LUNG ABSCESS

Fall 2021-2022
Definition

• Lung abscess is defined as necrosis of the pulmonary tissue /

parenchyma that collapse and ends up in the formation of
cavities containing necrotic debris or fluid caused by
microbial infection.

• The formation of multiple small abscesses (<2 cm)

containing purulent material, is occasionally referred to as
necrotizing pneumonia or lung gangrene

Fall 2021-2022
Pathophysiology

• Most lung abscesses are a complication of bacterial

pneumonia or caused by aspiration of oral anaerobes into
the lung

• Abscesses 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.

• Staph aureus and Klebsiella are frequently associated with

lung abscesses

Fall 2021-2022
? at risk
• Impaired cough reflexes & swallowing difficulties (Aspiration)

• Central Nervous System disorders (seizure & stroke), drug

addiction, alcoholism, esophageal diseases, compromised
immunity, NG feedings, altered state of consciousness, poor
dentition.

• Secondary to mechanical or functional obstruction of the

bronchi (TB, pulmonary embolism, tumors, chest trauma)

• These conditions occur more commonly in elderly patients

because of the increased incidence of periodontal disease
(infected sinuses or teeth) and the increased prevalence of
micro-aspiration.
Fall 2021-2022
Clinical Manifestations
• Fever,
• Productive cough with moderate to copious
amounts of foul-smelling, often bloody sputum.
• Pleurisy, dull chest pain, dyspnea,
• Weakness, anorexia and weight loss may be present
• Leukocytosis (may be present)

Fall 2021-2022
 Assessment and diagnostics findings

• Decreased or absent breath sounds with intermittent

friction rub (rubbing sound) on auscultation and
dullness in percussion

• Crackles

• Confirmed by chest X-ray, sputum culture and fiber

optic bronchoscopy, CT scan.

Fall 2021-2022
Prevention
• Appropriate antibiotic (ATB) therapy before any
dental procedures

• Appropriate ATB therapy for patients with

pneumonia

• Adequate dental and oral hygiene

Fall 2021-2022
 Medical management
• IV ATB depending on sputum culture and sensitivity.
Large IV doses and prolonged use are required
because ATB must penetrate the necrotic tissue and
fluid in the abscess

• Drainage of lung abscess and chest physiotherapy

• Diet high in protein and calories

• Lobectomy (is rare) when there’s massive hemoptysis

or no response to medical management
Fall 2021-2022
 Nursing management
• Administer ATB and monitor for adverse effects.

• Chest physiotherapy

• Teach the patient to perform deep breathing and

coughing exercises.

• Provide a diet high in protein and calories

• Offer an emotional support

Fall 2021-2022
THANK YOU
Fall 2021-2022