Lung Abscess Nursing Management

 LUNG ABSCESS

Lung abscess is a pus containing lesion of the lung parenchyma that gives rise to a cavity formed by the necrosis of lung tissue

Causes

1. Aspirated foreign material eg. Vomitus, mucus, blood, food or tissue due to upper airway surgery.
2. Benign or malignant Tumours.
3. Sequelae of necrotizing pneumonias, tuberculosis, pulmonary embolism or chest trauma

Pathophysiology

Lung abscess is a pus containing lesion of the lung parenchyma. By necrosis of lung tissue, it forms a cavity. Fibrous tissue forms around the abscess to wall it off.
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Foul smelling Sputum."
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Abscess may erode into the bronchial system, producing a foul smelling sputum.
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Areas affected are posterior segments of the upper lobe and apical segments of the lower lobes.

Clinical Manifestations

1. Posterior segment of the upper Yobe and apical segment of the lower lobe
2. Cough with purulent sputum (dark brown) which is foul smelling and foul tasting.
3. Haemoptysis occurs especially when the abscess ruptures into the bronchus.
4. Fever, chills, prostration, dyspnoea, pleuritic pain, cough and weight loss.
5. Anaemia wonder

Diagnostic Investigations

1. Physical examination
2. Chest X-ray
3. Physical Examination, Chest tray, Sputum culture and gram stain, Bronchoscopy.
4. Sputum culture and gram stain
5. Bronchoscopy

Medical Management

1. Antimicrobial therapy depending on the results of sputum culture and sensitivity. Clindamycin or metronidazole and penicillin G is the primary therapy-6-16 weeks.
2. Postural drainage and chest physiotherapy-helps to drain the abscess.
3. Bronchoscopy to drain the abscess is controversial because it may cause spread of infection.
4. A high protein, high calorie diet facilitates healing

Nursing Management

1. Administer antibiotics and monitor patient for side effects.
2. Initiate chest physiotherapy to drain abscess
3. Teach deep breathing and coughing exercises - helps to expand the lungs.
4. Frequent mouth care (every 2-3 hours) relieves putrid odour and taste from foul smelling sputum.
5. Rest, good nutrition and adequate fluid intake supportive measures.
6. Emotional support to be provided because lung abscess may take a long time to resolve.