Nursing care of patient with EMPYEMA (1).pptx

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1. NEKEMTE HEALTH SCIENCE COLLEGE 12/29/2023 AM 1

2. DEPARTEMENT OF POST BASIC NURSING YEAR ONE SEMSTER II COURSE TITTLE: medical surgical nursing GROUP Assignment ;EMPYEMA GROUP ONE ID.NO ( 1-10) INSTRUCTOR BY; Abdi wakjira ( bsc,msc ) NEKEMTE HEALTH SCIENCE COLLEGE 12/29/2023 AM 2

3. Group members S/N NAME OF TEAM DEPT ID.NO 1 ABDULKERIM TEHA NURSING 001/2015 2 ABABAYE TIBABU NURSING 002/2015 3 ABEBECH WEKGARI NURSING 003/2015 4 ABINAT FELEKE NURSING 004/2015 5 ADEM MOHAMMED NURSING 005/2015 6 AHMED ABRAHIM NURSING 006/2015 7 AHMED TEMAM NURSING 007/2015 8 AYELAW KASEHUN NURSING 008/2015 9 BAKELECH FAYISA NURSING 009/2015 10 BIRHANU GETAHUN NURSING 010/2015 12/29/2023 AM 3

4. out lines Tittle: Definition of empyema Risk factors/ couse Pathopysiology C/manifestations Diagnosis Differential diagnosis Medical mgt Nursing mgt Complication 12/29/2023 AM 4

5. EMPYEMA Empyema is an accumulation of thick , purulent fluid within the pleural space,often with fibrin development and a loculated (walled-off) area where infection is located. Most empyemas occur as complications of bacterial pneumonia or lung abscess. 12/29/2023 AM 5

6. Cont’d…. Other causes include penetrating chest trauma , hematogenous infection of the pleural space, nonbacterial infections, or iatrogenic causes (after thoracic surgery or thoracentesis ). 12/29/2023 AM 6

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8. Stage of empyema 1.Exudative stage aproximately (1 to 3 days) 2.Fibrino purulent stage (4 to 14 days 3.Organizing stage after 14 days 12/29/2023 AM 8

9. 1.Exudative stage Imediate response with outpouring of the fluid Low cellular content Its simple parapneumonic effusion with normal ph and glucose level 12/29/2023 AM 9

10. 2.Fibrino purulent stage Large number of poly morphonuclear leukocytes and fibrin accumulates Accumulation of neutrophils and fibrin effusion becomes purulent and viscous leading to development of empyema 12/29/2023 AM 10

11. 3.Organizing stage Fibro blasts grow into exudates on both the visceral and parietal pleural surfaces Development of an inelastic membrene the peel Most common in s.aureus infection. Thickened pleural peel can restrict lung movement and its commonly termed as trapped lung 12/29/2023 AM 11

12. Causes … The most common organisms : Staphylococcus aureus (90% of causes in infants and children) Streptococcus pneumonie . H. influenzae 12/29/2023 AM 12

13. Cause of empyema The most common cause of empyema is pneumonia. Other causes include : Tuberculosis. Lung abscess. Chest surgery. Chest injuries or trauma. 12/29/2023 AM 13

14. Risk factors Alcoholism Drug use ( eg.IV drug) HIV infection Neoplasm Pre- existant pulmonary disease Thoracic trauma Immunocompromised state 12/29/2023 AM 14

15. Pathopysiology The pleural space naturally has some fluid But infection and 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 12/29/2023 AM 15

16. Clinical Manifestations With an empyema, the patient is acutely ill and has signs and symptoms similar to those of an acute respiratory infection or pneumonia . Empyema can be simple or complex .  Simple empyema Simple empyema occurs in the early stages of the illness. A person has this type if the pus is free-flowing. The symptoms of simple empyema include:  Shortness of breath Dry cough Fever 12/29/2023 AM 16

17. Cont..d sweating chest pain when breathing that may be described as stabbing headache confusion loss of appetite 12/29/2023 AM 17

18. Cont…d Complex empyema occurs in the later stage of the illness. In complex empyema, the inflammation is more severe. Scar tissue may form and divide the chest cavity into smaller cavities. This is called loculation , and it’s more difficult to treat .   If the infection continues to get worse, it can lead to the formation of a thick peel over the pleura, called a pleural peel. This peel prevents the lung from expanding. Surgery is required to fix it .   12/29/2023 AM 18

19. Cont … Other symptoms in complex empyema include: difficulty breathing decreased breath sounds weight loss chest pain 12/29/2023 AM 19

20. Assessment and Diagnostic Findings Chest auscultation demonstrates decreased or absent breath sounds over the affected area, and there is dullness on chest percussion as well as decreased fermatas. The diagnosis is established by chest x-ray or chest CT scan. Usually a diagnostic thoracentesis is performed, often under ultrasound guidance. 12/29/2023 AM 20

21. Differential DX Pneumonia Heart failure Pulmonary infarction( artery to the lung become blocked and lung tissue dies) Sequestration(cystic lung lesion) 12/29/2023 AM 21

22. Medical Management The objectives of treatment are to drain the pleural cavity and to achieve full expansion of the lung. The fluid is drained and appropriate antibiotics, in large doses , are prescribed based on the causative organism. Sterilization of the empyema cavity requires 4 to 6 weeks of antibiotics 12/29/2023 AM 22

23. Cont’d…. Drainage of the pleural fluid depends on the stage of the disease and is accomplished by one of the following methods: 1. Needle aspiration ( thoracentesis ) with a thin percutaneous catheter, if the volume is small and the fluid not too purulent or thick 12/29/2023 AM 23

24. Needle aspiration 12/29/2023 AM 24

25. Cont’d…. 2.Tube thoracostomy (chest drainage using a large-diameter intercostals tube attached to water-seal drainage with fibrinolytic agents instilled through the chest tube in patients with loculated or complicated pleural effusions 12/29/2023 AM 25

26. Cont’d…. 3. Open chest drainage via thoracotomy, including potential rib resection, to remove the t hickened pleura, pus, and debris and to remove the underlying diseased pulmonary tissue 12/29/2023 AM 26

27. Nursing mgt Monitoring vital sign Assesting with drainage procedure( thoracentiasis ) Administrating medications Providing patient education 12/29/2023 AM 27

28. Complication of empyema Necrosis of visceral pleura Bronchopleural fistula Necrosis parietal pleura and chest wall Osteomyelitis of rib or spine Metastatic spread(brain abscess) 12/29/2023 AM 28

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30. THE END 12/29/2023 AM 30