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This order may be present at birth (primary atelectasis), ot it may develop in the neonatal period or in later life (acquired or secondary atelectasis). The term atelectasis is derived from the Greek words ateles and ektasis, meaning incomplete expansion. The disorders of the pleura include pain, pneumothorax, and pleural effusion. Pain is commonly associated with condition that produce inflammation of the pleura. Characteristically, it is unilateral, abrupt in onset, and exaggerated by respirstory movements. Pneumothorax refers to an accumulation of air in the pleural cavity with the partial or complete collapseof the lung. It can result from rupture of an air-filled bleb on the lung surface or from the penetrating or non-penetrating injuries. A tension pneumothorax is a life threatening event in which air progressively accumulates within the thorax. Causing not only the collapse of the lung on the injured side but also a progressive shift of the mediastinum to the opposite side of the thorax, producing severe cardiorespiratory impairment. Pleural effusion refers to the collection of fluid in the pleural cavity. The fluid may be transudate (hydrothorax), exudates (empyema), blood (hemothorax), or chyle (chylothorax). Primary atelectasis of the newborn implies that the lung has never been inflated. It is seen most frequently in premature and high-risk infants. A secondary form of atelectasis can occur in infants who established respiration and subsequently developed impairment of the lung expansion. Among the causes of secondary atelectasis in the newborn are the respiratory distress syndrome associated with lack of surfactant and airway obstruction due to aspiration of amniotic fluid or blood. It result in a patchy form of atalectasis. Acquired atelectasis occurs mainly in adult. It is most commonly caused by airway obstruction and lung compression. Obstruction caused by a mucous plug within the airway or by external compression due to fluid, tumor mass, exudates, or other matter in the area surrounding the airway. A small segment of lung or an entire lung lobe may be involved in obstructive atelectasis. Complete obstruction of an airway is followed by the absorption of air from the dependent alveoli and collapse of that portion of the lungs. Breathing high concentrations of oxygen, such as while on a ventilator, increases the rate at which gases are absorbed from the alveoli and predisposes to atelectasis. Both chest compression and breath sound are decreased on the affected side. There may be intercostal retraction over the involved area during inspiration. If the collapsed area is large, the mediastrium and trachea shift to the affected side. Sign of respiratory distress proportional to the extent of lung collapse. The danger of obstructive atelactasis increases after surgery. Anesthesia, pain, administration of narcotics, and immobility tend to promote retention of viscid bronchial secretions and hence airway obstruction.
PATHOPHYSIOLOGY ACUTE OBSTRUCTION ALVEOLI ABSORBS ALVEOLAR GAS HYPOXEMIA EXTENSIVE ALVEOLAR HYPOVENTILATION HYPOXIA PNEUMONIA PULMONARY EDEMA LUNG COLLAPSE Following acute obstruction to bronchus. Tissue hypoxia results in entry (transudation) of fluid in to the alveoli leading to pulmonary edema. causing airlessness. The impaired breathing resulting from alveolar collapse also leads to hypoxia and pneumonia. . Mobilization of secretions may be inhibited by inflammatory lung disease leading to edema.II. the capillary surrounding the alveoli absorbs the alveolar gas. hypoxemia occurs. which may prevent complete collapse of the atelectatic lung. The reduced alveolar distention results in decreased surfactant production which propagates the atelectasis further. with a need for tracheal intubation. lung retraction and collapse. Despite blood perfusion. Extensive alveolar hypoventilation may result in an effective right to left shunt of blood in the heart which also leads to hypoxia. because there is no air in the lung to transfer the oxygen.
Compensatory hyperinflation as evidenced by increased radiolucency can be seen in the normal lobe or unaffected lung. lung-pleura pressure and alveolar size. Posterior-anterior and lateral chest x-rays are usually requested for. tachycardia. and intercostal retractions. sign of hypoxemia. . DIAGNOSIS Diagnosis is based on clinical and x-ray findings. diminished chest expansion. cause inadequate regional ventilation and atelectasis. Bronchoscopy and CT scan of thorax may be more valuable in identifying the affected site and cause. airless dense opacification of the affected lobe (as seen in x-ray). Frequency The incidence and prevalence of atelectasis is not well known. blood.In non-obstructive case. and compensatory increased distention of unaffected lung). deviated trachea and mediastinum. There is diminution of lung size (rib retraction and crowding. It occurs when the pleural cavity is partially or completely filled with fluid. elevated diaphragm. Complication y y Pneumonia Scarring of lung tissue: pulmonary fibrosis Manifestation The clinical manifestation of atelectasis includes tachypnea. Causes It can be caused by airway obstruction. However postoperative atelectasis and lobar atelectasis are the common types. increased recoil of the lung due to loss of pulmonary surfactant or the lung compression such as occurs in pneumothorax or pleural effusion. Fever and other sign of infection that may develop. In such cases the lung tends to recoil due to elastic property and becomes atelectatic. exudates. There is loss of negative pressure in the pleural space in case of pleural effusion or pneumothorax. a tumor mass or air. Radiographic appearance may vary from complete collapse to relatively normal-appearing lungs. There is no specific racial or sex predilection. cyanosis. In practice the involvement is more extensive than is suggested by the x-ray. dyspnea. III. absence of breath sounds. changes in alveolar surface tension.
Ambulation and body positions that favor increased lung expansion are used when appropriate. 4th edition.Prevention Adequate management of chronic bronchitis through antibiotics. bronchodilators to improve ventilation. Carol Mattson Porth. prohibition of smoking. It is usually good in case of post-operative atelectasis and poor in case of advanced cancer. MANAGEMENT/ TREATMENT The treatment depends on the cause and extent of lung involvement. specific antituberculous. Bronchodilators (beta adrenergic agonists like salbutamol. antifungal drugs may be needed depending upon the etiology. REFERENCE y Pathopysiology concepts of altered health status . . in appropriate situations. It is directed at reducing the airway obstruction or lung compression and at reinflating the collapsed area of the lung. Lippincott Company. respiratory physiotherapy. Bronchoscopy may be used as both a diagnostic and treatment method. age of the patient. deep breathing exercises. intermittent positive pressure breathing (IPPB). underlying complications and the management. Drugs Apart from antibiotics. Mucolytics like acetyl cysteine to liquify sputum may be more useful especially if directly applied via a bronchoscope. c 1994. judicious use of central nervous system depressant drugs. Administration of oxygen may be needed to treat the hypoxemia. encouragement of cough and early movement would prevent development of atelectasis. Prognosis Prognosis depends upon the cause. Philadelphia USA. bronchial toiletry to liquify thick sputum. suction to remove secretions.B. IV. J. anticholinergics like ipratropium) may be necessary improve ventilation.
Republic of the Philippines UNIVERSITY OF NORTHERN PHILIPPINES Tamag. RN Instructor Presented by: Mark Kevin Reboldela III-A-Paramedics . Vigan City COLLEGE OF HEALTH SCIENCES In partial Fulfilment of the Requirements in the course: Pathophysiology ATELECTASIS Presented to: Mark Velasco.
October 11. 2010 .
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