empyema secondary to pneumonia

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  • 1.VELEZ COLLEGE COLLEGE OF NURSING A CASE STUDY OF PATIENT K. S. DIAGNOSED WITH EMPYEMASECONDARY TO PNEUMONIA Presented by: Dave Jay S. Manriquez, RN. CHAPTER ONEINTRODUCTION This is a case study on patient KNS, 3 months old, female, Roman Catholic, Filipino, residing at Candabo, Argao and born on January 26, 2007 via Normal Spontaneous Vaginal Delivery (NSVD) at Argao Isidro Quintana Memorial Hospital, who was admitted for the 1st time in Cebu Velez General Hospital (CVGH) for complaints of fever, cough, and convulsion. The patient was admitted under the services of Dr. Lydia Chang and Dr. Maribel Du under the Department of Pediatrics and Surgery with the case number of 87395 and hospital number of 039874. The case was chosen by the researchers on May 9, 2007 at around 12 noon.PNEUMONIAPneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms, including viruses, bacteria, fungi, and parasites. Although different types of pneumonia tend to affect children in different age groups, pneumonia is most commonly caused by viruses. Some viruses that cause pneumonia are adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (the virus that causes croup). Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). When this happens, symptoms of pneumonia begin after 2 or 3 days of a cold or sorethroat.Types of Pneumonia1. Community-acquired pneumonia(CAP)a. Pneumococcal causative agent: S. pneumonia; incidence are common on elderly, with COPD, CHF, alcoholismb. Influenzae pneumonia or Haemophilus influenza- CA: H. pneumoniae; I: splenectomy, alcoholics, in chronic care facilities

