LUNG ABSCESS

Prepared By,
Jeevitha P
 OBJECTIVES
At the end of the class the student will be able to
understand the
 Anatomy and physiology of lungs
 Definition of lung abscess
 Etiology of lung abscess
 Pathophysiology of lung abscess
 Clinical manifestations of lung abscess
 Diagnostic techniques of lung abscess
 Management of lung abscess
ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY
The lungs are essential organ of
respiration. Each lung is conical in shape.
Each lung has,
An Apex at the upper end
A base resting on the diaphragm.
Three borders Anterior,
Superior and Posterior.
Two surfaces Costal and Medial
 ANATOMY AND PHYSIOLOGY
 The lung consists of right and left
lobes.
 Right lung has three lobes.
 Upper, middle and lower
lobe
 Left lung has two lobes.
 Upper and lower lobe.
 ANATOMY AND PHYSIOLOGY
Each lung is enclosed in a serous pleural sac that
consist of two membrane.
 Visceral
 Parietal Pleura

Functions of Lungs
 Ventilation
 Diffusion
 BLOOD SUPPLY AND NERVE
SUPPLY
The human lung contains dual blood supply
• Bronchial circulation
• Pulmonary circulation
Nerve supply
• Autonomic nervous system
 LUNG VOLUMES AND LUNG
CAPACITIES
 Tidal volume
 Inspiratory reserve volume
 Expiratory reserve volume
 Residual volume
LUNG ABSCESS
 INTRODUCTION
Necrosis of the
pulmonary tissue and
formation of cavities
containing necrotic debris or
fluid caused by microbial
infection.
 DEFINITION
Lung abscess is pus containing lesions of
lung parenchyma that gives rise to cavity. The
cavity is formed by necrosis of the lung tissue.
or
A localized area of destruction of lung parenchyma
in which infection by pyogenic organisms results
in tissue necrosis & suppuration
LUNG ABSCESS
 RISK FACTORS/CAUSES

Aspiration of materials from GI tract

Alcoholism
Seizure disorder
Drug overdose
General anesthesia
Stroke
 RISK FACTORS/CAUSES

Infectious Agents
Gram negative organism (eg.Klebsilla)
Anaerobic bacilli
Staphylococcus aureus – Strep.pyogenes
Klebsiella pneumonia
Pseudomonas aeruginosa
Hemophilic influenza
E.coli
Acinetobacter
 RISK FACTORS/CAUSES

Other Causes
Malignant growth
Tuberculosis
Various parasitic and fungal diseases
of the lung
CLASSIFICATION OF LUNG
ABSCESS
Primary
Abscess in previously healthy patient or in
a patient at high risk for aspiration.
Secondary
Associated bronchogenic neoplasm or
immunocompromised patients.
CLASSIFICATION OF LUNG ABSCESS
 CLASSIFICATION OF LUNG
ABSCESS

Lung abscess is classified based on the

duration.
Acute Abscess Occurring less than 4-6 weeks.
Chronic Abscess Longer duration
 PATHOPHYSIOLOGY

Aspiration of materials from GI tract

Pneumonitis impairs the drainage of fluid or aspirated

materials

Inflammatory vascular obstruction

Tissue Necrosis and finally abscess will occur

CLINICAL MANIFESTATION
Cough with purulent sputum
Hemoptysis
Fever (>102 F)
Chills
Pleuritic chest pain
Dyspnea
Weight loss
 CLINICAL MANIFESTATION

On physical examination
 Dullness to percussion
 Decreased breathe sounds on auscultation
over the segment of lungs.
 Crackles
 OTHER SYMPTOMS

 Fatigue & Anemia

 Clubbing an upside-down spoon like
appearance on the finger nails.
 Weakness
 Anorexia
DIAGNOSTIC EVALUATION

 History Collection
 Physical examination
 Chest X-ray
 Sputum culture
 Fibro optic Bronchoscopy
 CT – Chest
 Complete blood counts (WBC)
LUNG ABSCESS
BRONCHOSCOPY
 MANAGEMENT
Management

Nursing
Surgical Management
Management
Medical Nutritional
Management Management
 MANAGEMENT
• Depending upon the results of
sputum culture and sensitivity
antibiotic therapy will be provided.
• Prolonged antibiotics (4-6 wks.)
metronidazoles
• Removal of obstruction /cause
• Surgery if needed
 MEDICAL MANAGEMENT

Antibiotic Therapy

Anaerobic lung infection

 Clindamycin-600-1200mg/day
 Ampicillin sulbactum-1.5 g
MEDICAL MANAGEMENT
Gram Negative Organism
Metronidazole- 500mg/ 100ml
infusion
Bronchodilators
Albuterol
POSTRUAL DRAINAGE AND
CHEST PHYSIOTHERAPY
 CHEST PHYSIOTHERAPY

• With your hands held in a rigid • Use manual compression and

cup position, strike the area over tremor to help loosen the
the lung lobes to be drained in a respiratory secretions
rhythmic pattern
SURGICAL MANAGEMENT
NUTRITIONAL MANAGEMENT
A diet high in protein and calories is necessary
 NURSING MANAGEMENT
• Assess the patient conscious level.
• Monitor vital signs including oxygen saturation
• Chest physiotherapy is initiated as prescribed to
facilitate drainage of the abscess
• The nurse educate the patient to perform deep
breathing and coughing exercise
• The nurse administer antibiotics and iv fluids as
prescribed and monitor for side effects.
 NURSING DIAGNOSIS
• Infective airway clearance related to pus
containing lesions in the lung parenchyma
as evidenced by excessive secretions.
• Ineffective breathing pattern related to
abnormal positions as evidenced by
breathing difficulty.
 NURSING DIAGNOSIS
• Impaired gas exchange related to
secretions in the lungs as evidenced by
desaturation and crackles.
• Impaired thermoregulation related to
invasion of micro organism enter into the
body as evidenced by elevated body
temperature.
 NURSING DIAGNOSIS
• Acute pain related to necrosis of pulmonary tissue
as evidenced by chest pain.
• Risk for aspiration related to aspiration of
materials from the GI tract.
• Imbalanced nutritional status less than body
requirement related to loss of protein through
sputum as evidenced by cough with productive
sputum.
 COMPLICATIONS
• The most common complication is
empyema, with or without Broncho
pleural fistula.
• Other complications, which are now rare,
include brain or other distal abscesses,
generalized infection, severe
hemorrhage, and pulmonary gangrene.
 PREVENTION
• Minimize aspiration
• Treatment of periodontal disease