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EMPYEMA THORACISBy: Evangelista, GrayzalynSN3What is Empyema ThoracisIt is a collection of purulent (infection) liquid or pus in the pleural cavityCLINICAL MANIFESTATIONFEVERNIGHT SWEATPLEURAL PAINCOUGHDYSPNEAANOREXIAWEIGHT LOSSDECREASED OR ABSENCE OF BREATH SOUNDS;DULLNESS ON CHESTPERCUSSION;DECREASED FREMITUS
ASSESSMENT AND DIAGNOSIS METHODSCHEST AUSCULTATION WHICH DEMONSTRATE DECREASED OR ABSENT BREATH SOUNDS OVER THE AFFECTED AREADULLNESS ON CHEST. PERCUSSION; DECREASED FREMITUS.CHEST RADIOGRAPHS - used to diagnose conditions affecting
the chest, its contents, and nearby structures. Chest radiographs are among the most common films taken, being diagnostic of many conditions.
Chest CT scan - A chest computed tomography scan, or chest CT scan, is a painless, noninvasive test. It creates precise pictures of the structures in your chest, such as your lungs.Thoracentesis - also known asthoracocentesisorpleural tap, is an invasive procedure to removefluidorairfrom thepleural spacefor diagnostic or therapeutic purposes.
Empyema doesnt occur on its own; it is a complication of other medical conditions.In order for empyema to occur, bacteria, fungi, or chemicals must get into your pleural space and cause inflammation, leading to the production of pus.
Surgical management:Close Tube Thoracostomy - Chest tubes are inserted to drain blood, fluid, or air and to allow the lungsto fully expand. The tube is placed between the ribs and into the space between the inner lining and the outer lining of the lung (pleural space).Pleral window creation is a complex procedure which involves creating an opening between the thoracic cavity and the external environment. This allows easy debridement and drainage of a pleural empyema.
Nursing managementProvide a specific care of method of drainage of pleural fluid or pus.Help patient to cope up with condition; instruct in lung expansion breathing exercises. such as pursed-lip and diaphragmatic breathing.Instruct or teach patient on how to do aseptic wound dressingEmphasize the importance of aseptic technique home medication and follow up check-up
Pleural WindowOpen pleural drainage is an uncommon modality in the current area of appropriate antibiotic coverage and multiple means of closed pleural drainage. Open drainage is usually reserved for very ill patients for whom athoracoscopyorthoracotomy would be too morbid. In its extreme form, open pleural drainage results in a thoracoplasty by removing ribs from the chest wall, which brings the chest wall to the lung andachieves obliteration of an empty space.
IndicationThe main current indications for open chest drainage are as follows:Patients who failed an initial approach with closed suctiondrainage and have a low physiologic reserve to tolerate more aggressive surgical interventions, such asdecortication
Patients who need a period of medical rehabilitation or correction of nutritional abnormalities prior to more radical and definitive procedures
Anticipation of long-term drainagePostpneumonectomy empyema with or withoutbronchopleural fistula
ContraindicationContraindications include the following:No proper adherence of surrounding lung tissue to the chest wall, which could lead to complications of open pneumothoraxPatients with good functional status who otherwise could tolerate a more invasive and definitivetreatment, such as a surgicaldecorticationNursing CareThe wound must be regularly inspected to ensure adequate drainage of the pleural space.Emphasized the importance of aseptic technique in wound dressingSome patients live with thoracic window for years or for the rest of their lives. They need to understand the importance of daily dressing changesand adjusting their lifestyle for this new routine. Good family support is also important because many spouses actively participate in the management of these patients.
Emphasized the importance of good hygiene.