Empyema Nursing Care

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EMPYEMA































































Nursing Care Plan






Julie James Abdullah

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Contents


Impaired gas exchange related to compressed lung ................................................................................. 3

Nursing Interventions and Rationale .......................................................................................... 4






































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Impaired gas exchange related to



compressed lung




Related Factors

• Physiological damage to the alveoli
• Circulatory compromise
• Lack of oxygen supply
• Insufficient availability of blood (carrier of oxygen)

Assessment

• Oxygen saturation below 90%
• Abnormal lung sounds
• Tripod position
• Anxious appearance
• Irritability, restlessness, confusion
• Altered characteristics of respirations: rate, rhythm, and depth
• Dyspnea (difficulty breathing)
• Altered skin color: pallor; cyanosis; dusky
• Diaphoresis
• Abnormal chest x-ray
• Abnormal blood gas value
• Anemia: Decreased hemoglobin and hematocrit
• Past medical history reveals respiratory comorbidities such as COPD and asthma

Goals and outcomes

• The patient will demonstrate adequate oxygenation with ABGs within normal limits
• The patient will have vital signs that are within the patient’s normal range
• The patient will have clear lung sounds
• The patient will deny any difficulty breathing
• The patient will be free of any signs of respiratory distress
• The patient will demonstrate an intact mentation














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Nursing Interventions and Rationale


Nursing Interventions Rationale

Assessment


Assess the characteristics of These indicators show the severity of respiratory
respirations. Note distress. Factors such as pain, immobility, and
sedation can affect breathing patterns and cause
• Rate shallow breaths. This leads to reduced lung
• Rhythm volume and decreased gas exchange. Hypoxia
• Depth often goes along with prolonged increased work of
• Use of accessory muscles breathing.

Consistent monitoring allows for better tracking
of a trend. A slow decline in oxygen saturation
Monitor oxygen saturation might get missed with only spot-checking oxygen
continuously. saturation. Increased oxygen demand and

decreased oxygen saturation indicate a
compromise in oxygenation.

Patients with respiratory problems may have
wheezes, crackles, or sound diminished. Changes
Auscultate lung sounds at least every 2 or worsening in these lung sounds may indicate a
to 4 hours. Listen for adventitious decline in ventilation. Often lung sounds
breath sounds.
contribute to disclosing the source of poor
ventilation.

Assess the ability to cough and clear
secretions. Note characteristics of
sputum. The pooling of secretions in the respiratory tract
affects gas exchange. Sputum may be sampled to
Amount rule out an infectious process.
Color
Consistency


Note the color of the tongue and oral mucous
membranes. Blue discoloration of the tongue and
Assess for cyanosis. oral membranes may indicate central cyanosis, a
medical emergency. This condition means that
tissues and organs are deprived of adequate
amounts of oxygen.


Irritability, restlessness, and confusion can be
early signs of hypoxia, whereas late signs are
Assess the patient’s mentation. lethargy and somnolence. Deterioration in
cognition may be a sign of decreased oxygenation
of the brain and other organs.




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Nursing Interventions Rationale

Assess the patient’s mental makeup and Stress and anxiety can function as a catalyst in
level of stress and anxiety. worsening breathing.

Blood gases provide information about gas
exchange. Abnormal blood gases could cause an
acidotic or alkalotic state. An increase in Paco2
and a decrease in Pao2 might indicate respiratory
Monitor ABGs frequently.
acidosis and hypoxemia. Hypoxemia is a low
oxygen level in the blood. If oxygen levels in the
blood are low, supply for the brain and other
organs are affected.


Prolonged increased work of breathing requires a
large amount of calories. Patients with chronic
respiratory conditions use a lot of energy.
Achieving an ideal BMI is crucial because obesity
Assess the patient’s nutritional status.
might need a lot of energy to use the diaphragm
and accessory muscles. In contrast, malnutrition

and underweight may lead to loss of muscle mass.
With this loss, breathing muscles could be affected
and weakened, leading possibly to respiratory
failure.

Imaging can often provide information about the
Review chest x-rays. etiology of the impaired gas exchange and monitor
a trend of the disease process.

Hemoglobin carries oxygen within the blood. If
Check Hemoglobin (Hbg) levels. Hbg levels are low, there is a decreased capacity to
carry oxygen to the tissues.

