Minggu, 26 Agustus 2012


Good evening friends, At night cold, I will share about nursing care in patients with lung abscess
Please liaht below and do not forget his comments as the assessment

http://www.artikelkeperawatan.info/wp-content/uploads/2011/07/Abses-Paru.jpgLung abscess is a cavity in the lung tissue containing purulent material containing necrotic inflammatory cells due process by the infected lung parenchyma.
When the cavity diameter <2 cm and polynomial (multiple small abscesses) called "necrotising pneumonia". Large or small abscesses abscesses have different clinical manifestations, but have the same predisposition and differential diagnosis principle equally. Abscesses caused by aspiration of infected objects, decreasing the body's defense mechanisms or virulence of bacteria is high. In general cases of lung abscess associated with dental caries, uncontrolled epilepsy, previous lung damage and alcohol abuse. In developed countries except for patients with a rare disorder of the immune response such as drug abuse, systemic disease or complications of post-obstruction. In some studies found that aerobic bacteria colonies of anaerobic maupupn oropharing a frequent cause of lung abscess. (1, 2, 3, 6)Studies in patients with lung abscess nosokonial found aerobic bacteria such as Enterobacteriaceae group the most. While research by percutaneous biopsy or aspiration technique transtrakeal found most are anaerobic. (4, 6, 7)
In general, clinicians use a combination of antibiotics such as penicillin therapy, metronidazole and aminoglycoside group on lung abscess. Although still effective, combination therapy is still giving some problems as follows: (4)1. Treatment time in the hospital a long time2. Potential high drug toxicity reactions3. Encourage the occurrence of antibiotic resistance.4. The existence of super Nosokonial bacterial infection resulting in pneumonia.
Ideal therapy should be based on the discovery of germs cause a culture and sensitivity. This paper will discuss lung abscess began pathogenesis, therapy and prognosis as a refresher existing theories.I. EPIDEMIOLOGY1. Predisposing FactorsThere bebreapa condition that causes or encourages lung abscess. Janet et al in 1995 conducted a study on the intensive care hospital in South Africa, found some predisposing factors such as lung abscess following: (1, 2, 3, 4, 7)2. EtiologyGerms or bacteria cause lung abscess varies according to the researchers and research techniques used. Finegolal and fisliman get that organisms causing lung abscess more than 89% are anaerobic. Asher and Beandry found that in children the germs that cause most lung abscesses is stapillococous aureus (1).II. Pathofisiologi1. PathologyLung abscess occurs when the pulmonary parenchyma obstruction, infection, and then the process of suppuration and necrosis.Change starts from the first inflammation and thrombosis suppurasi local blood vessels, leading to necrosis and likuifikasi. Formation of granulation tissue around the abscess occurred, localizing the abscess with fibrotic tissue. At one point the abscess broke and necrotic tissue out with a cough, sometimes occur in other parts of the bronchial aspiration abscesses new. Usually foul smelling sputum, when the abscess ruptured into the pleural cavity occurred empyema (2, 3, 10).2. PathofisiologiGarry in 1993 suggests the occurrence of lung abscess is mentioned as follows: (5)a. Is an advanced process of inhalation pneumonia bacteria in patients with predisposing factors. Bacteria held multiplication and parenchymal lung damage with necrosis process. When dealing with the bronchus, air fluid level is formed bacteria into the lung parenchyma than inhalation can also haematogenous spread (septic emboli) or by direct extension of the abscess elsewhere (nesisitatum) eg liver abscess.b. Cavity infections. In some patients with tuberculosis with cavitation, caused by inhalation of the bacteria undergo a process of suppuration Inflammation. In patients with pulmonary emphysema or lung polikisrik secondary infections.c. Bronchial obstruction can cause pneumonia, lung abscess berlajut up process.This often occurs due to obstruction bronkogenik cancer. The same symptoms are also seen in foreign body aspiration that has not come out. Sometimes it is also found on the obstruction due to enlarged lymph limphe peribronkial.d. Cavity formation in lung cancer.The growth of the cancer mass rapid bronkogenik not