Can be used to revise medical surgical nursing 1

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ATELECTASIS
GROUP 6

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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 < 101˚F (38.3˚C)
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 patient’s 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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References:
1. Medical Surgical Nursing by Joyce Black
2. Medical Surgical Nursing by Brunner and Suddarth
3. NCLEX-RN Review Materials