26. Atelectasis Edited

7/29/2019 26. Atelectasis Edited

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ATELECTASISFAMADOR 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 microscopicIt 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 thoracicprocedures

Clients who are elderly, obese, or

bedridden or who have a history ofsmoking are also susceptible to

atelectasis


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ACUTE ATELECTASIS

Occurs frequently in the post-operative

setting or in people who are immobilizedand have a shallow, monotonous

breathing pattern.


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CHRONIC ATELECTASIS

Observed in patients with chronic

airway obstruction that impedes orblocks 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, pleuraltumor

Chest wall disorders: scoliosis, flail chest

Impaired diaphragmatic movement:

ascites, obesityCNS dysfunction: coma, neuromusculardisorders, oversedation


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B. Localized Airway Obstruction

Mucus plugging

Foreign body aspirationBronchiectasis

C. Increased Elastic RecoilInterstitial fibrosis: silicosis, radiationpneumonitis


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D. Insufficient Pulmonary Surfactant

Respiratory distress syndrome

Inhalation anesthesia

High concentrations of O2 (O2 toxicity)

Lung contusion

Aspiration of gastric contentsSmoke 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 airto 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 airbecause of the blockage.

Thus, the isolated portion of the lung

becomes airless and the alveolicollapse.


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Diagnostic EvaluationPhysical Examination

Can diagnose the disease process

Chest auscultation: bronchial or diminished

breath sounds and crackles over theinvolved 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

DyspneaTachypnea

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

atelectasisA decrease in tactile fremitus over theaffected lung area

A dull percussion note over the atelectatic

regionDecreased chest movement on theinvolved 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 andantipyretics


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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 mobilizationEncourage early mobilization from bed to

chair followed by early ambulation.


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Lung Volume Expansion Exercises

Deep Breathing Exercises (every 2hours)

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 respiratorydepression.


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SALAMAT POReferences:

1. Medical Surgical Nursing by Joyce Black

2. Medical Surgical Nursing by Brunner and Suddarth

3. NCLEX-RN Review Materials

26. Atelectasis Edited

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