Lung abscess is a collection of pus within the lungs caused by aspiration or infection, usually by anaerobic bacteria. Risk factors include periodontal disease, impaired swallowing, and conditions causing altered consciousness. Symptoms include cough with purulent sputum and chest pain. Diagnosis involves chest x-ray, bronchoscopy, and culture of sputum. Treatment is long-term IV and oral antibiotics, postural drainage, and surgery if antibiotics fail or cause massive hemoptysis. Prevention involves good oral hygiene and care to prevent aspiration during unconsciousness or seizures.

1. LUNG ABSCESS

2.  Definition :
 Definition Lung abscess is the collection of pus
within the lungs.
 A lung abscess is a localized necrotic lesion of
the lung parenchyma containing purulent
material that collapses and forms a cavity.
 It generally caused by aspiration of anaerobic
Bactria.
 If a lung abscess remains unidentified &
untreated ,tissue necrosis may occur.

3.  Etiology Primary abscess is infectious in origin, caused
by aspiration or pneumonia in the healthy host;
 Bronchiectasis
 Immunocompromised state
 Patients at the highest risk for developing lung abscess
have the following risk factors:
1. Periodontal disease
2. Seizure disorder
3. Alcohol abuse
4. Dysphagia

4.  Most frequently, the lung abscess are a
complication of bacterial pneumonia or
caused by aspiration of oral anaerobes in the
lung.
 LA also may occur secondary to mechanical
or functional obstruction of the bronchi by a
tumor, foreign body, or bronchial stenosis, or
from necrotizing pneumonias,TB ,
Pulmonary embolism, or chest trauma.

5.  The patients who develop lung abscess are
predisposed to aspiration and commonly
have periodontal disease.
 Patients who have impaired cough reflexes
and can not close the glottis, and those with
swallowing difficulties ,are at risk for
aspiration of foreign material and
development of LA.

6.  Other at –risk patients include those with
central nervous system disorders ( e.g.
seizure, stroke) drug addiction, alcoholism,
esophageal disease and compromised
immune function .
 patients without teeth and those reciving
nasogastric tube feeding and patient with an
ALOC (altered level of consciousness ) due to
anesthesia.

7.  A bacterial reaches the lower airways, and
infection is initiated because the bacteria are
not cleared by the patient's host defense
mechanism.
 This results in aspiration pneumonitis and
progression to tissue necrosis 7-14 days later,
resulting in formation of lung abscess.

8.  Diagnostic evaluationThe following tests are
used to diagnose a lung abscess:
 1. Auscultation of the chest may reveal
crackles and decreased breath sounds
 .2. Chest X-ray
 3. Bronchoscopy may be used to obtain
cultures to identify the causative organism.
 4. Blood cultures, Gram stain, and culture of
sputum are also used to detect the causative
organism.
 5.White blood cell count commonly exceeds
10,000/ul.

9.  Treatment for Lung Abscess long term IV
antimicrobial and Antibiotic therapy often
lasts for months until radiographic resolution
or definite stability occurs.
 Clindamycin is often the drug of choice.
 Symptoms usually disappear in a few weeks.
 Postural drainage may facilitate discharge of
necrotic material into upper airways.

10. Oral antibiotic therapy replaces IV therapy
after the patient shows signs of
improvement.

11.  oxygen therapy may relieve hypoxemia.
 A poor response to therapy may require
resection of the lesion or removal of the
diseased section of the lung All patients need
proper follow-up and serial chest X-rays.

12.  Special Considerations and Prevention of
Lung AbscessTo prevent a lung abscess in
the unconscious patient and the patient
with seizures, first prevent aspiration of
secretions.
 Do this by suctioning the patient and by
positioning him to promote drainage of
secretions.

13.  Provide chest physiotherapy (including
coughing and deep breathing). Increase fluid
intake to loosen secretions.
 Appropriate antibiotic therapy before any
dental procedure in patients who must have
teeth extracted while their gums and teeth
are infected

14.  Adequate dental and oral hygiene because
anaerobic Bactria play a role in the
pathogenesis of lung abscess
 Appropriate antibiotic therapy for patients
with pneumonia.

15.  Surgical therapy patient with lung abscess is
rare ,but “ Pulmonary resection ( Lobectomy)
is performed if massive Hemoptysis
(coughing up blood) occurs or if there is little
or no response to medical management.

16.  Nursing management Note the color
,quantity ,quality & smell of the expectorated
material including the presence of blood.
 Use gloves when handling articles
contaminated with sputum Provide frequent
opportunities for the client to use mouthwash
,brush the teeth.


17.  Encourage long term dental care. Long term
antibiotics administration is usually ,observe
oral mucous membrane.
 Administer antibiotic and monitor side
effects
 Assist in CPT
 Encourage and teaches the patient t perform
deep breathing exercise
 Ensure proper nutritional intake ( high in
protein and calories)