▲Use a towel to fix the chest tube wound and get out of bed early to promote lung expansion. (Photo courtesy of Hong Chae-e)
Text / Hong Cai-e
56-year-old Ms. Li has a history of diabetes for 20 years. She took oral hypoglycemic drugs to control it. She complained of dyspnea, fever, and chest pain for 3 days. She was sent to the emergency department by her family. Chest X-ray showed infiltration of the left lower lobe. The pleural effusion was empyema, and the diagnosis of pneumonia and empyema was hospitalized. After antibiotics, the patient continued to have fever and increased infiltration on the left side of chest X-ray. Thoracic surgery performed endoscopic cortical stripping and placement of chest tube drainage for treatment.
Empyema is defined as an inflammatory infection in the pleural cavity. Most cases are caused by pneumonia infection, but a few patients are also caused by infection of other adjacent tissues (such as liver abscess) or infection caused by trauma.
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Risk factors for empyema include a history of choking, HIV infection, nutritional disorders, cancer, diabetes, cerebrovascular disease, chronic kidney disease, pulmonary obstruction, asthma, and chronic liver disease.
Appropriate antibiotic therapy for draining abscesses
The principles of treatment of empyema are drainage of the abscess, appropriate antibiotic therapy, and adequate nutrition. Good pain control can increase patient comfort, promote deep breathing and coughing, strengthen willingness to move, and reduce comorbidities.
◎Health and education matters following thoracic surgery:
● Give the chest tube a fixed support, do not pull it with force, and maintain a good drainage position.
● Encourage early getting out of bed, deep breathing, and effective coughing to promote lung expansion.
●Teach the patient to cooperate with breathing and use a towel to fix the wound of the chest tube, so as to avoid involvement and reduce pain.
●Pay attention to the height of the chest tube drainage bottle, and the drainage bottle holder is lower than the wound as the principle to prevent the liquid in the bottle from flowing back into the pleural cavity.
●When getting out of bed, please pay attention to whether the chest tube drainage is unobstructed, and do not twist the tube, block it under pressure, or pull it off.
●If the pain cannot be relieved, please tell the medical staff, so as not to limit the movement and hinder the expansion of the lungs due to the pain.
● After returning home, maintain breathing exercise and effective coughing to avoid accumulation of sputum.
●Avoid going in and out of public places or approaching people with upper respiratory tract infection.
● maintain a good nutritional status, a balanced diet.
●Have adequate rest and activities every day.
Empyema is a thoracic disease that cannot be underestimated. Early diagnosis and early treatment are the principles for dealing with empyema. If you have symptoms of difficulty breathing, cough, persistent fever and chest pain, you must seek medical attention in time to avoid delaying treatment.
(The author is a respiratory therapist at Hanming Christian Hospital)
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