Empyema: Causes, Symptoms, Diagnosis & Treatment

• Empyema represents a collection of pus within a body cavity, notably the pleural space.
• If not addressed promptly, empyema can induce considerable discomfort.
• Empyema, when left untreated, may result in pleural scarring and fibrosis, diminishing lung elasticity.

Causes of Empyema

• Bacterial pneumonia
• Tuberculosis (TB)
• Chest trauma

Signs and Symptoms of Empyema

• Respiratory Distress:
• Diminished breath sounds
• Tachypnea (accelerated breathing)
• Nasal flaring
• Fever: Continuous, even with antibiotic intervention.
• Dyspnea: Labored breathing.
• Air Hunger: Sensation of insufficient air intake.
• Cough: Potential symptom.
• Anxiety and Fear: Stemming from respiratory distress.

Diagnosis and Treatment of Empyema

• Diagnosis:
• Chest X-ray: Tool for visualizing pleural effusion
• Treatment:
• Thoracentesis: Procedure for pleural fluid removal, enabling culture and sensitivity testing and alleviating dyspnea.
• Chest Tube Insertion: Possibly required for draining sizable fluid or pus volumes.
• Placement: Typically involves two tubes, positioned anteriorly and posteriorly.
• Management:
• Chest tubes are secured via sutures and shielded with a sterile dressing.
• Linked to a closed drainage system employing negative pressure to avert lung collapse. Water Seal System: Drainage approach in common use.
• Nursing Interventions:
• Bed Rest: Supports healing and eases respiratory effort.
• Oxygen Therapy: Enhances oxygenation.
• Oral Care: Averts infection.
• Deep Breathing Exercises: Encourages lung expansion, preventing atelectasis.
• Nebulized Treatments: Aids in loosening secretions and facilitating improved breathing.
• Dressing Changes: Applicable for thoracentesis and chest tube insertion sites.
• Fluid Removal Limits: Thoracentesis limits fluid removal to 1300-1500 ml in one session.

Chest Tube Management

• Drains fluid, blood, or air from the pleural space.
• Used to deliver medications into the pleural space.
• Placement: Secured with sutures and needs sterile dressing.
• Drainage System: Closed configuration maintaining adverse pressure to impede lung collapse.
• Water Seal System: A frequently employed drainage setup.
• Nursing Interventions:
• Predominantly bed rest, supplemented by regular turning, coughing, and deep breathing every two hours.
• Positioning: Semi-Fowler's to high Fowler's position.
• Pain Management: Analgesics administered as required.
• Chest X-ray: Executed post-placement for positional confirmation.
• Positioning: Patient placed on unaffected side to prevent tube kinking.
• Ambulation: Permitted post initial drainage, maintaining the system below chest level.
• Auscultation: Repeated breath sound assessment.
• Water Seal Level: Regular monitoring to maintain level per directives.
• Water Seal Disruption: Instruct patient to take deep breaths and forcefully cough.
• Emergency Measures: Availability of clamps, occlusive dressings, and sterile water.

Tension Pneumothorax

• Signs and Symptoms:
• Increased heart rate and respirations
• Cyanosis
• Absent breath sounds on one side
• Distended neck veins
• Mediastinal shift and tracheal deviation
• Respiratory distress
• Chest asymmetry

Chest Tube Monitoring

• Connections: Inspect all connections for integrity and absence of kinks.
• Drainage: Mark drainage with date and time at shift end.
• Documentation: Document drainage amount.
• Water Seal Chamber: Fluctuations with respirations.
• Constant bubbling: Indicates an air leak.
• Clamping: Only with physician's order.
• Chest Tube Site: Assess for redness, pain, infection, and crepitus.
• Drainage System:
• Keep extra chest drainage set in room.
• Keep the drainage system below chest level.
• Tape all connections securely.
• Never place the drainage device under the bed.
• Secure the drainage device to prevent breakage.
• Tube Removal: Have the patient exhale and apply a Vaseline gauze dressing.

