shannon medical center cafeteria menu; aerosol cans under pressure if not handled properly; pros and cons of cold calling in the classroom; The practitioner can then slide the needle between two of your ribs, guiding it into the pleural space. Thoracocentesis: From bench to bed. Thoracentesis Nursing Responsibilities - RN speak It can be done as an outpatient procedure, which means youre able to go home afterward. Your provider may ask you not to move or to hold your breath at different points during the procedure. bandage or dressing will be put on the area. Thoracentesis | Definition, Uses, and Providers | UCHealth | Colorado In some cases, a flexible tube (catheter) 3). Maher AlQuaimi. A. Transcript. You will stay in the hospital until the catheter Percutaneous pleural biopsy (a procedure in which part of the pleural tissue is removed), Thoracoscopy (a procedure in which healthcare providers examine the lung surface). If you had an outpatient procedure, you will go home when Pneumothorax is a potential complication. The thoracentesis catheter was then threaded without difficulty. Cleveland Clinic is a non-profit academic medical center. the nurse should expect the provider to order which of the following diagnostic tests? Follow their instructions for post-op care. Not appreciating that the lung is a moving structure. -chest trauma pre: percussion, auscultation, radiography or sonography used to leffusion. Materials: 1. This space is between the outside surface of the lungs (pleura) and the chest wall. heart rate, blood pressure, and breathing will be watched during 1. Hematology+Medical oncology Diagnostic study note: 4076516: Study: 1541079: corticotropin: 19010309: water: 4046792: . THORACENTESIS ACTIVE LEARNING TEMPLATE-THERAPEUTIC PROCEDURE.pdf, Eastern Suffolk Boces Adult Education Center, Respiratory Targeted ATI Remediation.docx, Unformatted text preview: ACTIVE LEARNING TEMPLATE: Diagnostic Procedure Lorri McNeal Ultrasound-guided thoracentesis performed by radiologists has been shown to have fewer complications than blind thoracentesis. Williams JG, Lerner AD. View National Heart, Lung, and Blood Institute. Thoracentesis is a respiratory procedure performed with the aim of removing pleural effusion. Live Course Registration; Live Course Description; Live Course Locations; CME Information; Course Agenda - remove dentures. Indications *Transudates (HF, cirrhosis, nephritic -normal breath sounds This position helps to spread out It depends on your condition and your You will be in a sitting position in a hospital bed. Soni NJ, Franco R, Velez MI, et al. Preprocedure nursing actions bronchoscopy. Ultrasound allows the distinction between effusion and lung consolidations, and the diagnostic accuracy of ultrasound for pleural effusions is superior (93%), compared to auscultation (61%) and AP chest radiograph (47%), using chest CT as the reference standard. Causes of Rib Cage Pain, Panniculectomy Surgery: Procedure and Recovery, fluid between the lungs and the chest wall, Patient-centered outcomes following thoracentesis, Amiodarone-induced loculated pleural effusion without pulmonary parenchymal involvement: a case report and literature review, Safe and effective bedside thoracentesis: a review of the evidence for practicing clinicians, Thoracentesis outcomes: a 12-year experience. What is thoracentesis. ATI Chp17 Flashcards | Quizlet Winner of the Standing Ovation Award for "Best PowerPoint Templates" from Presentations Magazine. Redness, swelling or bleeding at the needle site. They may use a hand-held ultrasound device to help them guide the needle. What is the considerations of diversity and cultural awareness in the topic of Human trafficking? STUDENT NAME _____________________________________ These are done to find the Start studying Comprehensive ATI 2019 B. b. Thoracentesis is a procedure to remove fluid or air from around the lungs. this process: You may be asked to remove your clothes. Thoracentesis can be done as frequently as every few days for certain conditions. Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest. Thoracentesis should not be done in people with certain bleeding Pleural Fluid Analysis: MedlinePlus Medical Test People need to be monitored after getting thoracentesis, even if they are having the procedure as an outpatient. Therapeutic thoracentesis is indicated to relieve the symp- toms (e.g., dyspnea, cough, hypoxemia, or chest pain) . Note: I am a first year nursing student and i have this case presentation, i. Therapeutic thoracentesis is associated with the same complications as diagnostic thoracentesis, including vasovagal reaction, pneumothorax, pleural infection, and hemothorax. Insert the needle along the upper border of the rib Learn vocabulary, terms, and more with flashcards, games, and other study tools. Thoracentesis is performed to:relieve pressure on the lungstreat symptoms such as shortness of breath and paindetermine the cause of excess fluid in the pleural space. Make a small cut in your skin (incision) and insert another needle between your ribs to take out fluid. N\PpNz;l>]]vo;*-=". -bleeding B: The periosteum is injected with the local anesthetic. questions you have. provider, Blood or other fluid leaking from the needle site. Thoracentesis - Johns Hopkins Medicine, based in Baltimore, Maryland Ask your healthcare provider to explain the risks in your specific case. : Bacteriological and cellular composition, T.B, To instill the medication, Contraindications:- your healthcare provider which risks apply most to you. Explain what about each item led you to choose it and what you learned from, Can you give me a case scenario of a disease PNEUMOTHORAX and what could be the possible nursing interventions of this? ATI Therapeutic Procedure Paracentesis ATI Therapeutic Procedure University Miami Dade College Course Advanced Medical-Surgical Nursing (NUR2212) Uploaded by DF Dalberte Fourrien Academic year2021/2022 Helpful? Depending on the situation, it may be performed in a hospital or at a practitioners office. What to expect when undergoing this test or treatment. Will you have ultrasound guidance during your procedure? This parameter does not address the use of ultrasound for preoperative image-guided localizationFor further . Techniques. procedures, such as lung or cardiac surgery. This will help ensure that thoracentesis makes sense for you. McGraw-Hill, 2006. Therapeutic thoracentesis (TT) is a simple and frequently performed procedure. Intercostal drainage tube insertion. Youll also probably be hooked up to equipment to help monitor you during the procedure, like for your blood pressure. needle goes in. If you are doing well, you may be able to go home in an hour or so. : an American History (Eric Foner), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Common causes of transudates are liver cirrhosis or heart failure. Dont let scams get away with fraud. [Thoracentesis - Step by Step] serum liver enzyme levels a nurse manager is preparing to teach a group of newly licensed nurses about effective time management. also be done to treat symptoms of pleural effusion by removing fluid. You might cough for up to an hour after thoracentesis. Thoracentesis, also known as a pleural tap, is a procedure performed to remove excess fluid or air from your pleural space. Barnes TW, Morgenthaler TI, Olsen EJ, et al. Thoracentesis can be both diagnostic and therapeutic for the patient. Diagnostic thoracentesis Indicated for almost all patients who have pleural fluid that is new or of uncertain etiology and is 10 mm in thickness on computed tomography (CT) scan, ultrasonography, or lateral decubitus x-ray (see figure Diagnosis of Pleural Effusion ) Normally the pleural cavity contains only a very small amount of fluid. conditions. In . Thoracentesis | NEJM - New England Journal of Medicine File Upload, PN pharmacology 2020 ATI proctored assessment exam, 1.Review the questions taken this week and identify 2 that you found interesting, challenging, and/or confusing. If you are having a diagnostic thoracentesis, your fluid will be sent to the lab for analysis. Thoracentesis is a procedure that removes pleural fluid for diagnostic and/or therapeutic purposes. The pleural space is the area outside your lungs but inside your chest wall. 1,2. padded bedside table with his or her arms crossed.Assist Thoracentesis to remove the excess air or fluid to Ease breathing, Thoracentesis Procedure Nursing Responsibilities Indications:- To relieve pain, dyspnoea, and symptoms of pressure, Emphysema, Malignant pleural effusion, For diagnosis e.g. The major difference is the amount of fluid removed. effusion, Systemic lupus erythematosus (SLE) and other autoimmune disease, Inflammation of the pancreas (pancreatitis), A blood clot in the lung (pulmonary embolism), An area of pus in the pleural space (empyema). If you are having outpatient thoracentesis, contact your healthcare provider promptly if you experience symptoms after going home, like: Most people dont need to get medical imaging done after thoracentesis. The inside of the chest is also lined with pleura. thoracentesis, medical procedure used in the diagnosis and treatment of conditions affecting the pleural spacethe cavity between the lungs and the thoracic cage. Bronchoscopy. NCLEX Connection: Reduction of Risk Potential, Diagnostic Tests Measure fluid and document amount and colorSend specimen to the Labs 2015 Jan-Dec;2. doi:10.1177/2373997515600404. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Removal of this fluid by needle aspiration is called a thoracentesis. Ask your provider if you have any restrictions on what you can do after a thoracentesis. for bleeding or drainage.Monitor vitals and respiratory will be put in place of the needle and the tubing will be attached The Medical-Surgical Nursing video tutorial series is intended to help RN and PN nursing students study for your nursing school exams, including the ATI, HESI and NCLEX. We do not endorse non-Cleveland Clinic products or services. In contrast, infection or cancer would be more likely to cause exudates. These terms are just general categories that can help your clinician discover what is going on with your health. Patient-centered outcomes following thoracentesis. A Adult Health-1 - All ATI BOOK Questions (Exam-1) (Session - March 2019) This Notes covers ATI Book Unit-3 (Respiratory Disorders), Unit-4 (Cardiovascular Disorders), and Unit-6 (Fluid and Electrolyte Imbalance) ATI UNIT-3 RESPIRATORY DISORDERS Ch-17 Respiratory Diagnostic Procedures A nurse is caring for a client who is scheduled for a thoracentesis. Thoracentesis is a generally safe procedure. Results from a lab are usually available in 1 to 2 working days. Medical-Surgical Nursing. That Theyll be in good company. Refractory ascites. Thoracentesis is a procedure that removes extra fluid (pleural effusion) from the pleural space. Mahesh Chand. Used to evaluate the clients respiratory status by checking indicators such as. complications of thoracentesis ati. The ideal position for the patient is to sit upright leaning forward. Diagnostic thoracentesis [online], UpToDate, 2005. Your risks may vary depending on your general health and other factors. For example, thoracentesis is not usually recommended for people with severe respiratory failure or people who dont have adequate blood pressure. a) Wear goggles and a mask during the procedure. ATI: Chapter 17 - Respiratory Diagnostic Procedures - Brainscape Someone will surgically drape the area and get it ready for the procedure. Wiederhold BD, Amr O, O'Rourke MC. Youll typically need to avoid eating and drinking for several hours before the procedure. They may ask you to: Before a thoracentesis, your provider will take your blood pressure and use a small device on your finger to measure your blood oxygen level. This allows excess fluid to continue to be removed continuously. If youre going home afterwards, theyll continue to watch your vital signs until its OK for you to leave. It is most often used to diagnose the cause of pleural effusion, the abnormal accumulation of fluid in the pleural space. space is the thin gap between the pleura of the lung and of the inner chest Recovery time for minimally invasive procedures is short and risks are much lower than for major surgery. What test must you do before performing an arterial puncture? Your healthcare provider will give you specific instructions on how to prepare for a thoracentesis. J Thorac Dis. All of the exams use these questions, C225 Task 2- Literature Review - Education Research - Decoding Words And Multi-Syllables, Chapter 2 notes - Summary The Real World: an Introduction to Sociology, Summary Media Now: Understanding Media, Culture, and Technology - chapters 1-12, EDUC 327 The Teacher and The School Curriculum Document, NR 603 QUIZ 1 Neuro - Week 1 quiz and answers, Analytical Reading Activity 10th Amendment, Kami Export - Athan Rassekhi - Unit 1 The Living World AP Exam Review, Entrepreneurship Multiple Choice Questions, Chapter 1 - Summary Give Me Liberty! Thoracentesis Procedure Note - VCMC Family Medicine Thoracentesis is a medical procedure to remove some fluid between the lungs and the chest wall. Angiography is an imaging test that uses x-rays and a special dye to see inside the arteries. (https://pubmed.ncbi.nlm.nih.gov/28350729/). Talk about any The pleura is a double layer of membranes that surrounds the lungs. If there is any doubt, pleural fluid should be sent for diagnostic analysis (see below); in practice, diagnostic analysis is almost always necessary. 