offset increased supply of blood vessels, resulting in likuifikasi central necrosis. If an infection can form an abscess.III. Clinical manifestations.1. Clinical symptoms: (1, 2, 3, 4, 5, 6)Clinical symptoms for lung abscess is almost the same as the symptoms of pneumonia in general, namely:a. Heat lossFound about 70% - 80% of patients with lung abscess. Sometimes encountered with temperatures> 400C.b. Cough, non-productive in the early stages. When is there an abscess cavity with a bronchial cough is enhanced with a distinctive rotten odor (ex Foetor oroe (40-75%).c. Increased sputum production and ex Foetor oero encountered ranged 40-75% of patients with lung abscess.d. 50% of cases)  chest pain (e. 25% of cases)  Coughing up blood (f. Additional symptoms such as fatigue, loss of appetite and weight.On examination found signs of consolidation processes such as dim, increased breath sounds, often found a finger clubbing and tachycardia.2. Radiological picture (1, 2, 9)In the photo there is a piston cavity with thick walls with signs of consolidation around it. This cavity can be multiple or single 2-20 cm.  with sizeThe picture is often found in the right lung over the left lung. If there is contact with the bronchial fluid in the cavity contained water level. But if there is no connection then only found signs of consolidation (opacity).3. Laboratory tests (2, 3, 5)a. In routine blood tests. Specified leukocytosis, an increase of more than 12.000/mm3 (90% of cases) had even reported increases of up to 32.700/mm3. Found increased erythrocyte sedimentation rate> 58 mm / 1 hour.On the count of white blood cell types obtained shit shift to the leftb. Examination of the sputum gram staining and acid resistant KOH an initial examination to determine the appropriate antibiotic selection.c. Examination of bacterial culture and sensitivity test antibiotikan is the best way clinical and etiological diagnosis.IV. DiagnosisDiagnosis of lung abscess can not be enforced only by a collection of symptoms such as pneumonia and physical examination alone.Diagnosis should be established based on: (1, 2, 3, 4, 5, 6)1. History of previous illness.Typical patient complaints such as malaise, weight loss, mild heat loss, and a productive cough.A history of impairment of consciousness associated with sedation, trauma or epileptic seizures. History of drug abuse that may aspired unconscious when stomach acid or the presence of bacteria diparu embolism due to drug injections.2. The results of a physical examination that supports the data on the basis of disease which promotes lung abscess.3. Laboratory examination of sputum gram, blood cultures can lead to infectious organisms.4. Radiological picture shows cavity with surrounding consolidation process, the presence of water fluid level changes position according to gravity.5. BronchoscopyBronchoscopy is a diagnostic function as well in addition to doing therapy when drainage was not associated with bronchial cavities.Diagnosis of Appeals (2):1. Karsimoma bronkogenik experiencing cavitation, cavity walls are usually thick and uneven. Definitive diagnosis by cytology / pathology.2. Pulmonary tuberculosis or fungal infections3. Clinical symptoms about the same or more than the chronic lung abscess. In tuberculosis obtained smear and fungal infections found mushroom.4. Bula infected, it appears water fluid level. Around bula no or only a slight consolidation.5. Infected lung cysts. The walls are thin and there is no reaction in the vicinity.6. Pulmonary hematoma. There is a history of trauma. Just a little cough.7. Pneumoconiosis are experiencing cavitation. Work in this area is clear of people and got dusty in patients with simple pneumoconiosis.8. Hiatus hernia. No pulmonary symptoms. Restrosternal pain and heart burn to gain weight at the time of bending. Definitive diagnosis with barium photos.9. Sekuester lung. Location in the basal left behind. Definitive diagnosis with bronkografi or retrograde arteriography.V. MANAGEMENTTreatment of lung abscess should berdasarkkan microbiological examination data and basic diseases and conditions that affect patient severity of lung infections. There are several modalities of therapy given to lung abscess: (2, 4, 5, 9, 10)1. Medika MentosaIn the pre-antibiotic era the mortality rate reached 33% in the antibiotic era levels and prognosis of lung abscess kkematian better.The first option is a class of antibiotics as penicillin