Download - Emphysema & Empyema
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EMPHYSEMA
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DEFINITIONEmphysema results from
distention & rupture of the
alveoli due to the loss ofelasticity of the lung tissue
with resultant air trapping.
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CAUSESCigarette smoking
Exposure to pollutants
Lower respiratory infectionChildhood lung infection
Connective tissue disorder
Family members with emphysemaHIV infcetion
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TYPESOF EMPHYSEMA
Obstruction emphysema
It occurs due to partialocclusion of bronchus or a bronchiole. In case ofatelectasis, bronchial asthma, lung infection,bronchiolitis, tuberculosis, mucoviscidosis, tumors,foreign body, aspiration etc.
Compensatory emphysema
It occurs when normallung tissue expands to fill up across of collapsed lungsegments. E.g. Pneumonia, empyema, pneumothoraxetc.
Congenital lobar emphysema It is found in neonates
& young children resulting from severe respiratorydistress.
Familial Emphysema It is found especially in femaleyoung child as progressive dyspnea, which is inheritedas autosomal recessive trait.
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CLINICAL MANIFESTATIONS
Coughing in the morning
Wheezing
Shortness of breath with activity
Decrease exercise
Fatigue
Loss of appetite
Weight loss
Dyspnea
Tachypnea Cough
Chest retration
Cynosis
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DIAGNOSTIC EVALUATION
History of patient
Physical examination
Chest x-ray
CT scan Complete blood cell count
Sputum examination
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COMPLICATIONS Respiratory failure
Meningitis
Osteomyelitis
Arthritis
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MEDICAL MANAGEMENT
Management of the emphysema
condition depend upon the cause of
emphysema. Symptomatic relief is
important with oxygen therapy,bronchodilators, mucolytic agents,
and antibiotics. Interstitial
emphysema can be treated byconservative therapy.
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SURGICAL MANAGEMENT
Lobectomy Congenital lobar
emphysema should be managed
with lobectomy.
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NURSING MANAGEMENT Continuous monitoring of childs conditions is required with
special emphasis on respiratory functions.
Supportive nursing care is essential with need based nursing
care.
The nursing care should include routine care with rest.
To provision of the bed rest with comfortable position, prop-upposition.
Administration of oxygen therapy & clearing of airway.
To maintain the intake & output recording.
To increase oral fluid intake. Avoidance of bronchial irritants e.g. smoking.
Maintain oral hygiene specially after inhalation of medications.
Care during surgery & health teaching to parents.
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EMPYEMA
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DEFINITIONEmpyema is the collection of
thick pus in the plural cavity. It
may develop directly fromlungs or from neighboring
structure or through blood. It is
fairly common in infancy.
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CAUSES Staphylococcus
Pneumococcus
Streptococcus
Tuberculosis Chest injury
Suppurative lung disease
Osteomyelitis
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CLINICAL MANIFESTATIONS
Staphylococcus infection
Growth failure
Fever
Diarrhea Cough
Respiratory distress
Chest pain
Loss of weight
Anemia
Toxemia
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DIAGNOSTIC TEST Chest X-ray
Diagnostic plural aspiration
Bacteriological exam
CT scan
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COMPLICATIONS Pyopneumothorax
Lung abscess
Purulant pericarditis
Osteomyelitis of ribs Septicemia
Meningitis
Arthritis
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MEDICAL MANAGEMENTAntibiotic Therapy Antibiotic therapy should be
started as early as possible and to be continued for
3 to 4 weeks. Commonly used antibiotics are
Penicillin, cloxacillin, ampicillin, chloramphnical or
newer antibiotics e.g. cephalosporins (cefazolin,cephalexin) etc.
Continues closed intercostal drainage is strongly
recommended for the management of empyema
rather than the multiple aspiration of the pluralcavity.
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SURGICAL MANAGEMENT
Thoracotomy
Surgical drainage after thoracotomy may be
needed to remove the collection, in case of
severe respiratory difficulty, or in loculatedpus or in the presence of marked medistinal
shift and when there is no improvement of
the condition even after 3-4 weeks of
medical management.
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NURSING MANAGEMENT To give antipyretics, analgesics & nutritionalsupplement as prescribed.
Supportive nursing care with bed rest.
Give semi fowler position to patient.
Give oxygen therapy. Give protein rich diet.
Give antibiotic therapy.
Assist in breathing exercise & postural drainage.
Give emotional support & health teaching. Monitor childs condition & chest drainage
continuously.
Other nursing care should be given priority wise.
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NURSING DIAGNOSIS Ineffective breathing pattern related to
inflammatory process
Altered nutritional status: less than body
requirements related to loss of appetite,diarrhea
Fatigue related to increased work of
breathing
Anxiety related to respiratory distress &
hospitalization of infant
Knowledge deficit related to care of infant
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SUMMARIZATION
Emphysema Definition
Causes
Clinical Manifestations
Diagnostic Evaluation
Complications
Medical Management
Surgical Management
Nursing Management
Empyema Definition
Causes
Clinical Manifestations Diagnostic Evaluation
Complications
Medical Management
Surgical Management
Nursing Management
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BIBLIOGRAPHY Datta Parul, Pediatric Nursing Ed-2nd Jaypee
Publishers 279-281.
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