2. c. Viral pneumonia (occur in every 2-3 years) CA: Influenza viruses A and B, adenovirus, parainfluenza, cytomegalovirus. I: adultsd. Aspiration pneumonia- CA: aspiration of food or gastric contents I: children and elderly. 2. Hospital acquired pneumoniaa. Pseudomonas pneumonia - CA: pseudomonas aeruginosab. Staphylococcal pneumonia- CA: Staphylococcus aureusc. Klebsiella pneumonia- CA: Klebsiella pneumonia; I: immunosupressed, IV drug users, complication of epidemic nfluenza 3. In immunocompromised Hosta. Pneumocystic carnii pneumonia (PCP)- CA: Pneumocystis carnii; I: patients with AIDS, immunosupressed patients, recipients of organ transplantsb. Fungal pneumonia- CA: Aspegillus fumigates; I: immunosupressed patients, recipients of organ transplants immunosupresse patients, neutopenic patientsIncubationThe incubation period for pneumonia varies, depending on the type of virus or bacteria causing the infection. Some common incubation periods are: respiratory syncytial virus, 4 to 6 days; influenza, 18 to 72 hours.DurationWith treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks. Viral pneumonia may last longer. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely.ContagiousnessThe viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. Illness can spread when an infected person coughs or sneezes on a person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person.Signs and SymptomsSymptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Some common symptoms include: fever chills cough unusually rapid breathing breathing with grunting or wheezing sounds labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath) 3. vomiting chest pain abdominal pain decreased activity loss of appetite (in older children) or poor feeding (in infants) in extreme cases, bluish or gray color of the lips and fingernailsSometimes a child's only symptom is rapid breathing. Sometimes when the pneumonia is in the lower part of the lungs near the abdomen, there may be no breathing problems at all, but there may be fever and abdominal pain or vomiting. When pneumonia is caused by bacteria, an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia. Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in older children and adolescents, pneumonia due to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia.In infants, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever. When pneumonia is due to whooping cough (pertussis), the child may have long coughing spells, turn blue from lack of air, or make a classic quot;whoopquot; sound when trying to take a breath.PreventionThere are vaccines to prevent infections by viruses or bacteria that cause some types of pneumonia. Children usually receive routine immunizations against Haemophilus influenzae and pertussis (whooping cough) beginning at 2 months of age. (The pertussis immunization is the quot;Pquot; part of the routine DTaP injection.) Vaccines are now also given against the pneumococcus organism (PCV), a common cause of bacterial pneumonia.When to seek prompt treatment?Call your child's doctor immediately if your child has any of the signs and symptoms of pneumonia, but especially if your child: - is having trouble breathing or is breathing abnormally fast- has a bluish or gray color to the fingernails or lips- has a fever of 102 degrees Fahrenheit (38.9 degrees Celsius), or above 100.4 degrees Fahrenheit (38 degrees Celsius) in infants under 6 months of ageTreatment 4. Doctors usually make the diagnosis of pneumonia after a physical examination. The doctor may possibly use a chest X-ray, blood tests, and (sometimes) bacterial cultures of mucus produced by coughing when making a diagnosis. In most cases, pneumonia can be treated with oral antibiotics given to your child at home. The type of antibiotic used depends on the type of pneumonia.Children may be hospitalized for treatment if they have pneumonia caused by pertussis or other bacterial pneumonia that causes high fevers and respiratory distress. They may also be hospitalized if supplemental oxygen is needed, if they have lung infections that may have spread into the bloodstream, if they have chronic illnesses that affect the immune system, if they are vomiting so much that they cannot take medicine by mouth, or if they have recurrent episodes of pneumonia. EMPYEMAEmpyema is a pus within a natural body cavity. It must be differentiated from an abscess, which is a collection of pus in a newly formed capsule rather than a pre-existing cavity. Empyema can occur as a complication of pneumonia, tuberculosis or surgical procedures (postsurgical empyema). The incidence of empyema is not well characterized, although a recent study suggests empyema may be common in patients admitted to the medical ICU. Fartoukh et al. reported an 8.4% of patients admitted to the medical ICU had physical and radiographic evidence of pleural effusion. Diagnostic thoracentesis was performed in 73% of these patients, and empyema was diagnosed in 17% of cases of pleural effusion. The infective organism can get into the pleural cavity either through the bloodstream or other circulatory system, in secretions from lung tissue, or on the surfaces of surgical instruments or objects that cause open chest wounds. Microorganisms associated with empyema included Staphylococcus aureus , Streptococcus spp. , E. coli , K. pneumoniae , M. tuberculosis , and PeptoStreptococcus.Its development can be divided into three phases: an acute phase in which the body cavity fills with a thin fluid containing some pus; a second stage in which the fluid thickens and a fibrous, coagulation protein (fibrin) begins to accumulate within the cavity; and a third or chronic stage in which the lung or other organ is encased within a thick covering of fibrous material.In humans, the pleural space surrounding the lungs is most commonly affected. This particular condition is called pyothorax and is usually caused by a bacterial infection of the lungs (pneumonia). Other common empyemas include appendicitis and pyometra.Pleural space empyemaSymptoms Typical symptoms are just about the same as tuberculosis which includes: fever (which may be spiking), chest pain, cough, sweating and shortness of breath.Clubbing of the fingernails is present. There is a dull percussion note and reduced breath sounds on the affected side of the chest. Chest x-ray shows a pleural effusion, often with a lateral bulge and pleural thickening. Ultrasound confirms the size and location of the pocket of pus and the presence of fibrin aggregates.There are 3 stages:Exudative, fibrinopurulent and organizing. In the exudative stage, the pus accumulates. This is followed by the fibrinopurulent stage in which there is loculation of the pleural fluid (the creation of grapelike pus pockets). In the final organizing stage there is the potential for lung entrapment by scarring. If it makes it to the final stage and scarring occurs there is a good chance of pulmonary fibrosis and other conditions that will happen in years to come, such as 5. right sided heart failure (cor pulmonale). This is due to the high pulmonary pressures due to the scarring and the treatment is most likely a single lung transplant. The only drug that might have any effect is prednisone, but the use of prednisone is only temporary.Diagnosis Diagnosis is confirmed by thoracentesis, X-Ray and CT Scan. Frank pus may be aspirated from the pleural space. The pleural fluid h

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