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Unit III 2. Lung Abscess.ppt

  2. At the end of the class the students are able to,  Define lung Abscess  Enlist the types of lung Abscess  Describe the causes of lung Abscess  Enumerate the pathophysiology of lung Abscess OBJECTIVES
  3. At the end of the class the students are able to,  Explain the clinical manifestation of lung abscess  Discuss the diagnostic evaluation of lung abscess  Enumerate medical, surgical and nursing management of patient with lung Abscess OBJECTIVES
  4. At the end of the class the students are able to,  Lung Abscess  Types of lung Abscess  Causes of lung Abscess  The pathophysiology of lung Abscess  Clinical manifestations of lung Abscess  Diagnosis and management of lung Abscess OVERVIEW
  5. DEFINITION  Lung abscess is a pus containing lesion of the lung parenchyma that forms a cavity.  The cavity is formed by necrosis of lung tissue.  In its early stage the abscess resembles a localized pneumonia, if it remains unidentified and untreated tissue necrosis may occur.
  6. ETIOLOGY • Lung infections – pneumonia ,Tuberculosis etc • Cystic fibrosis • Foreign body, Tumor in bronchial region • Impaired mucociliary clearance • Immunodeficiency – congenital or acquired • Bacterial invasions like - staphylococcus,klebsiella,pseudomonas • Alcohol or drug use.
  7. CLASSIFICATION • PRIMARY: It is when abscess develops in individuals prone to aspiration • SECONDARY: It is due to any obstruction or intrathoracic surgery or due to systemic condition [eg.pulmonary embolism,cong.heart failure]
  8. Pneumonitis- inflammation of lung tissue Liquefaction-Transformation of tissue into liquid viscous mass[purulent material]
  9. CLINICAL MANIFESTATIONS  The presenting features of lung abscess vary considerably .  Symptoms progress over weeks to months  Fever, cough, and sputum production  Night sweats, weight loss & anemia  Hemoptysis[coughing up blood]  Pleuritis
  10.  Digital clubbing[rounding of nail beds] – develop within a few weeks if treatment is inadequate.  Dullness to percussion  Diminished breath sounds if abscess is too large and situated near the surface of lung.  Amphoric / cavernous breath sounds-low pitch sound[sounds like blowing into an empty glass] CLINICAL MANIFESTATIONS
  11. DIAGNOSTIC STUDIES • Chest X ray (fluid filled cavity) • AFB • CT scan • Sputum cultures • Pleural fluid • Blood culture • Broncoscopy
  12. TREATMENT  Antibiotic therapy (2 – 4 months ) 1. Ampi / Amoxicillin x orally 2. Metronidazole 400mg TDS 3. Cry.penicillin & clindamycin +/- metronidazole IV – in hospitalised pts.
  13. TREATMENT 1. Can change – according to sensitivity  Coughing technique  Chest physiotherapy with postural drainage  Good rest and Nutrition  More intake of fluid  Dental care
  14. SURGICAL MANAGEMENT • Lobectomy -A lobectomy is a surgical procedure where an entire lobe of your lung is removed • Pneumonectomy -is a surgical procedure to remove a lung. • Percutaneous drainage-External drainage of lung abscess through percutaneous approach appears to be a safe alternative to thoracotomy and has the advantage of preserving lung function. It is the preferred method of treatment for pleural based abscesses, particularly in patients with high risk surgical mortality.
  15. COMPLICATIONS 1. Empyema-pus collection 2. Bronchopleural fistula-abn.connection btw pleura and bronchial tree 3. Pneumothorax-lung collapse 4. Metastatic cerebral abscess-transports through lymph or blood 5. Sepsis, Amyloidosis-deposition of amyloid proteins in organs 6. Fibrosis,bronchiectasis
  16. Ineffective airway clearance related to increased tracheo broncheal secretion Ineffective breathing pattern related to decreased lung capacity Pain related to the inflammatory process Altered nutrition less then body requirement related increased metabolic demand and decreased food intake Anxiety related to lack of knowledge NURSING DIAGNOSIS:
  17.  Teach patient about deep breathing exercises  Encourage alternating activity with rest periods  Chest physiotherapy  Suctioning  Bronchodilator medication  O2 administration, if required INEFFECTIVE BREATHING PATTERN
  18.  Instruct the patient to stop smoking  Semi-fowler position  Administered antibiotics as prescribed  Adequate hydration  Deep breathing exercises  Nebulization  Suctioning, as required IMPAIRED GAS EXCHANGE
  19.  Relaxation techniques  Divertional therapy  Frequent massage  Comfortable position  Education to concern about pharmacological and non- pharmacological therapies  Medication , as prescribed. PAIN
  20. SUMMARY • Lung abscess is defined as necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection. The formation of multiple small (<2 cm) abscesses is occasionally referred to as necrotizing pneumonia or lung gangrene.
  21. • Chintamani., Lewis., Heitkemper., Dirksen., O’brien and Bucher. (2011). Lewis’s Medical Surgical Nursing: Assessment and Management of Clinical Problems. (7th Ed.) Mosby. • Suzanne.C.S., Brenda.G.B.,Hinkel. J.L. &.Cheevar.K.(2015) .Brunner & Suddarth’s Textbook of Medical Surgical Nursing (12th ed). Wolters Kluwer. • Lippincott Manual of Nursing Practice.(2010). 9th ed. William and Wilkins. • Joyce M Black Jane Hokanson Hawks “ Medical surgical Nursing ” 7th edition volume no 7 Elsevier publications. REFERENCES