Introduction[edit | edit source]A Pleural friction rub or Pleural rub, is an audible raspy breathing sound, a medical sign present in some patients with pleurisy and other conditions affecting the chest cavity. It can be noticed by listening to the internal sounds of the body, usually using a stethoscope on the lungs. Show
These are the squeaking or grating sounds of the pleural linings rubbing together. It is best described as the sound made by treading on fresh[1] snow. Pleural rubs are common in pneumonia, pulmonary embolism, and pleurisy. Because these sounds occur whenever the patient's chest wall moves, they appear [2]on inspiration and expiration.[3] (Click here to read about the anatomy of pleura) Pleural friction rub occurs when the two layers[4] of tissue become inflamed or if they lose the lubrication between them. A pleural friction rub may be a symptom of a serious lung condition.[5] [1] Causes[edit | edit source]
Diagnosis[edit | edit source]
Treatment[edit | edit source]Treatment depends on the underlying cause.
Further Reading[edit | edit source]
References[edit | edit source]
Master Acute Pericarditis Assessment with Picmonic for Nursing RNWith Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing.DOWNLOAD PDFRecommended PicmonicsAcute Pericarditis AssessmentAcute-angle Pear-heart-on-fire with Assess-man Acute pericarditis is a condition caused by inflammation of the pericardial sac related to various causes (refer to the Picmonic on "Acute Pericarditis Causes"). Some patients with acute pericarditis may be asymptomatic. Patients with symptoms of acute pericarditis may experience sharp chest pain, pericardial friction rub, and fever.
Electrocardiogram (ECG) assessment findings include a widespread ST-elevation and T-wave inversion. Cardiac tamponade and pericardial effusion are complications of acute pericarditis. 10 KEY FACTS Acute pericarditis is caused by inflammation of the pericardial sac. The pericardial sac, or pericardium, is composed of the inner serous and outer fibrous layers surrounding serous fluid. The pericardium provides lubrication to decrease friction during heart movements. Causes of inflammation of the pericardium include infections, acute myocardial infarction, neoplasms, trauma, radiation, myxedema, rheumatic fever, and drug reactions. Severe, sharp chest pain is characteristic of acute pericarditis. The pain may radiate to the patient's clavicle, neck, or trapezius. Trapezius muscle pain is characteristic of acute pericarditis because the phrenic nerve innervates the areas of the shoulders and upper back. Since it may also radiate to the left shoulder, the pain may be mistaken for angina. Patients with acute pericarditis may experience worsening chest pain with deep inspiration. To avoid chest pain, the patient may begin to develop dyspnea by breathing rapid, shallow breaths. Patients with acute pericarditis may exacerbate sharp chest pain when lying supine. Instruct the patient to sit up and lean forward in order to relieve the severe pain.
The hallmark symptom of acute pericarditis is the pericardial friction rub. This scratching, grating, high-pitched sound is caused by friction between the roughened pericardial and epicardial surfaces. The sound is best heard at the left lower sternal border. In order to consistently hear the sound and differentiate it from a pleural friction rub, instruct the patient to hold their breath during auscultation. If the sound is still present, it is cardiac-related. Obtaining an electrocardiogram (ECG) will help diagnose the patient with acute pericarditis. Since the pericardial inflammation causes abnormal repolarization, characteristic changes in the ECG includes diffuse or widespread, ST-segment elevations. Additional ECG changes include T-wave inversion and PR-segment depression. Inflammation of the epicardium causes changes in the patient's ECG. The ECG of a patient with acute pericarditis may include T-wave inversion. Fever is a result of the body's anti-inflammatory response. A large percentage of patients with acute pericarditis experience chronic or intermittent fever as an early symptom. Instruct the patient to monitor body temperature to determine if drug therapy is effective. Acute pericarditis may be asymptomatic in some patients. Since the infection is recurrent, the patient may not show symptoms between cases of pericarditis. Instruct the patient to carefully monitor for unassuming symptoms such as fever and chest pain. Pericardial effusion is a complication related to acute pericarditis. The build-up of fluid in the pericardium may compress surrounding structures such as the heart, lungs, laryngeal nerve, and phrenic nerve. Cardiac tamponade is an acute type of pericardial effusion that compresses the heart. Symptoms include chest pain, confusion, anxiety, restlessness, tachypnea, and tachycardia. Increased compression of the heart causes decreased cardiac output, muffled heart sounds, and narrowed pulse pressure. The patient may develop pulsus paradoxus, which is a decrease in systolic blood pressure during inspiration. DOWNLOAD PDFTake the Acute Pericarditis Assessment QuizPicmonic's rapid review multiple-choice quiz allows you to assess your knowledge. Picmonic for Nursing RN CoversRegistered Nurse (RN) *Average video play time: 2-3 minutes Our Story Mnemonics Increase Mastery and RetentionMemorize facts with phonetic mnemonics Unforgettable characters with concise but impactful videos (2-4 min each) Ace Your Registered Nurse (RN) Classes & Exams with Picmonic:Choose the #1 Registered Nurse (RN) student study app.Works better than traditional Registered Nurse (RN) flashcards.What is the difference between pleural friction rub and pericardial friction rub?A friction rub is an audible medical sign. Pleural friction rubs can only be heard during inspiration and expiration, whereas, pericardial friction rubs can be heard even when the patient is not breathing. Pleural friction rubs can be detected more laterally compared to pericardial friction rubs.
How does the nurse differentiate between a pleural rub and a pericardial rub?Pleural rub creates pain mostly on the lateral part of the chest wall, whereas pain due to pericardial rub is always central in location. The intensity of pleural rub is increased on pressing the diaphragm of the stethoscope over the affected area, whereas there is no such change in case of a pericardial rub.
How do you identify a pericardial friction rub?Rubs: Pericardial friction rubs usually occur in the setting of pericarditis. They are caused by friction between the inflamed pericardial surfaces. It is a rocking to-and-fro sound that resembles walking in fresh snow. It is more pronounced with the patient leaning forward.
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How does the nurse differentiate a pleural friction rub from a pericardial friction rub?
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