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Atelectasis
- 1. Atelectasis By- Shristi Shrestha BY, Shristi Shrestha
- 2. Learning Objectives At the end of seminar participants will be able to: • Review the anatomy and function of alveoli • Define atelectasis • State the etiology & classification of atelectasis • Describe the pathophysiology of atelectasis • Name the clinical manifestations • State the diagnostic measures • Explain the medical and nursing management • State the complications & prognosis of atelectasis • Discuss the prevention of atelectasis
- 5. Definition • Atelectasis is derived from the Greek words “ateles” and “ektasis”, meaning incomplete expansion. • Refers to closure or collapse of alveoli.
- 6. Atelectasis • Atelectasis is also defined as diminished volume affecting all or part of a lung. • One of the most commonly encountered abnormalities. • It is usually unilateral
- 7. Risk Factors
- 8. Risk Factors
- 9. Risk Factors
- 11. Classification: Based on Etiology Obstructive atelectasis • Most common type • Due to a physical blockage of airflow • Obstruction can occur at the level of the larger or smaller bronchus Non obstructive atelectasis • When alveoli collapse due to factors acting via other mechanisms. • Least common
- 12. Obstructive/Resorptive Atelectasis • When airways are obstructed there is no further ventilation to the lungs and beyond. • In the early stages, blood flow continues and gradually the oxygen and nitrogen get absorbed, resulting in atelectasis.
- 15. Non Obstructive Causes • Occurs as a result of any thoracic space- occupying lesion compressing the lungCompressive • occurs when contact between the parietal and visceral pleura is disrupted. Passive/Relaxatio n • Occurs from surfactant deficiencyAdhesive • Alveoli gets trapped in scar and becomes atelectaticCicatrization
- 16. Compressive Atelectasis Causes: • Chest wall, pleural, or intraparenchymal masses
- 17. Relaxation/Passive Atelectasis Causes: • Pleural effusion • Pneumothorax • A large emphysematous bulla
- 18. Adhesive Atelectasis Causes: • Hyaline membrane disease • Acute respiratory distress syndrome • Smoke inhalation • Cardiac bypass surgery • Uremia
- 19. Cicatricial Atelectasis Causes: • Idiopathic pulmonary fibrosis • Chronic tuberculosis • Fungal infections • Radiation fibrosis
- 20. Classification: Based on Onset • Acute: post operative settings, the lung has recently collapsed and is primarily notable only for airlessness. • Chronic: in COPD patient (insidious and slower in onset) In chronic atelectasis, the affected area is often characterized by infection, bronchiectasis, destruction, and scarring (fibrosis).
- 21. Pathophysiology Reduced alveolar ventilation or any type of blockage impedes the passage of air to and from the alveoli trapped alveolar air is absorbed into bloodstream & outside air cannot replace the absorbed air the isolated portion of the lung becomes airless and the alveoli collapse.
- 22. Pathophysiology Following lung injury there is damaged type II alveolar cells Lack of production or inactivation of surfactant As there will be increased surface tension of the alveoli Decreased alveolar complaince & recoil Resulting in atelectasis
- 23. Clinical Manifestations • Development – insidious • Cough, sputum production, and low-grade fever • Dyspnea, tachycardia, tachypnea, pleural pain and central cyanosis • Difficulty breathing in the supine position and anxious.