An increased white count can be an indication of
Monitor WBCs.
infectious disease.

Medications such as sedatives, pain medications,
and other drugs might affect the brain’s
Monitor the effects of medications.
ventilatory response. This could lead to carbon
dioxide retention impeding adequate oxygenation.


Interventions


Supplemental oxygen improves gas exchange and
oxygen saturation. The patient may need a nasal
Administer oxygen as ordered to cannula or other devices such as a venturi mask or
maintain oxygen saturation above 90%.
opti-flow to maintain an oxygen saturation above
90%.





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Nursing Interventions Rationale

Assist the patient in an upright (30 to A proper body alignment allows for adequate lung
45 degrees) position as their condition expansion and movement of respiratory muscles
allows. to support the lungs.


Patients might tire quickly because of increased
work of breathing. Frequent adjustment helps
maintain a correct body alignment for easier
Adjust the position frequently.
ventilation and gas exchange. The nurse may use
pillows and other devices to keep the patient
comfortable and positioned correctly.


Cough and deep breathing exercises
Use of incentive spirometry
Use of a flutter valve to loosen secretions.
Encourage frequent pulmonary toiletry.
Using these devices helps with ventilation and
prevents atelectasis. The flutter valve helps break
up mucus and secretions.


Small meals require less energy to consume, and
Provide small frequent meals and add supplements might help patients who do not meet
supplements.
their required daily calorie intake.


Encourage the patient to ambulate as Ambulation helps with lung expansion and
tolerated. promotes deep breathing.


Calming words can help reduce anxiety and
Provide reassurance if the patient is decrease the work of breathing. This can decrease
anxious.
oxygen demand and improve gas exchange.


Provide rest periods between ADLs and Frequent rest periods may be helpful to prevent
pace activities. increased oxygen demand.


Proning and percussion help loosen secretions
Consider a rotoprone bed or mattresses and remove them from the respiratory system
with a percussion function. allowing for more surface area on the alveoli.
More surface area allows for better gas exchange.

Medications depend on the etiology of the disease
process. Antibiotics may be used for infections,
Administer medications as ordered. diuretics for fluid accumulation. The treatment
plan is very dependent on the condition that is
being treated.


For the Critical Care Patient






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Nursing Interventions Rationale

Anticipate the need for intubation if Mechanical ventilation is often needed to achieve
noninvasive oxygen delivery methods adequate gas exchange.
fail to maintain adequate ventilation.


Frequent positioning helps prevent the pooling of
Turn and reposition the patient every 2
hours. secretions in the lungs and prevents alveoli from
collapsing.


Intubated patients have a decreased ability to
Keep the head of the bed elevated at manage their secretions. Keeping the head
least 30 degrees at all times. elevated helps move secretions and prevents
compromising the airway.

Clearing the airway from secretions helps improve
Suction the airway as needed.
ventilation and, therefore, gas exchange.


Patient Teaching and Continuity of Care

Prioritization and spacing activities help conserve
Educate about energy conserving
techniques. The primary care physician energy. Another essential part of saving energy is
making use of resources. Encourage the patient to
may consult occupational therapy to have family and caregivers help with more
adjust to new situations.
demanding activities.

Exercises such as pursed-lip breathing and using
Teach about coughing and deep the tripod position aid in clearing secretions and
breathing methods. increasing lung expansion, helping facilitate gas
exchange.

Explain to the patient and family about Knowledge about the use, troubleshooting,
the type of oxygen therapy used at precautions, and storage of the oxygen delivery
home. system promotes safety.


Early recognition and intervention can make a big
Explain to the family and caregiver difference in the patient’s outcome. Taking action
early signs of decreased oxygenation may reduce the number of hospital visits and
and interventions to take.
emergencies.


Educate about smoking cessation and
provide resources such as outpatient
facilities that can help. The primary Smoking causes damage to the lungs and impairs
health care provider can prescribe adequate gas exchange.
medications that reduce withdrawal
symptoms.

Teach about the correct use of Safe and correct use of medications ensures the
medications. best possible patient outcome. It is most beneficial



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Nursing Interventions Rationale

• Indication for the patient if the drug is used as intended and
• Dosage ordered.
• Frequency
• Route
• Possible side effects
• Use of metered-dose inhaler








































































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