EMPHYSEMA

DEFINITION
Emphysema results from distention & rupture of the alveoli due to the loss of elasticity of the lung tissue with resultant air trapping.

CAUSES
Cigarette

smoking Exposure to pollutants Lower respiratory infection Childhood lung infection Connective tissue disorder Family members with emphysema HIV infcetion

TYPES OF EMPHYSEMA

Obstruction emphysema It occurs due to partial occlusion of bronchus or a bronchiole. In case of atelectasis, bronchial asthma, lung infection, bronchiolitis, tuberculosis, mucoviscidosis, tumors, foreign body, aspiration etc. Compensatory emphysema It occurs when normal lung tissue expands to fill up across of collapsed lung segments. E.g. Pneumonia, empyema, pneumothorax etc. Congenital lobar emphysema It is found in neonates & young children resulting from severe respiratory distress. Familial Emphysema It is found especially in female young child as progressive dyspnea, which is inherited as autosomal recessive trait.

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

DIAGNOSTIC EVALUATION
History of patient Physical examination Chest x-ray CT scan Complete blood cell count Sputum examination

COMPLICATIONS
Respiratory failure Meningitis Osteomyelitis Arthritis

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 by conservative therapy.

SURGICAL MANAGEMENT
Lobectomy Congenital lobar emphysema should be managed with lobectomy.

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-up position. 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.

EMPYEMA

DEFINITION
Empyema is the collection of thick pus in the plural cavity. It may develop directly from lungs or from neighboring structure or through blood. It is fairly common in infancy.

CAUSES
Staphylococcus Pneumococcus Streptococcus Tuberculosis Chest injury Suppurative lung disease Osteomyelitis

CLINICAL MANIFESTATIONS
Staphylococcus infection Growth failure Fever Diarrhea Cough Respiratory distress Chest pain Loss of weight Anemia Toxemia

DIAGNOSTIC TEST
Chest X-ray Diagnostic plural aspiration Bacteriological exam CT scan

COMPLICATIONS
Pyopneumothorax Lung abscess Purulant pericarditis Osteomyelitis of ribs Septicemia Meningitis Arthritis

MEDICAL MANAGEMENT
Antibiotic 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 plural cavity.

SURGICAL MANAGEMENT
Thoracotomy

Surgical

drainage after thoracotomy may be needed to remove the collection, in case of severe respiratory difficulty, or in loculated pus 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.

NURSING MANAGEMENT
To give antipyretics, analgesics & nutritional supplement 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.

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

SUMMARIZATION
Emphysema

Empyema

Definition Causes Clinical Manifestations Diagnostic Evaluation Complications Medical Management Surgical Management Nursing Management

Definition Causes Clinical Manifestations Diagnostic Evaluation Complications Medical Management Surgical Management Nursing Management

BIBLIOGRAPHY

Datta Parul, Pediatric Nursing Ed-2nd Jaypee Publishers 279-281.

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