Empyema and nursing care

Empyema and nursing care

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  EMPYEMA Mr.Veerabhadra.B.Badiger Asst Professor Dept ofMedical Surgical Nursing.
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  EMPYEMA An empyema isan accumulation of thick, purulent fluid within the pleural space. Empyema is also called pyothorax or purulent pleuritis Empyema usually develops after pneumonia
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  CAUSES OF EMPYEMA Complication of bacterial pneumonia or lung abscess  Penetrating chest trauma  Bacterial infection Streptococcus pneumoniae and Staphylococcu s aureus.  Hematogenous infection of the pleural space  Nonbacterial infections  Iatrogenic causes (after thoracic surgery or thoracentesis).
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  RISK FACTORS FORDEVELOPING EMPYEMA  Bronchiectasis  Chronic obstructive pulmonary disease (COPD)  Rheumatoid arthritis  Alcoholism  Diabetes  A weakened immune system  Surgery or recent trauma  Lung abscess
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  PATHOPHYSIOLOGY The pleural spacenaturally has some fluid but infection & other etiology factors leads to increased fluid production than it can be absorbed . The fluid then becomes infected with the bacteria The infected fluid thickens lining of your lungs and chest cavity to stick together and form pockets. Empyema
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  CLINICAL MANISFESTATION  Fever Night sweats ( excessive sweat)  Pleural pain  Dry Cough  Dyspnea  Shortness of breath  Anorexia  Weight loss
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  DIAGNOSTIC STUDIES.  Historycollection  Physical examination :Chest auscultation  Chest x-ray or chest CT scan  Ultrasound of chest (Amount of fluid and its exact location)  Thoracentesis is performed, often under ultrasound guidance.  Blood test: Complete blood count , Blood culture & sensitivity.
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  CT Scan ofChest Fluid collection in pleural space Chest Xray , collection of fluid (left side)
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  MANAGEMENT  Percutaneous Thoracentesis. Needleaspiration (thoracentesis) with a thin percutaneous catheter. Antibiotics : Depends on type of bacteria. Analgesics : To relieve pain and fever.
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  Percutaneous Thoracentesis
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  SURGICAL MANAGEMENT 1. Thoracotomy Ribresection, Remove the thickened pleura, pus, and debris Remove the underlying diseased pulmonary tissue
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  SURGICAL MANAGEMENT CONTINUED… 2.Video-assisted thoracic surgery: Surgeon create three small incisions and use a tiny camera called a thoracoscope for this process Then surgeon will remove the affected tissue around your lung Later insert a drainage tube or use medication to remove the fluid.
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  NURSING DIAGNOSIS 1. Ineffectiveairway clearance related to increased production of secretions.  Assess the respiratory status  Provide comfortable bed & position  Provide nebulization / Steam inhalation.  Administer bronchodilator as ordered.
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  2. Impaired GasExchange related to airway obstruction secondary to the buildup of secretions  Assess the respiratory status  Provide comfortable bed & position  Monitor vital signs & Spo2.  Administer oxygen  Monitor arterial blood gas level (ABG)
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  3. Imbalanced Nutrition,Less Than Body Requirements related to Shortness of breath, anorexia, nausea, vomiting  Assess the nutritional status  Provide diet rich in protein & Vitamins.  Allow small & frequent diet.  Monitor patient weight .
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  NURSING MANAGEMENT  Monitoringvital signs  Lung-expanding breathing exercises  Care of intercostal chest drainage tube.  Observation of drainage, signs and symptoms of infection.  Administering oxygen if required.  Adequate rest & sleep.