Emphysema & Empyema

7/30/2019 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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Emphysema & Empyema