was found increased lung abscess caused by the bacteria anaerobs (more than 35% of gram-negative anaerobic bacteria). So can dipikrkan to choose a combination of penicillin G antibiotic between the categories with Metronidazole or clindamycin, or a combination of clindamycin and Cefoxitin.Another alternative is a combination of imipenem with B lactamase inhibitase, in patients with nosocomial pneumonia which developed into a lung abscess.Time of antibiotics depends on the clinical symptoms and radiological response of the patient. Patients are given free treatment 2-3 weeks after resolution of symptoms or the presence of cavities, so given antibiotics at least 2-3 weeks.2. DrainagePostural drainage and chest Fisiotherapi 2-5 times a week for 15 minutes is needed to accelerate the process of resolution of lung abscess.In patients with pulmonary abscess associated with bronchial drainage is necessary to be considered through the bronchoscope.3. SurgeryResection of necrotic lung segment is required when:a. Low response to antibiotic therapy.b. A large abscess that disrupts the process of ventilation perfusionc. Recurrent pulmonary infectionsd. Drainage disruption due to obstruction.VI. COMPLICATIONS AND PROGNOSIS1. Some of the complications that arise are: (4, 5)a. Empyemab. Brain abscessc. Atelectasisd. Sepsis2. PrognosisLung abscess still marupakan causes significant morbidity and mortality. The mortality rate of lung abscess between 15-20% represents a decline when compared to the pre antibiotic era ranged from 30-40% (7).In patients with predisposing factors have a worse prognosis compared to patients with a predisposition fakktor. Perlman et al found that 2% mortality rate in patients with a predisposing factor compared to 75% in patients with multi predisposition. Muri et al reported a 2.4% mortality rate due to lung abscess CAP compared to 66% of lung abscess due to HAP. Some factors that increase the mortality rate of lung abscess following: (7)a. Anemia and Hipo Albuminemiab.  large abscess (> 5-6 cm)c. Lesions obstructiond. Aerobic bacteriae. Immune Compromisedf. Old ageg. Disorders of intelligenceh. The treatment is delayedVII. SUMMARYLung abscess is a cavity in the lung tissue containing purulent material and necrotic inflammatory cells due to the lung parenchyma by the infection process. Lung abscess caused by predisposing factors such as impaired immune function due to drugs, impaired consciousness (anesthesia, epilepsy), as well as oral higine less obstruction and foreign body aspiration.In lung abscess providing clinical symptoms of fever, cough, purulent sputum, and smelling, accompanied by malaise, naspu eating and weight loss. On physical examination found tachycardia, signs of consolidation. On examination the plain chest cavity image obtained with water or fluid level only when the consolidation process is not associated with bronchial cavities.Definitive diagnosis is obtained when cultured germs that cause so to do etiological treatment.Giving antibiotics is the main option in addition to surgical treatment and supportive therapy physio therapy.REFERENCESAsher MI, Beadry PH; Lung Abscesses in infections of Respicatory tract; Canada; 1990: 429-34.Assegaff H. et al; Lung abscess in Basics Pulmonary Medicine; AUP; Surabaya; 136-41.Bartlett JG; Lung Abscesses in: Cecil text book of Medicine, 19th ed; Phildelphia; 1992, 413-15.Finegold SM, Fishman JA; empyema and Lung Abscesses; in Fishman's Pulmonary Diseases and disorders 3rd ed; Philadelphia; 1998; 2021-32.Garry et al; Lung abscess in a Lange Clinical Manual: Internal Medicina: Diagnosis and Therapy 3rd; Oklahoma, 1993; 119-120.JMJ Hammond et al; The Ethiology and Anti Microbial Susceptibility Patterns of Microorganism in acute commuity - Acquired Lung abscess; Chest; 108; 4; 1995; 937-41.Hirshberg B et al; Factors predicting mortality of Patients with lung Abscsess; Chest; 115; 3; 1999; 746-52.Johnson KM, Huseby JS; Lung Abscesses Caused by Legionella micdadei; Chest 111; 1; 1997; 109-13.Klein JS et al; Interventional Radiology of the Chest: Image Guided Percutaneons Drainage of pleural effusions, Lung abscess, and pneumothorax; AJR; 1995; 164; 581-88.Ricaurte KK et al; Allergic aspergillosis with multiple broucho pulumonary Streptococceus pneumonie Lung abscess: an unussual insitial case presentation; joutnal of allergy and clinical imonoligy; 104; 1 1999; 238-40.

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