STUDY - Technical - New Dacian's Medicine
Pleural
friction rub (Classical / Allopathic Medicine)
Commonly
resulting from a pulmonary disorder or trauma, this loud,
coarse, grating, creaking, or squeaking sound may be
auscultated over one or both lungs during late inspiration
or early expiration. It's heard best over the low axillae
or the anterior, lateral, or posterior bases of the lung
fields with the patient upright. Sometimes intermittent,
it may resemble crackles or a pericardial friction rub.
A
pleural friction rub indicates inflammation of the
visceral and parietal pleural lining, which causes
congestion and edema. The resultant fibrinous exudate
covers both pleural surfaces, displacing the fluid that's
normally between them and causing the surfaces to rub
together.
ALERT:
When you detect a pleural friction rub:
- quickly look for signs of respiratory distress
- find out whether the patient has had chest pain; if so, ask him to describe its location and severity
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
When you detect a pleural friction rub:
- quickly look for signs of respiratory distress
- find out whether the patient has had chest pain; if so, ask him to describe its location and severity
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
If the patient complains of chest pain, ask him how long he has had the pain and about its characteristics. Does it radiate to his shoulder, neck, or upper abdomen? Does it worsen with breathing, movement, coughing, or sneezing?
Ask the patient if he has experienced a fever.
Review the patient's medical history for rheumatoid arthritis, respiratory or cardiovascular disorders, recent trauma, asbestos exposure, and radiation therapy.
If the patient smokes, obtain a history in pack years.
If the patient complains of chest pain, ask him how long he has had the pain and about its characteristics. Does it radiate to his shoulder, neck, or upper abdomen? Does it worsen with breathing, movement, coughing, or sneezing?
Ask the patient if he has experienced a fever.
Review the patient's medical history for rheumatoid arthritis, respiratory or cardiovascular disorders, recent trauma, asbestos exposure, and radiation therapy.
If the patient smokes, obtain a history in pack years.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, noting his level of consciousness.
Observe the patient's skin color.
Auscultate the patient's chest with him sitting upright and breathing deeply and slowly through his mouth. Listen for absent or diminished breath sounds, noting their location and timing in the respiratory cycle. Note the work of breathing. Explore whether the pain abates if he splints his chest, holds his breath, exerts pressure, or lies on the affected side.
Check for clubbing and pedal edema.
Palpate for decreased chest motion, and percuss for flatness or dullness.
Take the patient's vital signs, noting his level of consciousness.
Observe the patient's skin color.
Auscultate the patient's chest with him sitting upright and breathing deeply and slowly through his mouth. Listen for absent or diminished breath sounds, noting their location and timing in the respiratory cycle. Note the work of breathing. Explore whether the pain abates if he splints his chest, holds his breath, exerts pressure, or lies on the affected side.
Check for clubbing and pedal edema.
Palpate for decreased chest motion, and percuss for flatness or dullness.
SPECIAL
CONSIDERATIONS:
Monitor the patient's respiratory status and vital signs. Administer an antitussive if the patient has a dry, persistent cough, as ordered.
Monitor the patient's respiratory status and vital signs. Administer an antitussive if the patient has a dry, persistent cough, as ordered.
PEDIATRIC
POINTERS:
Auscultate for a pleural friction rub - an early sign of pleurisy - in a child who has grunting respirations, reports chest pain, or protects his chest by holding it or lying on one side.
Auscultate for a pleural friction rub - an early sign of pleurisy - in a child who has grunting respirations, reports chest pain, or protects his chest by holding it or lying on one side.
AGING
ISSUES:
In an elderly patient, the intensity of pleuritic chest pain may mimic that of cardiac-related chest pain.
In an elderly patient, the intensity of pleuritic chest pain may mimic that of cardiac-related chest pain.
PATIENT
COUNSELING:
Because pleuritic pain commonly accompanies a pleural friction rub, teach the patient splinting maneuvers to increase his comfort. Although coughing may be painful, instruct the patient not to suppress it because coughing and deep breathing help prevent respiratory complications.
Because pleuritic pain commonly accompanies a pleural friction rub, teach the patient splinting maneuvers to increase his comfort. Although coughing may be painful, instruct the patient not to suppress it because coughing and deep breathing help prevent respiratory complications.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.