Education

1. NEKEMTE HEALTH SCIENCE COLLEGE
4/10/2024 AM 1

2.  DEPARTEMENT OF POST BASIC NURSING
YEAR ONE SEMSTER II
COURSE TITTLE:MEDICAL SURGICAL
NURSING
GROUP ASSIGNMENT;EMPYEMA
GROUP ONE ID.NO (1-10)
INSTRUCTOR BY; ABDI WAKJIRA(BSC,MSC)
NEKEMTE HEALTH SCIENCE
COLLEGE
4/10/2024 AM 2

3. Group members
S/
N
NAME OF TEAM DEPT ID.NO
1 ABDULKERIM TEHA NURSING 001/2015
2 ABABAYE TIBABU NURSING 002/2015
3 ABEBECH WEKGARI NURSING 003/2015
4 ABINAT FELEKE NURSING 004/2015
5 ADEM MOHAMMED NURSING 005/2015
6 AHMED ABRAHIM NURSING 006/2015
7 AHMED TEMAM NURSING 007/2015
8 AYELAW KASEHUN NURSING 008/2015
9 BAKELECH FAYISA NURSING 009/2015
10 BIRHANU GETAHUN NURSING 010/2015
4/10/2024 AM 3

4. out lines
• Tittle:
Definition of empyema
Risk factors/couse
Pathopysiology
C/manifestations
Diagnosis
Differential diagnosis
Medical mgt
Nursing mgt
Complication
4/10/2024 AM 4

5. EMPYEMA
Empyema is an accumulation of thick, purulent fluid
within the pleural space,often with fibrin
development and a loculated (walled-off) area where
infection is located.
Most empyemas occur as complications of bacterial
pneumonia or lung abscess.
4/10/2024 AM 5

6. Cont’d….
Other causes include penetrating chest trauma,
hematogenous infection of the pleural space,
nonbacterial infections, or iatrogenic causes (after
thoracic surgery or thoracentesis).
4/10/2024 AM 6

7. 4/10/2024 AM 7

8. Stage of empyema
1.Exudative stage aproximately (1 to 3 days)
2.Fibrino purulent stage (4 to 14 days
3.Organizing stage after 14 days
4/10/2024 AM 8

9. 1.Exudative stage
Imediate response with outpouring of the
fluid
Low cellular content
Its simple parapneumonic effusion with
normal ph and glucose level
4/10/2024 AM 9

10. 2.Fibrino purulent stage
Large number of poly morphonuclear
leukocytes and fibrin accumulates
Accumulation of neutrophils and fibrin
effusion becomes purulent and viscous
leading to development of empyema
4/10/2024 AM 10

11. 3.Organizing stage
Fibro blasts grow into exudates on both the
visceral and parietal pleural surfaces
Development of an inelastic membrene the
peel
Most common in s.aureus infection.
Thickened pleural peel can restrict lung
movement and its commonly termed as
trapped lung
4/10/2024 AM 11

12. Causes …
The most common organisms:
Staphylococcus aureus(90% of causes in
infants and children)
Streptococcus pneumonie.
H. influenzae
4/10/2024 AM 12

13. Cause of empyema
The most common cause of empyema is
pneumonia. Other causes include:
• Tuberculosis.
• Lung abscess.
• Chest surgery.
• Chest injuries or trauma.
4/10/2024 AM 13

14. Risk factors
Alcoholism
Drug use (eg.IV drug)
HIV infection
Neoplasm
Pre-existant pulmonary disease
Thoracic trauma
Immunocompromised state
4/10/2024 AM 14

15. Pathopysiology
The pleural space naturally has some fluid
But infection and other etiology factors leads to increased fluid production
than it can be absorbed
The fluid then becomes infected with the bacteria
The infected fluid thickens
Lining of your lungs and chest cavity to stick together and form pockets
Empyema
4/10/2024 AM 15

16. Clinical Manifestations
With an empyema, the patient is acutely ill and has
signs and symptoms similar to those of an acute
respiratory infection or pneumonia.
 Empyema can be simple or complex.
Simple empyema
 Simple empyema occurs in the early stages of the illness. A
person has this type if the pus is free-flowing. The
symptoms of simple empyema include:
 Shortness of breath
 Dry cough
 Fever
4/10/2024 AM 16

17. Cont..d
• sweating
• chest pain when breathing that may be
described as stabbing
• headache
• confusion
• loss of appetite
4/10/2024 AM 17

18. Cont…d
Complex empyema occurs in the later stage of the
illness.
In complex empyema, the inflammation is more
severe.
Scar tissue may form and divide the chest cavity
into smaller cavities.
This is called loculation, and it’s more difficult to
treat.
If the infection continues to get worse, it can lead
to the formation of a thick peel over the pleura,
called a pleural peel.
This peel prevents the lung from expanding.
Surgery is required to fix it.
4/10/2024 AM 18

19. Cont…
Other symptoms in complex empyema
include:
difficulty breathing
decreased breath sounds
weight loss
chest pain
4/10/2024 AM 19

20. Assessment and Diagnostic Findings
Chest auscultation demonstrates decreased or absent breath
sounds over the affected area, and there is dullness on chest
percussion as well as decreased fermatas.
 The diagnosis is established by
• chest x-ray or
• chest CT scan.
• Usually a diagnostic thoracentesis is performed, often under
ultrasound guidance.
4/10/2024 AM 20

21. Differential DX
Pneumonia
Heart failure
Pulmonary infarction( artery to the lung
become blocked and lung tissue dies)
Sequestration(cystic lung lesion)
4/10/2024 AM 21

22. Medical Management
• The objectives of treatment are to drain the pleural
cavity and to achieve full expansion of the lung.
• The fluid is drained and appropriate antibiotics, in
large doses, are prescribed based on the causative
organism.
• Sterilization of the empyema cavity requires 4 to 6
weeks of antibiotics
4/10/2024 AM 22

23. Cont’d….
Drainage of the pleural fluid depends on the stage of
the disease and is accomplished by one of the
following methods:
1. Needle aspiration (thoracentesis) with a thin
percutaneous catheter, if the volume is small and the
fluid not too purulent or thick
4/10/2024 AM 23

24. Needle aspiration
4/10/2024 AM 24

25. Cont’d….
2.Tube thoracostomy (chest drainage using a large-
diameter intercostals tube attached to water-seal
drainage with fibrinolytic agents instilled through
the chest tube in patients with loculated or
complicated pleural effusions
4/10/2024 AM 25

26. Cont’d….
3. Open chest drainage via thoracotomy, including
potential rib resection, to remove the thickened
pleura, pus, and debris and to remove the underlying
diseased pulmonary tissue
4/10/2024 AM 26

27. Nursing mgt
Monitoring vital sign
Assesting with drainage
procedure(thoracentiasis)
Administrating medications
Providing patient education
4/10/2024 AM 27

28. Complication of empyema
 Necrosis of visceral pleura
 Bronchopleural fistula
 Necrosis parietal pleura and chest wall
 Osteomyelitis of rib or spine
 Metastatic spread(brain abscess)
4/10/2024 AM 28

29. 4/10/2024 AM 29

30. THE
END
4/10/2024 AM 30