Laboratory Monitoring

• White Blood Cell Count: Monitor for infection indications.

Chest Tube Drainage System

• Drainage Collection Chamber: Collects drained fluid and pus.
• Water Seal Chamber: Averts air entry into pleural space.
• Suction Control Chamber: Regulates drainage system suction.

Chest Tubes

• Purpose: To remove air or fluid from the pleural space, between lung and chest wall.
• Components:
• Water Seal Chamber: Permits air exit while blocking entry.
• Suction Control: Modulates suction based on provider order.
• Removal: Chest tube removed upon full lung re-expansion.

Atelectasis

• Definition: Lung collapse, leading to decreased gas exchange.
• Causes:
• Post-Surgery: Reduced lung expansion post-surgery.
• Hypoventilation: Insufficient air intake.
• Mucus Accumulation: Blockage from mucus plugs.
• Signs and Symptoms:
• Dyspnea: Difficulty breathing.
• Tachypnea: Rapid breathing.
• Air Hunger: Feeling like you can't get enough air.
• Fever: Elevated body temperature.
• Anxiety: Feeling of unease or worry.
• Changes in Consciousness: Altered mental state.
• Cyanosis: Bluish skin discoloration.
• Tachycardia: Rapid heart rate.
• Hypertension: High blood pressure.
• Hypotension: Low blood pressure.
• Bradycardia: Slow heart rate.
• Pleural Friction Rub: Grating sound during breathing.
• Pain: On the affected side.
• Crackles: Clicking or crackling sounds during breathing.
• Decreased Breath Sounds: On the affected side.
• Complications:
• Pneumonia: Infection of the lung.
• Lung Damage: Long-term damage to the lung tissue.
• Diagnosis:
• Chest X-ray: Imaging test to visualize the lungs.
• CT Scan: More detailed imaging of the lungs.
• ABGs (Arterial Blood Gases): Blood test to measure oxygen and carbon dioxide levels.
• Pulse Oximetry: Non-invasive test to measure oxygen saturation in the blood.
• Bronchoscopy: Procedure to visualize the airways.
• Treatment:
• Increased Fluids: To help thin mucus secretions.
• Mechanical Ventilation: To assist with breathing.
• Turning, Coughing, Deep Breathing: To promote lung expansion.
• Incentive Spirometry: Device used to encourage deep breathing.
• Position Changes: Every 1-2 hours to prevent atelectasis.
• Chest Physiotherapy (CPT): Techniques to clear airways.
• Postural Drainage: Positioning the patient to drain mucus from the lungs.
• Humidified Oxygen: To provide supplemental oxygen.
• Bronchodilators: Medications to open airways.
• Antibiotics: If a bacterial infection is present.
• Mucolytics: Medications to thin mucus.
• Analgesics: Pain relievers.
• Suctioning: To remove mucus from the airways.
• Bronchoscopy: To remove mucus plugs.

Pneumothorax

• Definition: Air in the pleural cavity.
• Causes:
• Ruptured Bleb: A small air sac in the lung can rupture.
• COPD: Chronic obstructive pulmonary disease.
• Thoracentesis: Procedure to remove fluid from the pleural space.
• Trauma: Penetrating wounds or blunt force trauma.
• Secondary Infection: Infection in the pleural space.
• Signs and Symptoms:
• Decreased Breath Sounds: On the affected side.
• Mediastinal Shift: Displacement of the heart and other structures towards the unaffected side.
• Sucking Sound on Inspiration: If a penetrating wound is present.
• Air Hunger: Feeling like you can't get enough air.
• Respiratory Distress: Difficulty breathing.
• Sudden Sharp Pleuritic Pain: Pain in the chest that worsens with breathing.
• Dyspnea: Difficulty breathing.
• Tachycardia: Rapid heart rate.
• Tachypnea: Rapid breathing.
• Diaphoresis: Excessive sweating.
• Decreased Cardiac Output: Reduced blood flow from the heart.
• Anxiety: Feeling of unease or worry.
• Asymmetrical Chest Wall Expansion: One side of the chest does not expand as much as the other.
• Diagnosis:
• Chest X-ray: Imaging test to visualize the lungs.
• ABGs (Arterial Blood Gases): Blood test to measure oxygen and carbon dioxide levels.
• Treatment:
• Chest Tube: To remove air from the pleural space and re-inflate the lung.
• Oxygen: To provide supplemental oxygen.

