Concept and Etiology: Pleural effusion affects the respiratory system by causing difficulty breathing.
Pleural effusion happens when there is an excessive amount of fluid located in the pleural cavity
and it limits the expansion of the lungs during inhalation (Story, 2018). This can occur in one or both
lungs.
Classification: This disease can be fixed by having the extra fluid removed so that they lungs can
fully expand. The way that the fluid can be removed is by thoracentesis, placement of a chest
drainage tube and antibiotics (Story, 2018).
Clinical Manifestations: c c The symptoms and signs of pleural effusion include dyspnoea, chest pain,
tachypnoea, tracheal deviation, diminished or absent lung sounds, dullness to percussion,
tachycardia, and pleural friction rub (Story, 2018).
Diagnostic Test: The way to test for a pleural effusion includes history, physical examination, chest
X-ray, CT, ABGs, CBC and thoracentesis (Story, 2018).
Concept and Etiology: Pneumothorax refers to air in the pleural cavity (Story, 2018). It can be
related to other medical situations occurring in the body, reaction to a procedure being performed,
or by traumatic event.
Classification: Pneumothorax is categorized in four classifications. Primary, secondary, iatrogenic, or
traumatic. Primary occur mostly in young, tall, thin males. Secondary occurs when there are
underlying lung abnormalities. Iatrogenic is commonly caused by procedures such as central vein
cannulation, pleural tap or biopsies, needle aspirations, and even acupuncture. Traumatic is through
direct injury to the thorax such as penetrating chest or fractured rib lacerating the pleura (Currie et
al., 2007).
Clinical Manifestations (Symptoms and Signs): Manifestations vary and include sudden chest pain
over affected lung, chest tightness, dyspnoea, tachypnoea, decreased breath sounds in affected
lung, asymmetrical chest movement, trachea and mediastinum deviation, anxiety, tachycardia,
pallor, and hypotension (Story, 2018).
Diagnostic Tests: Diagnostics include physical examination, imaging such as chest x-ray, CT, and
ABGs (Story, 2018).
Concept and Etiology: Cancer is defined by abnormal cell growth, when this abnormal cell growth
initiates in the lungs, it is classified as lung cancer. Lung cancer can affect the respiratory system if
the tumour grows large enough to impede the airways, it can also cause bleeding within the
airways. Lung cancer can cause fluid to accumulate in the plural space which would cause a plural
effusion. IF for some reason the lung cancer was not found and treated early enough, lung cancer
could spready (metastasize) to other areas of the body as well. If a person has lung cancer, they
would no longer be in a state of complete physical health due to effects cancer has on the body,
therefore that person would no longer be considered healthy.
Classification: Lung cancers are broadly classified into two types: small cell lung cancers (SCLC) and
non-small cell lung cancers (NSCLC). This classification is based upon the microscopic appearance of
the tumour cells. These two types of cancers grow, spread, and are treated in different ways, so
making a distinction between these two types is important. Small cell lung cancers are known to
grow and spread very quickly and are also very aggressive. Once found, they have often spread to
several other parts of the body. Non- small cell lung cancers can be broken down into 3 subtypes:
Adenocarcinoma in situ (previously called bronchioloalveolar carcinoma) is a subtype of
adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the pre-
existing alveolar walls. It may also look like pneumonia on a chest X-ray. Squamous cell cancers arise
most frequently in the central chest area in the bronchi. This type of lung cancer most often stays
within the lung, spreads to lymph nodes, and grows quite large, forming a cavity. Large cell
carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of
NSCLC, accounting for 10%-15% of all lung cancers. This type of cancer has a high tendency to
spread to the lymph nodes and distant sites. Additionally, there is also Bronchial carcinoids. These
tumours are generally small (3-4 cm or less) when diagnosed and occur most commonly in persons
under age 40. Unrelated to cigarette smoking, carcinoid tumours can metastasize, and a small
proportion of these tumours secrete hormone-like substances. Carcinoids generally grow and
spread more slowly than bronchogenic cancers, and many are detected early enough to be
surgically removed (Robinson, 2020).
Lung cancer is staged on the following information:
T – Tumour size and location
N – Regional lymph node involvement. Lymph nodes are small ball-shaped immune system organs
distributed throughout the body. It is important to know whether the lung cancer has spread to the
lymph nodes around the lung.
M – Metastasis status. Metastasis status refers to which organs the cancer has spread.
While non-small cell ranges in stages from 0 to IV, small cell is staged as either limited or extensive
(American Lung Association, 2021).
Signs: persistent cough measured by a healthcare provider, fever, swelling which is a sign of vena
cava syndrome, finger clubbing,
Symptoms: persistent cough that gets worse, recurrent chest infections, coughing up blood, pain
when breathing or coughing, shortness of breath, fatigue, loss of appetite and unexplained weight
loss, dysphagia
Often the disease has progressed extensively before any signs any symptoms are present of the
disease. It should be noted that many of the signs(objective) and symptoms (subjective) could be
the same, the difference would be dependent upon if the patient reports them or if they have been
observed by clinical staff.
Diagnostic Tests:
A chest X-ray is usually the 1st test used to diagnose lung cancer. Most lung tumours appear on X-
rays as a white-grey mass.
A CT scan is usually the next test you will have after a chest X-ray. A CT scan uses X-rays and a
computer to create detailed images of the inside of your body.
A PET-CT scan may be done if the results of a CT scan show you have cancer at an early stage. The
PET-CT scan (which stands for positron emission tomography-computerized tomography) can show
where there are active cancer cells. This can help with diagnosis and choosing the best treatment.
There are also numerous biopsies that can be done to distinguish if cancer is present and decide
what type of cancer it is and where it is located. (NHS,2019)
References:
Lung cancer staging. American Lung Association. (2021, October 28). Retrieved November 7, 2021,
from https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-
diagnosis/lung-cancer-staging.
NHS. (2019, August 15). Lung Cancer. NHS choices. Retrieved November 7, 2021, from
https://www.nhs.uk/conditions/lung-cancer/diagnosis/.
Robinson, J. (2020). Types of lung cancer: small cell and non-small cell lung cancer types. WebMD.
Retrieved November 7, 2021, from https://www.webmd.com/lung-cancer/lung-cancer-types.
Currie, G. P., Alluri, R., Christie, G. L., & Legge, J. S. (2007). Pneumothorax: an update. Postgraduate
Medical Journal, 83(981), 461–465. https://doi.org/10.1136/pgmj.2007.056978
Story, L. (2018). Pathophysiology: a practical approach (3rd ed.). Jones & Bartlett Learning.
Story, L. (2018). Pathophysiology: A Practical Approach. Burlington: Jones & Bartlett Learning.
