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Empyema - Causes, Symptoms and Treatment

What is Empyema?

Empyema is the accumulation of pus and necrotic tissue in the pleural space. Normally, this space contains a small amount of extracellular fluid that lubricates the pleural surfaces. Empyema typically is a complication of pneumonia but may result from penetrating chest trauma, esophageal rupture, or inoculation of the pleural cavity after thoracentesis or chest tube placement. The prognosis for empyema with treatment is generally good.

What are the Causes of Empyema?

Empyema is usually associated with infection in the pleural space, which may be idiopathic or related to pneumonitis, carcinoma, perforation, or esophageal rupture.

What are the Signs and Symptoms of Empyema?

Most patients experience fever, malaise, shortness of breath, night sweats, anorexia, and pleuritic chest pain. Physical findings include tachypnea, and decreased breath sounds; percussion over the effused area, detects dullness, which doesn't change with breathing.

Diagnosis for Empyema

Chest X-ray is done to differentiate between pneumonia, pulmonary abscess, and empyema. A computed tomography scan or ultrasound of the chest may be needed to help localize the fluid collection. The most useful test is thoracentesis and aspiration of pus for analysis.

Treatment for Empyema

Treatment of empyema requires insertion of one or more chest tubes after thoracentesis to allow drainage of purulent material, and possibly decortication (surgical removal of the thick coating over the lung) or rib resection to allow open drainage and lung expansion. Empyema also requires parenteral antibiotics. Associated hypoxia requires oxygen administration.

Special Considerations and Prevention Tips for Empyema

1. Explain thoracentesis to the patient. Before the procedure, tell the patient to expect a stinging sensation from the local anesthetic and a feeling of pressure when the needle is inserted. Instruct him to tell you immediately if he feels uncomfortable or has trouble breathing during the procedure.

2. Reassure the patient during thoracentesis. Remind him to breathe normally and avoid sudden movements, such as coughing or sighing.

3. Encourage the patient to do deep-breathing exercises to promote lung expansion. Use an incentive spirometer to promote deep breathing.

4. Provide meticulous chest tube care, and use aseptic technique for changing dressings around the tube insertion site in empyema. Ensure tube patency by watching for fluctuations of fluid in the underwater seal chamber. Watch for bubbling in the water-seal chamber, indicating the presence of air in the pleural spaces. Record the amount, color, and consistency of any tube drainage.

5. If the patient has open drainage through a rib resection or intercostal tube, use hand and dressing precautions.

6. Because weeks of such drainage are usually necessary to obliterate the space, make visiting nurse referrals for patients who will be discharged with the tube in place.

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