NEKEMTE HEALTH SCIENCE COLLEGE

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 NEKEMTE HEALTH SCIENCE
COLLEGE
 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)
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 Group members
S/ NAME OF TEAM DEPT ID.NO
N

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
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NURSING 010/2015 3
 out lines
• Tittle:
 Definition of empyema
 Risk factors/couse
 Pathopysiology
 C/manifestations
 Diagnosis
 Differential diagnosis
 Medical mgt
 Nursing mgt
 Complication
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 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.

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

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 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

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

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 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

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 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

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

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

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

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 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
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 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
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 Cont..d
• sweating
• chest pain when breathing that may be
described as stabbing
• headache
• confusion
• loss of appetite

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 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.
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 Cont…
Other symptoms in complex empyema
include:
 difficulty breathing
 decreased breath sounds
 weight loss
 chest pain

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 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
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 Differential DX
 Pneumonia
 Heart failure
 Pulmonary infarction( artery to the lung
become blocked and lung tissue dies)
 Sequestration(cystic lung lesion)

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 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
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 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
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 Needle aspiration

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 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

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 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

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 Nursing mgt

 Monitoring vital sign

 Assesting with drainage
procedure(thoracentiasis)
 Administrating medications
 Providing patient education

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 Complication of empyema

 Necrosis of visceral pleura

 Bronchopleural fistula
 Necrosis parietal pleura and chest wall
 Osteomyelitis of rib or spine
 Metastatic spread(brain abscess)

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 THE
END
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