A nurse is caring for a client diagnosed with empyema. Which nursing intervention should be the priority?

Priority Intervention for Empyema

Correct Answer: 1. Monitor respiratory status and oxygen saturation continuously

Empyema is the accumulation of purulent fluid within the pleural space, which directly compromises lung expansion and impairs gas exchange. The primary pathophysiological concern is respiratory compromise due to the space-occupying collection compressing the lung parenchyma. Therefore, the immediate nursing priority is to assess and ensure adequate oxygenation and ventilation, which aligns with the airway, breathing, and circulation (ABC) framework fundamental to NCLEX-RN prioritization.

Continuous monitoring of respiratory status and oxygen saturation allows the nurse to detect early signs of deterioration, such as increasing tachypnea, use of accessory muscles, or declining SpO₂. A chest tube (thoracostomy) is the definitive treatment to drain the infected fluid and restore negative intrapleural pressure, as described by Merkle et al. ^[1]. The chest tube system, which includes a water seal chamber, works to re-expand the lung by removing fluid and air. The effectiveness of this intervention is directly evaluated through ongoing respiratory assessment; a sudden change in respiratory status could indicate a life-threatening complication such as a tension pneumothorax or a dislodged or occluded chest tube ^[1]. While systemic infection and inflammation are present in empyema, the immediate threat to life is hypoxemia from the mechanical compression of the lung, not the infection itself.

The other options represent important but secondary aspects of care. Administering pain medication (Option 2) is crucial for comfort and to facilitate deep breathing, but pain is not an immediately life-threatening condition. Encouraging deep breathing exercises (Option 3) aids in lung re-expansion and secretion clearance, yet this intervention is ineffective and potentially harmful if the patient is in acute respiratory distress. Maintaining strict intake and output (Option 4) is a standard component of monitoring fluid balance, especially in the context of infection, but it does not address the critical, immediate risk of respiratory failure. The prognostic value of inflammatory markers like C-reactive protein (CRP) in empyema has been studied for mortality risk, but this reflects a longer-term assessment of treatment response rather than the moment-to-moment monitoring required for a patient with an active pleural space infection .