain.
The Mechanism: Why Does Inflammation Occur?
The mechanism behind pleuritis is typically a secondary response to an initial insult to the respiratory system.
- Viral Infections: The most common cause (e.g., influenza or pneumonia).
- Underlying Lung Disease: Conditions like pulmonary embolism, tuberculosis, or lung cancer.
- Autoimmune Disorders: Lupus or rheumatoid arthritis can trigger pleural inflammation.
- Trauma: Rib fractures or chest injuries.
Recognizing the Signs and Symptoms
The hallmark of pleuritis is pleuritic chest pain. Unlike cardiac pain, which is often a dull pressure, pleuritic pain has specific characteristics:
- Sharp, Stabbing Pain: Usually localized to one area of the chest.
- Respiratory Aggravation: The pain worsens significantly during deep breathing, coughing, or sneezing.
- Shortness of Breath (Dyspnea): Patients often take shallow breaths to avoid the pain of lung expansion.
- Pleural Friction Rub: On auscultation, a clinician may hear a “creaking” sound caused by the inflamed layers rubbing together.
Nursing Care and Management
Effective nursing care for pleuritis focuses on pain control and the prevention of respiratory complications like atelectasis (collapsed lung).
1. Pain Management
Because the pain prevents the patient from breathing deeply, pain relief is the first priority.
- Administer prescribed NSAIDs or analgesics.
- Encourage the patient to splint the affected side (holding a pillow firmly against the chest) when coughing to minimize friction.
2. Monitoring Respiratory Status
- Assess lung sounds frequently for a friction rub or signs of pleural effusion (fluid buildup).
- Monitor oxygen saturation levels ($SpO_2$) to ensure shallow breathing isn’t causing hypoxia.
3. Patient Education
- Deep Breathing Exercises: Teach the patient how to perform controlled deep breaths to keep the alveoli open.
- Incentive Spirometry: Encourage the use of a spirometer to track and improve lung volume during recovery.