Emphysema & Empyema

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    EMPHYSEMA

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    DEFINITIONEmphysema results from

    distention & rupture of the

    alveoli due to the loss ofelasticity of the lung tissue

    with resultant air trapping.

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    CAUSESCigarette smoking

    Exposure to pollutants

    Lower respiratory infectionChildhood lung infection

    Connective tissue disorder

    Family members with emphysemaHIV infcetion

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    TYPESOF EMPHYSEMA

    Obstruction emphysema

    It occurs due to partialocclusion of bronchus or a bronchiole. In case ofatelectasis, bronchial asthma, lung infection,bronchiolitis, tuberculosis, mucoviscidosis, tumors,foreign body, aspiration etc.

    Compensatory emphysema

    It occurs when normallung tissue expands to fill up across of collapsed lungsegments. E.g. Pneumonia, empyema, pneumothoraxetc.

    Congenital lobar emphysema It is found in neonates

    & young children resulting from severe respiratorydistress.

    Familial Emphysema It is found especially in femaleyoung child as progressive dyspnea, which is inheritedas autosomal recessive trait.

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    CLINICAL MANIFESTATIONS

    Coughing in the morning

    Wheezing

    Shortness of breath with activity

    Decrease exercise

    Fatigue

    Loss of appetite

    Weight loss

    Dyspnea

    Tachypnea Cough

    Chest retration

    Cynosis

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    DIAGNOSTIC EVALUATION

    History of patient

    Physical examination

    Chest x-ray

    CT scan Complete blood cell count

    Sputum examination

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    COMPLICATIONS Respiratory failure

    Meningitis

    Osteomyelitis

    Arthritis

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    MEDICAL MANAGEMENT

    Management of the emphysema

    condition depend upon the cause of

    emphysema. Symptomatic relief is

    important with oxygen therapy,bronchodilators, mucolytic agents,

    and antibiotics. Interstitial

    emphysema can be treated byconservative therapy.

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    SURGICAL MANAGEMENT

    Lobectomy Congenital lobar

    emphysema should be managed

    with lobectomy.

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    NURSING MANAGEMENT Continuous monitoring of childs conditions is required with

    special emphasis on respiratory functions.

    Supportive nursing care is essential with need based nursing

    care.

    The nursing care should include routine care with rest.

    To provision of the bed rest with comfortable position, prop-upposition.

    Administration of oxygen therapy & clearing of airway.

    To maintain the intake & output recording.

    To increase oral fluid intake. Avoidance of bronchial irritants e.g. smoking.

    Maintain oral hygiene specially after inhalation of medications.

    Care during surgery & health teaching to parents.

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    EMPYEMA

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    DEFINITIONEmpyema is the collection of

    thick pus in the plural cavity. It

    may develop directly fromlungs or from neighboring

    structure or through blood. It is

    fairly common in infancy.

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    CAUSES Staphylococcus

    Pneumococcus

    Streptococcus

    Tuberculosis Chest injury

    Suppurative lung disease

    Osteomyelitis

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    CLINICAL MANIFESTATIONS

    Staphylococcus infection

    Growth failure

    Fever

    Diarrhea Cough

    Respiratory distress

    Chest pain

    Loss of weight

    Anemia

    Toxemia

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    DIAGNOSTIC TEST Chest X-ray

    Diagnostic plural aspiration

    Bacteriological exam

    CT scan

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    COMPLICATIONS Pyopneumothorax

    Lung abscess

    Purulant pericarditis

    Osteomyelitis of ribs Septicemia

    Meningitis

    Arthritis

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    MEDICAL MANAGEMENTAntibiotic Therapy Antibiotic therapy should be

    started as early as possible and to be continued for

    3 to 4 weeks. Commonly used antibiotics are

    Penicillin, cloxacillin, ampicillin, chloramphnical or

    newer antibiotics e.g. cephalosporins (cefazolin,cephalexin) etc.

    Continues closed intercostal drainage is strongly

    recommended for the management of empyema

    rather than the multiple aspiration of the pluralcavity.

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    SURGICAL MANAGEMENT

    Thoracotomy

    Surgical drainage after thoracotomy may be

    needed to remove the collection, in case of

    severe respiratory difficulty, or in loculatedpus or in the presence of marked medistinal

    shift and when there is no improvement of

    the condition even after 3-4 weeks of

    medical management.

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    NURSING MANAGEMENT To give antipyretics, analgesics & nutritionalsupplement as prescribed.

    Supportive nursing care with bed rest.

    Give semi fowler position to patient.

    Give oxygen therapy. Give protein rich diet.

    Give antibiotic therapy.

    Assist in breathing exercise & postural drainage.

    Give emotional support & health teaching. Monitor childs condition & chest drainage

    continuously.

    Other nursing care should be given priority wise.

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    NURSING DIAGNOSIS Ineffective breathing pattern related to

    inflammatory process

    Altered nutritional status: less than body

    requirements related to loss of appetite,diarrhea

    Fatigue related to increased work of

    breathing

    Anxiety related to respiratory distress &

    hospitalization of infant

    Knowledge deficit related to care of infant

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    SUMMARIZATION

    Emphysema Definition

    Causes

    Clinical Manifestations

    Diagnostic Evaluation

    Complications

    Medical Management

    Surgical Management

    Nursing Management

    Empyema Definition

    Causes

    Clinical Manifestations Diagnostic Evaluation

    Complications

    Medical Management

    Surgical Management

    Nursing Management

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    BIBLIOGRAPHY Datta Parul, Pediatric Nursing Ed-2nd Jaypee

    Publishers 279-281.

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    THANK

    YOU

    ..