ATELECTASIS
Lung Atelectasis refers to closure or collapse of alveoli and often is described in relation to chest x-ray
findings and/or clinical signs and symptoms
It is one of the most commonly encountered abnormalities seen on a chest x-ray
OCCURS MOST OFTEN IN:
• postoperative setting
• people who are immobilized
• have a shallow, monotonous breathing pattern
MICROATELECTASIS
• Microscopic collapse of alveoli that does not involve the airways
• May not appear on radiographic examination.
MACROATELECTASIS
• Loss of segmental, lobar, or overall lung volume.
• Lobar or dependent atelectasis sufficiently large to be radiologically apparent
OBSTRUCTIVE ATELECTASIS: CAUSES
• inhalation of a foreign object, such as a small toy or small pieces of food, in an airway
• mucus plug (buildup of mucus) in an airway
• tumor growing within an airway
• tumor in the lung tissue that presses on the airway
NON OBSTRUCTIVE ATELECTASIS: CAUSES
• Surgery
• Pleural Effusion
• Pneumothorax
• Lung scarring
• Chest Tumor
• Surfactant Deficiency
ATELECTASIS: Risk Factors
Smoking
COPD
Obesity
Conditions that damage your nerves and muscles, such as a spinal cord injury or muscular
dystrophy
An illness or injury that makes it harder to breathe or swallow
Medications that affect your breathing
Conditions that damage your nerves and muscles, such as a spinal cord injury or muscular
dystrophy
An illness or injury that makes it harder to breathe or swallow (EXAMPLE: MYASTHENIA GRAVIS)
Medications that affect your breathing (EXAMPLE: OPIODS)
Atelectasis: ASSESSMENT AND DIAGNOSTIC FINDINGS
Increased work of breathing and hypoxemia
Decreased breath sounds and crackles are heard over the affected area.
A chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear.
ATELECTASIS: PATHOPHYSIOLOGY
REDUCED
VENTILATION OR
BLOCKAGE
OBSTRUCTION OF
PASSAGE OF AIR FROM
AND TO ALVEOLI
TRAPPED ALVEOLAR
AIR ABSORBED INTO
BLOODSTREAM
AFFECTED PORTION OF
ALVEOLI BECOMES
AIRLESS
ALVEOLI COLLAPSES
(ATELECTASIS)
ATELECTASIS: CLINICAL MANIFESTATIONS
DYSPNEA
COUGH
SPUTUM PRODUCTION
RESPIRATORY DISTRESS in LOBAR ATELECTASIS
• Tachycardia
• Tachypnea
• Pleural pain
• Central cyanosis
• Dyspnea in the supine position
• Anxious
Atelectasis: ASSESSMENT AND DIAGNOSTIC FINDINGS
Depending on the degree of hypoxemia, pulse oximetry (SpO2) may demonstrate a low
saturation of hemoglobin with oxygen (less than 90%) or a lower-than normal partial pressure
of arterial oxygen (PaO2).
COMPUTED TOMOGRAPHY SCAN (CT SCAN)
Ordered to check for infections or blockages, such as a tumor in the lung or airway
CT SCAN: NURSING INTERVENTIOS:
1. Inform patients to remain supine and still for a short period, typically less than 30
minutes, while a body scanner surrounds them and takes multiple images.
2. Patients typically do not experience claustrophobia during CT scanning but can be
given antianxiety medications pre-procedure if this is a concern.
3. If contrast dye is required, patients will need to stay nil per os (NPO) for 4 hours prior
to the examination. In this case, the nurse should also assess for allergies to iodine or
shellfish
Bronchoscopy - an excellent measure to acutely REMOVE SECRETIONS AND INCREASE
VENTILATION
- The doctor uses a device called a BRONCHOSCOPE to look inside the lungs and find the
problem.
- A bronchoscope is a thin tube with a light and a camera that goes down the throat and
into the airways.
- NURSING INTERVENTION: Bronchoscopy
- Assist the patient with maintaining the patency of the airways after
bronchoscopy using the traditional techniques of deep breathing, coughing,
and suctioning.
Atelectasis: Medical Management
Positive End Expiratory Pressure (PEEP)
Chest Physiotherapy
postural drainage
chest percussion
NEBULIZER TREATMENTS: BRONCHODILATOR OR SODIUM BICARBONATE
COUGHING AND SUCTIONING
Endotracheal intubation and Mechanical Ventilation
Severe or massive atelectasis may lead to acute respiratory failure, especially in patients with
underlying lung disease.
Atelectasis: Surgical Management
1. THORACENTESIS
- If the cause of atelectasis is compression of lung tissue, the goal is to decrease the
compression.
- With a large pleural effusion that is compressing lung tissue and causing alveolar
collapse, treatment may include thoracentesis (removal of the fluid by needle
aspiration) or insertion of a chest tube.
2 CRYOTHERAPY/ LASER THERAPY
- Management of chronic atelectasis focuses on removing the cause of the obstruction of
the airways or the compression of the lung tissue.
- For example, bronchoscopy may be used to open an airway obstructed by lung cancer
or a nonmalignant lesion, and the procedure may involve cryotherapy or laser therapy.
Atelectasis: Nursing Management
a. Encourage early mobilization from bed to chair followed by early ambulation.
b. Encourage appropriate deep breathing and coughing to mobilize secretions and prevent them
from accumulating.
c. Institute suctioning to remove tracheobronchial secretions, if indicated.
d. Educate/reinforce appropriate technique for incentive spirometry
e. Perform postural drainage and chest percussion, if indicated.
Multidisciplinary, evidence-based standardized intervention programs, such as ICOUGHSM hold
promise in preventing atelectasis
ICOUGHSM Program
I – Incentive spirometry
C – Coughing and deep breathing
O – Oral care (brushing teeth and using mouthwash twice a day)
U – Understanding (patient and staff education)
G – Getting out of bed at least three times daily
H – Head-of-bed elevation
