MEDICAL SURGICAL NURSING -I
UNIT: III -NURSING MANAGEMENT
OF PATIENTS WITH DISORDER OF
RESPIRATORY SYSTEM
LUNG ABSCESS

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

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

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

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.

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.

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]

Pneumonitis- inflammation of lung tissue
Liquefaction-Transformation of tissue into liquid viscous
mass[purulent material]

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

 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

DIAGNOSTIC STUDIES
• Chest X ray (fluid filled cavity)
• AFB
• CT scan
• Sputum cultures
• Pleural fluid
• Blood culture
• Broncoscopy

TREATMENT
 Antibiotic therapy (2 – 4 months )
1. Ampi / Amoxicillin x orally
2. Metronidazole 400mg TDS
3. Cry.penicillin & clindamycin +/- metronidazole
IV – in hospitalised pts.

TREATMENT
1. Can change – according to sensitivity
 Coughing technique
 Chest physiotherapy with postural drainage
 Good rest and Nutrition
 More intake of fluid
 Dental care

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.

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

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:

 Teach patient about deep breathing exercises
 Encourage alternating activity with rest periods
 Chest physiotherapy
 Suctioning
 Bronchodilator medication
 O2 administration, if required
INEFFECTIVE BREATHING PATTERN

 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

 Relaxation techniques
 Divertional therapy
 Frequent massage
 Comfortable position
 Education to concern about pharmacological and
non- pharmacological therapies
 Medication , as prescribed.
PAIN

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.

• 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