Pleurisy

Pleurisy, or pleuritis, is inflammation of the pleura, usually involving the pain-sensitive parietal layer. Inflamed pleural surfaces lose their smooth movement against one another, so each inspiration, cough, or sneeze can produce a sharp, localized pain. The visceral pleura has little pain sensation; the parietal pleura is what makes the pain noticeable. Most cases are viral and resolve as the inflammation settles. Pleurisy can also occur with bacterial pneumonia, pulmonary embolism, myocardial infarction, pneumothorax, trauma, connective-tissue disease, or malignancy. Therefore, “pleurisy” describes a pain pattern and inflammatory process; it does not, by itself, identify the underlying disease. Pain may cause splinting: the patient takes shallow breaths to avoid moving the painful pleural surfaces. That response can reduce ventilation and make the patient appear more distressed. The practical nurse watches both the pain and the respiratory effect of that pain—respiratory rate and effort, oxygen saturation, breath sounds, chest movement, and the patient’s ability to speak.