ATELECTASIS

FAMADOR O. GENALDO, RN, MD

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CHARACTERISTICS
It is the collapse of the lung tissue at any structural level: segmental, basilar, lobar, or microscopic It develops when there is interference with the natural forces that promote lung expansion

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Such interference may result from:

A reduction in lung distension forces, Inhalation of irritating anesthetics, Localized airway obstruction, Insufficiency of pulmonary surfactant , or Increased elastic recoil

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Atelectasis is particularly common after surgery, especially after upper abdominal surgery or thoracic procedures Clients who are elderly, obese, or bedridden or who have a history of smoking are also susceptible to atelectasis
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ACUTE ATELECTASIS Occurs frequently in the post-operative setting or in people who are immobilized and have a shallow, monotonous breathing pattern.

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CHRONIC ATELECTASIS Observed in patients with chronic airway obstruction that impedes or blocks air flow to an area of the lung.

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ETIOLOGY
A. Reduction in Lung Distention Forces
Pleural space encroachment: pneumothorax, pleural effusion, pleural tumor Chest wall disorders: scoliosis, flail chest Impaired diaphragmatic movement: ascites, obesity CNS dysfunction: coma, neuromuscular disorders, oversedation
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B. Localized Airway Obstruction

Mucus plugging Foreign body aspiration Bronchiectasis

C. Increased Elastic Recoil

Interstitial fibrosis: silicosis, radiation pneumonitis
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D. Insufficient Pulmonary Surfactant

Respiratory distress syndrome Inhalation anesthesia High concentrations of O2 (O2 toxicity) Lung contusion Aspiration of gastric contents Smoke inhalation
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Pathophysiology
Atelectasis may occur as a result of reduced alveolar ventilation or any type of blockage that impedes passage of air to and from the alveoli that normally receive air through the bronchi and network of airways.

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The trapped alveolar air becomes absorbed into the bloodstream, but outside air cannot replace absorbed air because of the blockage. Thus, the isolated portion of the lung becomes airless and the alveoli collapse.
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Diagnostic Evaluation
Physical Examination
Can diagnose the disease process Chest auscultation: bronchial or diminished breath sounds and crackles over the involved area

Chest x-ray
Initial diagnosis through chest radiograph

ABG determination
Hypoxemia

Bronchoscopy
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Clinical Manifestations
Some clients are asymptomatic Generally diagnosed by chest radiograph Fever: usually < 101F (38.3C)
Older adults typically do not exhibit fever

Productive cough

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Physical examination:
Bronchial or diminished breath sounds or crackles Dyspnea Tachypnea Tachycardia Cyanosis of skin and mucous membrane

None of the manifestations is specific for atelectasis

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In severe atelectasis:
A tracheal shift toward the side of the atelectasis A decrease in tactile fremitus over the affected lung area A dull percussion note over the atelectatic region Decreased chest movement on the involved side
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Medical Management
If atelectasis develops, treatment is directed toward the underlying cause O2 therapy for hypoxic client: 1-4 L/min per cannula Maintain airway patency Intermittent positive pressure breathing treatments

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Physiotherapy general pulmonary hygiene measures

Tracheal suctioning

Bronchoscopy done to remove obstruction Medications: analgesics and antipyretics

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Nursing Care Management

Nursing Diagnosis Ineffective Airway Clearance Ineffective breathing Pattern Impaired Gas Exchange

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Nursing Interventions Goal: to prevent atelectasis in the high risk client Frequent Change in Position.
Change patients position frequently, especially from supine to upright position, To promote ventilation and prevent secretions from accumulating.

Early mobilization
Encourage early mobilization from bed to chair followed by early ambulation.
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Lung Volume Expansion Exercises Deep Breathing Exercises (every 2 hours)

Encourage appropriate deep breathing and coughing
To mobilize secretions and prevent them from accumulating.

Teach/reinforce appropriate technique for spirometry.

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Secretion Management
Suctioning, aerosol nebulization, chest percussion, postural drainage

Administer Opioids and sedatives cautiously to prevent respiratory depression.

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SALAMAT PO
References: 1. Medical Surgical Nursing by Joyce Black 2. Medical Surgical Nursing by Brunner and Suddarth 3. NCLEX-RN Review Materials
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