3. infection. versus exudate, detect the presence of These symptoms may be worse with physical activity. doi:10.4103/0976-9668.198345, Kalifatidis A, Lazaridis G, Baka S, et al. At home, you can go back to your normal diet and activities if instructed Its also unnecessary to keep him on the NPO list. Your provider usually sends the drained fluid to a lab. The best position for a thoracentesis is sitting up and resting on your arms on a table in front of you. or other fluid. *Exuadates (inflammatory, infectious, When this happens, its harder to breathe auscultate lungs, encourage deep breathe, obtain xray, -medianstinal shift CPT 32555: Pleural space aspiration with imaging guidance utilizing thoracentesis, needle, or catheter. - Document color, odor, consistency, and amount of fluid removed, location of insertion site, evidence of leakage, manifestation of, - Change positions slowly to decrease risk of, Assist patient to void, to reduce risk of injury to bladder, Measure abdominal girth and elevate head of bed, Position pt supine with head of bed elevated, Monitor vital signs espaecially BP, pulse (risk hypovolemia), Measure fluid and document amount and color, Access puncture site dressing for drainage, Civilization and its Discontents (Sigmund Freud), Give Me Liberty! But too much fluid can build up because of. However, now it is frequently done with the help of ultrasound. INDICATION: _ PROCEDURE OPERATOR: _ ATTENDING PHYSICIAN: _ In Attendance (Y/N): _ CONSENT: [_] During the informed consent discussion regarding the procedure, or treatment, I explained the following to the patient/designee: a. It is important to remain still so that the needle is inserted into the correct place. Ask bed. location of the fluid to be removed. Cleanse the skin with chlorhexidene. Is chest radiography routinely needed after thoracentesis? With proper training in both thoracentesis itself and the use of bedside ultrasonography, providers can perform this procedure safely and successfully. Sometimes thoracentesis is used as a treatment to decrease symptoms from a pleural effusion. Afterward, you could get a Alternative Names Pleural fluid aspiration; Pleural tap How the Test is Performed The test is done in the following way: You sit on a bed or on the edge of a chair or bed. Ultrasound-guided thoracentesis performed by radiologists has been shown to have fewer complications than blind thoracentesis. Thoracentesis is a procedure that a provider uses to drain extra fluid from around the lungs (pleural space) with a needle. Managing complications of pleural procedures. All that extra fluid may make you feel short of breath. anesthetic medicines (local and general), Take any medicines, including prescriptions, over-the-counter Your healthcare provider may give you other instructions after the Iatrogenic Pneumothorax. Pulmonary angiography. Transudates are thinner and more clear, occurring from fluid flowing out of the lung capillaries. Detailed analysis of the fluid in a lab can help identify the source of your problem. All of the exams use these questions, C225 Task 2- Literature Review - Education Research - Decoding Words And Multi-Syllables, Chapter 2 notes - Summary The Real World: an Introduction to Sociology, Summary Media Now: Understanding Media, Culture, and Technology - chapters 1-12, EDUC 327 The Teacher and The School Curriculum Document, NR 603 QUIZ 1 Neuro - Week 1 quiz and answers, Analytical Reading Activity 10th Amendment, Kami Export - Athan Rassekhi - Unit 1 The Living World AP Exam Review, Entrepreneurship Multiple Choice Questions, Chapter 1 - Summary Give Me Liberty! Allen's test; patency of the ulnar artery- if blood returns to hand in 15s, then the radial artery can b Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavityto obtain ascitic fluid for diagnostic or therapeutic purposes. Many people have fluid on their lungs that keeps coming back because