Which of the following patho-physiological changes are seen in patient with pleurisy?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

Pleurisy is defined as the inflammation of the pleural layers (visceral and parietal) surrounding the lungs.
The parietal pleura is innervated with sensory nerve endings.
During respiration, the inflamed pleural layers rub against each other, stimulating these nerve endings and causing sharp, localized chest pain.
This pain is characteristically 'pleuritic,' meaning it worsens with deep inspiration, coughing, or sneezing.

Option B: This is the opposite of the actual pathophysiology. Pleurisy is fundamentally an inflammatory condition.
Option C: This describes a key feature of pulmonary hypertension, not pleurisy. Pleurisy involves inflammation of the pleural membranes, not primarily the pulmonary vasculature.
Option D: Similar to increased vascular resistance, this is a hallmark of pulmonary hypertension. The pain in pleurisy is due to nerve stimulation from friction, not elevated arterial pressure.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of Pleurisy to guide bedside assessment, documentation, and the next nursing action.
Recognizing pleuritic chest pain is a crucial nursing skill, as it can indicate underlying respiratory or cardiac issues that require prompt intervention.
A key nursing intervention is pain management, which not only provides comfort but also allows the patient to breathe deeply and cough effectively, preventing complications like atelectasis and pneumonia.
Positioning the patient on the affected side can help splint the chest wall, reducing movement and alleviating pain.

How to Approach the Question

First, identify the core concept of the question, which is 'pleurisy'.
Recall the definition of pleurisy: it is an 'inflammation' of the pleura.
Analyze the options in light of this definition. Option B, which suggests an 'absence of inflammation', can be immediately eliminated.
Consider the primary symptom of pleurisy, which is sharp chest pain. Connect the inflammation to the symptom. The parietal pleura has nerve endings; inflammation would stimulate them, causing pain. This makes Option A a strong candidate.
Evaluate the remaining options (C and D). Increased pulmonary resistance and pressure are related to pulmonary hypertension, a different pathophysiological process. Therefore, they are incorrect in the context of uncomplicated pleurisy.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 1-3

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 442-444

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 2 (215-514) p. 77-79

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