NCLEX Review Guide: Pleurisy

Definition & Mechanism

• Pleurisy (pleuritis) is inflammation of the pleural membranes that line the lungs and chest cavity, causing friction between the visceral and parietal pleura during breathing.
• The inflamed pleural surfaces lose their smooth, lubricated quality and rub against each other, creating the characteristic pleural friction rub sound.

Clinical Manifestations

• Sharp, stabbing chest pain that worsens with inspiration, coughing, or movement - this is the hallmark symptom.
• Pain is typically unilateral and localized to the affected pleural area.
• Shallow, rapid breathing (tachypnea) as patient attempts to minimize painful respirations.
• Dry, nonproductive cough that may develop to avoid deep inspiration.

Physical Assessment

1. Auscultate lungs for pleural friction rub - sounds like leather rubbing together or grating sound during both inspiration and expiration
2. Assess respiratory rate, depth, and pattern - expect shallow, guarded breathing
3. Evaluate pain using 0-10 scale, noting relationship to respiratory cycle
4. Observe for splinting behavior and positioning preferences

Priority Nursing Interventions

• Position patient on affected side to splint the area and reduce friction between pleural surfaces during breathing.
• Administer prescribed analgesics and anti-inflammatory medications to reduce pain and inflammation.
• Encourage deep breathing and coughing exercises once pain is controlled to prevent respiratory complications.
• Apply heat or cold therapy as ordered and tolerated for additional pain relief.