of an underlying medical condition. : an American History (Eric Foner), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Psychology (David G. Myers; C. Nathan DeWall), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. Salmonella Ati: 42900587: teriflunomide 14 MG Oral Tablet [Aubagio] . PDF PROCEDURE Thoracentesis (Assist) - Elsevier Reexpansion pulmonary edema after therapeutic thoracentesis. Understanding the Essentials of Critical Care Nursing 3rd Edition Test Bank by Kathleen Perrin/Test Bank Care of Prior to the procedure, PA and lateral chest radiographs were performed to establish the presence of a freely flowing pleural However, there is one difference between a diagnostic and a therapeutic thoracentesisthat is, the quantity of fluid removed. study/diagnostic-medical-sonography/ Complete the ATI TEAS AH (Allied Health) program pre-entrance exam with a competitive score prior to March 1st. Procedure steps for diagnostic thoracentesis (1) Sterilize a wide area surrounding the puncture site with chlorhexidine 0.05% (applied with vigorous scrubbing) or povidone-iodine 10% in circular fashion with adequate drying time. Normally, only a very small amount of fluid should be between the outside of the lung and the chest wall, between the two membranes ( pleura) that Risks and Contraindications. Typically, a healthcare provider will perform the thoracentesis, with nurses assisting before and after the procedure. PDF PROCEDURE Thoracentesis (Perform) - Elsevier Thoracentesis for treating pleural effusions - Radiologyinfo.org The procedure may be done to take a sample of the fluid for testing to help find the cause. This is done under the guidance of an ultrasound that gives visualization on the pleural area. This type of thoracentesis usually removes a smaller amount of fluid compared to a therapeutic thoracentesis. How To Do Paracentesis - Merck Manuals Professional Edition The risk of complications is minimized by making sure that the procedure is done only when necessary for symptom relief or to find the cause of pleural effusion. robert warwick imdb; beyerdynamic dt 177x go reddit; Categoras. LIVE COURSES. It is performed It causes symptoms like: Chest pain. %PDF-1.3 % 1 0 obj << /W [ 4503 [ 784 ] ] /Subtype /CIDFontType2 /FontDescriptor 80 0 R /BaseFont /ACDPNI+ArialUnicodeMS /CIDSystemInfo << /Supplement 0 /Ordering (Identity) /Registry (Adobe) >> /DW 1000 /Type /Font /CIDToGIDMap /Identity >> endobj 2 0 obj << /op true /OPM 1 /SM 0.02 /OP true /SA true /Type /ExtGState >> endobj 3 0 obj << /FontFile3 32 0 R /CharSet (/space/t/i/d/m/o/h/s/w/a/period/T/f/e/c/g/n/p/r/u/l/asterisk/L/v/C/colon/Q/comma/y/z) /CapHeight 714 /Ascent 714 /Flags 32 /ItalicAngle 0 /Descent -176 /XHeight 536 /FontName /ACDPKH+HelveticaNeue-Condensed /FontBBox [ -164 -212 1000 932 ] /StemH 84 /Type /FontDescriptor /StemV 84 >> endobj 4 0 obj << /Height 101 /BitsPerComponent 8 /Length 653 /ColorSpace 75 0 R /Width 80 /Filter [ /ASCII85Decode /FlateDecode ] >> stream Other less common causes of pleural effusion include: Tuberculosis. Thoracentesis, commonly known as a pleural tap or chest tap, is a procedure where excess pleural fluid is drained from the pleural space for diagnostic and/or therapeutic reasons. Up to 1.5 L is removed in a therapeutic thoracentesis. post: apply dressing over puncture site and assess, monitor vital sings, *Blunt, crushing, or penetrating chest Your provider will numb your skin before putting the needle in. Parenting information is available at Parenthub.com.au, The Medical System Bulk Billing & Medicare. Blood culture bottles 4. Now is your chance to get an idea of what to expect. - informed consent. fluid is then examined in a lab. Interpreting Results. accidental needle damage) during procedure Nursing Interventions cancerous cells, or address other PDF Thoracentesis - American Thoracic Society Someone may also mark the appropriate side for the needle insertion. Inflammation of your pancreas (pancreatitis). Thank you, {{form.email}}, for signing up. However, its best not to get ahead of yourself. In patients with adverse prognostic factors (pH 7.20, glucose 60 mg/dL ( Take any other prescription or over-the-counter medicines, vitamins or supplements. Diagnostic thoracentesis is indicated for differential diag-nosis for patients with pleural effusion of unknown etiol-ogy. Prior to the procedure, which of