- 24. Diagnostic Measures • Auscultation: Decreased breath sounds and crackles over the affected area. • Pulse oximetry (SpO2) - less than 90%
- 25. ABG Analysis • Provides information about respiratory and metabolic acid/base balance. • Adequacy of oxygenation pH =7.35-7.45 PCO2= 35-45mm of Hg PO2 =80-100 mm of Hg HCO3 =21-28 mEq/L SaO2 saturation >95%
- 26. Chest x-ray findings • Sharply-defined opacity obscuring vessels without air-bronchogram • Volume loss resulting in displacement of diaphragm, fissures, hili or mediastinum
- 32. • Treatment of the underlying cause BY, Shristi Shrestha
- 33. Bronchial Obstruction: due to secretions Nasotracheal & Oral Suctioning
- 37. Postoperative Atelectasis Management • Avoid narcotics as much as possible. • Ambulation(if hemodynamically stable) • Vigorous Chest physiotherapy
- 38. Management • Nebulized bronchodilators and humidity
- 40. Postural Drainage • Postural Drainage Postural drainage is the drainage by gravity of secretions from various lung segments
- 41. Lung infections: Management • Broad spectrum Antibiotics ▫ Inj. Ceftriaxone 2gm IV BD ▫ Inj. Durataz 4.5 gm IV TDS ▫ Inj Levofloxacin 750 mg IV stat then, 500 mg IV OD every alternate day • Anti-inflammatory ▫ Tab prednisolone 40 mg P/O OD
- 42. Supportive Management • Mucolytic agents and expectorants. ▫ Acetylcysteine, Carbocysteine, Bromhexine, Inhaled Bronchodilator
- 43. Flexible Fibreoptic Bronchoscopy • A procedure that allows a clinician to examine the breathing passages (airways) of the lungs • Can be diagnostic or therapeutic
- 45. Surgical Removal • If a tumor is blocking the airway, relieving the obstruction by surgery. • In certain cases, the affected part of the lung may be surgically removed when recurring or chronic infections become disabling or bleeding is significant.
- 47. Nursing Assessment • Ask for smoking history, exposure history, positive family history of respiratory disease, onset of dyspnea • Note amount, color, and consistency of sputum • Determine level of dyspnea, • Determine oxygen saturation at rest and with activity
- 48. Nursing Diagnosis 1. Ineffective Airway Clearance related to retained secretions and ineffective coughing 2. Ineffective Breathing Pattern related to chronic airflow limitation 3. Impaired gas exchange related to dysponea , mucous plug and decreased ventilation 4. Pain related to chronic cough 5. Activity intolerance related to fatigue and malaise 6. Insomnia related to orthopnea and required O2 therapy
- 49. Nursing Interventions • Maximizing Respiratory functions • Respiratory assessment • Suctioning • Artificial airway management • Positioning • Initiating Oxygen therapy • Teaching about the importance of adhering to drug therapy • Monitoring the side effects of drug
- 50. Nursing Interventions • Mobilization of pulmonary secretions • Hydration • Humidification • Nebulization • Coughing and deep breathing exercises • Chest physiotherapy • Postural drainage
- 51. Nursing Interventions • Maintenance and promotion of lung expansion • Ambulation • positioning • Incentive spirometry • Managing chest tubes • Health promotion and continuing care
- 52. Complications of Atelectasis • Acute pneumonia • Bronchiectasis • Hypoxemia and respiratory failure
- 53. Prognosis • Prognosis solely depends upon underlying cause ▫ For example, people with extensive cancer have a poor prognosis, while patients with simple atelectasis after surgery have a good prognosis.
- 54. Prevention of Atlectasis Perioperative Management • Identifying high-risk patients • Introducing intensive respiratory therapy of physiotherapy, • Bronchodilators • Cessation of smoking Postoperative Management • Early Ambulation • Chest physiotherapy with use of spirometer
- 55. Prevention of Atelectasis • Ventilation strategies ▫ Avoiding 100% FiO2 ▫ Adding PEEP at least 10cm of H2O ▫ CPAP ▫ High-frequency oscillation ventilation (HFOV) may be considered
- 56. ANY QUESTION??
- 57. Let’s Summarize
- 58. References • Kumar P, Clark M. Clinical Medicine.8th ed.Saunders Elsevier; 2012.p.812-820. • Mandal G. A Textbook of Medical Surgical Nursing. 5th ed. Makalu Publication house,Dillibazar,Kathmandu;2016. p.53-63. • Smeltzer C .S, Hinkle L. J, Bare G. B, Cheever H. K. Brunner and Suddarth's Textbook of Medical Surgical Nursing.12th ed, New Delhi: Wolters Kluwer (India) Pvt.Ltd; 2011.Vol. 2. p. 614-620. • Black JM, Hawks H. JK. Medical Surgical Nursing. 8th