Atelectasis

Introduction

Atelectasis is defined as the collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung

Atelectasis is the collapse of alveoli or lung tissue.

It develops when the alveoli becomes airless from absorption of their air without replacement of the air with breathing.

Contd…

Atelectasis may be acute or chronic

The most commonly described atelectasis is acute atelectasis, which occurs frequently in the postoperative setting or in people who are immobilized and have a shallow, monotonous breathing pattern.

Etiology

Obstruction of an airway Diminished distention of alveoli

Contd

Airway foreign bodyExtrinsic compression on an airway (eg,

compression due to an enlarged or aberrant vessel)

Enlarged lymph nodes that compress the airway

Masses in the chest that compress the airway or alveoli

Cardiomegaly or enlarged pulmonary vessels that compress adjacent airways

Etiology of atelectasis

Altered breathing patterns Retained secretions Pain, alterations in small airway function Anesthesia or sedationIncreased abdominal pressure Reduced lung volumes due to musculoskeletal

(Severe scoliosis) or neurologic disordersPain from upper abdominal surgery

Contd…Restrictive defects, and specific surgical procedures

(eg, upper abdominal, thoracic, or open heart surgery).

Persistent low lung volumesSecretions or a mass obstructing or impeding airflow

and compression of lung tissueBronchospasm, airway secretions and

airway inflammation in patients with asthma

Abnormal airway secretions in cystic fibrosis

Contd….

Abnormal airway clearance, such as with ciliary dyskinesia syndrome

Airway foreign bodyExcessive pressure on the lung tissue

(pleural effusion, pneumothorax, hemothorax)

Tumor growth within the thorax, or an elevated diaphragm

Pathophysiology

Reduced alveolar ventilation or any type of blockage

Impedes the passage of air

The trapped alveolar air becomes absorbed into the bloodstream, but outside air cannot replace the absorbed air because of the blockage

Isolated portion of the lung becomes airless and the alveoli collapse.

Excessive pressure on the lung tissue

Restricts normal lung expansion on inspiration

Becomes airless for prolong period

Alveolar colapse

Clinical Manifestations

Cough, sputum production, and low-grade fever.

Marked respiratory distressDyspnea, tachycardia,Tachypnea, pleural pain, and central

cyanosisDifficulty breathing in the supine position Anxious

Assessment and Diagnostic Findings

Chest x-ray : patchy infiltrates or consolidated areas.

Pulse oximetry: (SpO2) (less than 90%) or a (PaO2).

Physical examination: Decreased breath sounds and crackles are heard over the affected area.

Prevention

Frequent turning, early mobilization, Strategies to expand the lungs and to manage

secretions. Deep-breathing maneuvers (at least every 2 hours)The use of incentive spirometry or voluntary deep breathingDirected cough, suctioning, aerosol nebulizer

treatments followed by chest physical therapyPostural Drainage and chest percussion, or

bronchoscopy

Contd..

Change patient’s position frequently, especially from supine to upright position, to promote ventilation and prevent secretions from accumulating.

Encourage early mobilization from bed to chair followed by early ambulation.

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

Contd…

Administer prescribed Opioids and sedatives judiciously to prevent respiratory depression.

Perform postural drainage and chest percussion, if indicated.

Institute suctioning to remove tracheobronchial secretions, if indicated.

Management

The goal in treating the patient with atelectasis is to improve ventilation and remove secretions

In patients who do not respond to first-line measures or who cannot perform deep-breathing exercises, other treatments such as positive expiratory pressure (PEP therapy )

If the cause of atelectasis is bronchial obstruction from secretions, the secretions must be removed by coughing or suctioning to permit air to re-enter that portion of the lung

Chest physical therapy (chest percussion and postural drainage)

Nebulizer treatments with a bronchodilatorMedication or sodium bicarbonate may be used

to assist the patient in the expectoration of secretions.

If respiratory care measures fail to remove the obstruction, a bronchoscopy is performed.

Endotracheal intubation and mechanical ventilation may be necessary for respiratory failure

Contd…

Thoracentesis, removal of the fluid by needle aspiration, or insertion of a chest tube if cause is compression

Bronchoscopy

Nursing diagnosis

Ineffective breathing pattern related to collapse of lung tissue

Activity intolerance

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