Hemothorax

• Definition: Blood in the pleural cavity.
• Causes:
• Trauma: Injuries to the chest wall or lungs.

Lung Cancer

• Definition: Uncontrolled growth of abnormal cells in the lungs.
• Leading Cause of Death: For both men and women.
• Risk Factors:
• Smoking: Primary risk factor
• Industrial Substances: Exposure to air pollutants, chemicals, and pesticides.
• Genetic Predisposition: Increased risk with family history of lung cancer.
• Multiple Risk Factors: Increased risk with more than one risk factor present.
• Vitamin A and E Deficiency: Lower intake of these vitamins may increase risk.
• Low Fruit and Vegetable Intake: Reduced consumption of fruits and vegetables may increase risk.
• Signs and Symptoms:
• Asymptomatic in Early Stages: May not cause any noticeable symptoms initially.
• Cough: Persistent or worsening cough.
• Hemoptysis: Coughing up blood.
• Sputum Production: Increased mucus production.
• Dyspnea: Difficulty breathing.
• Fever: Elevated body temperature.
• Chills: Feeling cold.
• Shortness of Breath: Difficulty getting enough air.
• Unilateral Wheezing: Whistling sound in one lung due to airway obstruction.
• Weight Loss: Unexplained weight loss.
• Fatigue: Feeling tired or weak.
• Decreased Stamina: Reduced ability to exercise or perform daily activities.
• Treatment:
• Depends on Stage: Treatment options vary based on the stage of the cancer.
• Surgery: Removal of the lung (pneumonectomy) or a lobe of the lung (lobectomy).
• Chemotherapy: Medications to kill cancer cells.
• Radiation Therapy: Using high-energy rays to kill cancer cells.
• Combination Therapy: Using multiple treatment methods.
• Types:
• Small Cell Lung Cancer: More aggressive type of lung cancer.
• Non-Small Cell Lung Cancer: Less aggressive type of lung cancer.
• Psychosocial Issues:
• Emotional Support: Provide emotional support and counseling for patients and families.
• Support Groups: Encourage participation in support groups for patients with cancer.
• Prevention:
• Smoking Cessation: Quit smoking immediately.
• Turning, Coughing, Deep Breathing: To promote lung expansion.
• Deep Vein Thrombosis (DVT) Prevention: Measures to prevent blood clots in the legs.
• TED Hose: Compression stockings to improve blood circulation.
• Ambulation: Encourage walking as soon as possible.
• SCD Hose: Sequential compression devices that squeeze the legs to improve blood flow.
• Incentive Spirometry: Device used to encourage deep breathing.
• Position Changes: Frequent position changes to prevent atelectasis.
• Assessment:
• Cough: Assess the nature of the cough (moist, dry, hacking).
• Sputum: Assess the color, consistency, and amount of sputum.
• Lung Auscultation: Listen to the lungs for wheezes, crackles, or other abnormal sounds.
• Pain Management: Provide opioids for pain relief.
• Antipyretics: Medications to reduce fever.
• Antiemetics: Medications to prevent nausea and vomiting.

This covers empyema, a pus collection in the pleural space, detailing causes like bacterial pneumonia and TB. Learn about symptoms such as respiratory distress, fever, and dyspnea. Diagnostic methods and treatments like thoracentesis and chest tube insertion are also discussed.