Pleurisy - Causes, Symptoms and Treatments

Pleurisy, also known as pleuritis, is an inflammation of the visceral and parietal pleurae that line the inside of the thoracic cage and envelop the lungs.

Causes of Pleurisy:

Pleurisy develops as a complication of pneumonia, tuberculosis, viruses, systemic lupus erythematosus, rheumatoid arthritis, uremia, Dressler's syndrome, cancer, pulmonary infarction, and chest trauma.

Pleuritic pain is caused by the inflammation or irritation of sensory nerve endings in the parietal pleura. As the lungs inflate and deflate, the visceral pleura covering the lungs moves against the fixed parietal pleura lining the pleural space, causing pain. This disorder usually begins suddenly.

Signs and symptoms of Pleurisy:

Sharp, stabbing pain that increases with respiration may be so severe that it limits movement on the affected side during breathing. Dyspnea also occurs. Other symptoms vary according to the underlying pathologic process.

Diagnosis of Pleurisy:

Auscultation of the chest reveals a characteristic pleural friction rub - a coarse, creaky sound heard during late inspiration and early expiration, directly over the area of pleural inflammation. Palpation over the affected area may reveal coarse vibration. Other conditions to consider are myocardial infarction, pericarditis, and pulmonary embolus.

Treatment of Pleurisy:

Generally, symptomatic treatment includes anti-inflammatory agents, analgesics, and bed rest. Severe pain may require an intercostal nerve block of two or three intercostal nerves. Pleurisy with pleural effusion calls for thoracentesis as both a therapeutic and a diagnostic measure.

Special considerations of Pleurisy:

• Stress the importance of bed rest and plan your care to allow the patient as much uninterrupted rest as possible.
• Administer antitussives and pain medication as necessary, but he careful not to overmedicate.
• If the pain requires a narcotic analgesic, warn the patient about to be discharged to avoid overuse because such medication depresses coughing and respiration.
• Encourage the patient to cough. Tell him to apply firm pressure at the site of pain during coughing exercises to minimize pain.