EMPYEMA

THORACISBy:

Evangelista, Grayzalyn

SN3

What is Empyema Thoracis

It is a collection of purulent (infection) liquid or pus in the pleural cavity

CLINICAL MANIFESTATION

• FEVER• NIGHT SWEAT• PLEURAL PAIN• COUGH• DYSPNEA

• ANOREXIA• WEIGHT LOSS• DECREASED OR ABSENCE OF BREATH SOUNDS;DULLNESS ON CHEST

• PERCUSSION;DECREASED FREMITUS

ASSESSMENT AND DIAGNOSIS METHODS

• CHEST AUSCULTATION – WHICH DEMONSTRATE DECREASED OR ABSENT BREATH SOUNDS OVER THE AFFECTED AREA

• DULLNESS 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

as thoracocentesis or pleural tap, is an invasive procedure to remove fluid or air from the 

pleural space for diagnostic or

therapeutic purposes.

What Causes Empyema?

Empyema doesn’t 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 lungs

• to 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 management• Provide 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 dressing

•Emphasize the importance of aseptic technique home medication and follow up check-up

Pleural Window• Open 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 a thoracoscopy or thoracotomy 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 and

achieves obliteration of an empty space.

Indication• The main current indications for open chest drainage are as follows:

• Patients who failed an initial approach with closed suction

• drainage and have a low physiologic reserve to tolerate more aggressive surgical interventions, such as decortication

• Patients who need a period of medical rehabilitation or correction of nutritional abnormalities prior to more radical and definitive procedures

• Anticipation of long-term drainage

• Postpneumonectomy empyema with or without bronchopleural fistula

Contraindication• Contraindications include the following:

• No proper adherence of surrounding lung tissue to the chest wall,

• which could lead to complications of open pneumothorax

• Patients with good functional status who otherwise could tolerate a more invasive and definitive

• treatment, such as a surgical decortication

Nursing Care

• The wound must be regularly inspected to ensure adequate drainage of the pleural space.

• Emphasized the importance of aseptic technique in wound dressing

•Some patients live with thoracic window for years or for the rest of their lives. They need to understand the importance of daily dressing changes

•and 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.