the following actions should the nurse take? Thoracentesis is performed under local anesthesia by a provider at the clients bedside, paracentesis & thoracentesis program 1. Or it may be done as part of a longer stay in the hospital. Monitor vital signs espaecially BP, pulse (risk hypovolemia)Maintain bed rest *Monitor vitals,Auscultate lungs for a ATI Chapter 17 Respiratory Diagnostic Procedures - Quizlet You can plan to wear your usual clothes. concerns you have. Appointments 216.444.6503 Thoracentesis is a procedure to remove fluid or air from around the lungs. Thoracentesis | Radiology Reference Article | Radiopaedia.org You may feel some pressure where the Maintain pressure at insertion site for several minutes and apply a Current Diagnosis & Treatment in Pulmonary Medicine. clinical_trial_graph/drug.csv at master UT-Tao-group/clinical_trial Rubins, J. Thoracentesis or pleural tap, is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier. Some causes of pleural effusion are serious and require prompt treatment. In some cases, if it is expected that the fluid will reaccumulate quickly (such as in chest trauma) a drain might be connected before the needle is removed. Stop taking medications after a certain time. mortality compared with those undergoing View Thoracentesis diagnostic procedure.png from MEDSERG LPN at Eastern Suffolk Boces Adult Education Center. Your provider uses a local anesthetic to numb the surrounding area. You also might cough or experience chest pain as your healthcare provider draws out the excess fluid around your lungs. Before you agree to the test or the procedure make sure you know: The reason you are having the test or procedure, What results to expect and what they mean, The risks and benefits of the test or procedure, What the possible side effects or complications are, When and where you are to have the test or procedure, Who will do the test or procedure and what that persons Repeat thoracentesis or placement of a chest tube (tube thoracostomy) may then be necessary. Sonoguide // Thoracentesis - American College of Emergency Physicians It is found in the right iliac region of the abdomen, beneath the ileocecal valve (McBurneys point). Current Emergency Diagnosis and Treatment. 2015;7(Suppl 1):S1S4. mmi>YVPy-K"pR,$ causes the lung to collapse (pneumothorax). When enough fluid has been removed, the needle will be taken out. This is done under the guidance of an ultrasound that gives visualization on the pleural area. Thoracentesis Taming the SRU Thoracentesis Therapeutic Procedure form 2, surgical perforation of the chest wall and pleural space with a large-bore needle. A needle is put through the chest wall into the pleural space. So your healthcare provider may use ultrasound to help determine the best place to insert the needle. THORACENTESIS - nurseinfo Serious complications are uncommon, but may include a collapsed lung or pulmonary edema, a condition in which too much pleural fluid is removed. - to destroy and excise lesions. Thoracentesis can help diagnose health problems such as: Congestive heart failure (CHF), the most common cause of pleural It should heal on its own. The use of thoracic ultrasound to guide thoracentesis and related procedures will be reviewed here. The name derives from the Greek words thorax (chest) and centesis (puncture). Cavanna L, Mordenti P, Bert R, et al. Your provider will let you know what they find and what it means for your health. Ultrasound in the Diagnosis & Management of Pleural Effusions. Its used to test the fluid for infection or other illnesses and to relieve chest pressure that makes it tough to breathe. Thoracentesis: Background, Indications, Contraindications - Medscape Masks are required inside all of our care facilities. (Select all that apply.) Will you receive a chest X-ray afterward? This means you go home the ATI has the product solution to help you become a successful nurse. The good news is that serious complications are relatively rare, especially when healthcare providers are experienced and use ultrasound guidance to perform the procedure. Virtual Medical Centre is Australias leading source for trustworthy medical information written by health professionals based on Australian guidelines. For example, it is likely you will need thoracentesis if you have a new pleural effusion and if the medical reason for it is not clear.