ATELECTASIS

1. ATELECTASIS

2. INTRODUCTION
Atelectasis is a complete or partial collapse
of the entire lung or lobe of the lung. It
occurs when the alveoli within the lung
become deflated or possibly filled with
alveolar fluid.

4. INTRODUCTION
Atelectasis is one of the most common
respiratory complications after surgery. It's
also a possible complication of other
respiratory problems, including cystic
fibrosis, lung tumors, chest injuries, fluid in
the lung and respiratory weakness.

5. TYPES OF ATELECTASIS
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.

6. TYPES OF ATELECTASIS
 Relaxation Atelectasis:
The lung is held close to the chest wall because of
the negative pressure in the pleural space. Once the
negative pressure is lost the lung tends to recoil due
to elastic properties and becomes atelectatic. This
occurs in patients with pneumothorax and pleural
effusion. In this instance, the loss of negative
pressure in the pleura permits the lung to relax, due
to elastic recoil.

7. TYPES OF ATELECTASIS
Adhesive Atelectasis:
Surfactant reduces surface tension and
keeps the alveoli open. In conditions where
there is loss of surfactant, the alveoli
collapse and become atelectatic. In ARDS
this occurs diffusely to both lungs. In
pulmonary embolism due to loss of blood
flow and lack of CO2, the integrity of
surfactant gets impaired.

8. TYPES OF ATELECTASIS
Cicatricial Atelectasis:
Alveoli gets trapped in a scar and becomes
atelectatic in fibrotic disorders.
Round Atelectasis:
An instance where the lung gets trapped by
pleural disease and is devoid of air.
Classically encountered in asbestosis.

9. CATEGORIES
 Obstructive atelectasis: happens when a
blockage develops in one of your airways.
This prevents air from getting to your alveoli,
so they collapse.
 Non- obstructive atelectasis: refers to any
type of atelectasis that isn’t caused by some
kind of blockage in your airways.

10. CAUSES
 Obstructive atelectasis may be caused by:
 Mucus plug. A mucus plug is a buildup of mucus
in the airways. It commonly occurs during and
after surgery because one can't cough. Drugs
given during surgery make one to breathe less
deeply, so normal secretions collect in the airways.
Suctioning the lungs during surgery helps clear
them, but sometimes they still build up. Mucus
plugs are also common in children, people with
cystic fibrosis and during severe asthma attacks.

11. CAUSES
Foreign body. Atelectasis is common in
children who have inhaled an object, such
as a peanut or small toy part, into their
lungs.
Tumor inside the airway. An abnormal
growth can narrow the airway.

12. CAUSES
Possible causes of nonobstructive
atelectasis include:
Injury. Chest trauma — from a fall or
car accident, for example — can
cause one to avoid taking deep
breaths (due to the pain), which can
result in compression of your lungs.

13. CAUSES
Pleural effusion. This condition
involves the buildup of fluid between
the tissues (pleura) that line the lungs
and the inside of the chest wall.
Pneumonia. Various types of
pneumonia, a lung infection, can
cause atelectasis.
Pneumothorax. Air leaks into the
space between your lungs and chest
wall, indirectly causing some or all of a

14. CAUSES
Scarring of lung tissue. Scarring
could be caused by injury, lung
disease or surgery.
Tumor. A large tumor can press
against and deflate the lung, as
opposed to blocking the air passages.

15. RISK FACTORS
Older age
Any condition that makes it difficult to
swallow
Confinement to bed with infrequent
changes of position
Lung disease, such as asthma, COPD,
bronchiectasis or cystic fibrosis
Recent abdominal or chest surgery

16. RISK FACTORS
 Recent general anesthesia
 Weak breathing (respiratory) muscles due to
muscular dystrophy, spinal cord injury or another
neuromuscular condition
 Medications that may cause shallow breathing
 Pain or injury that may make it painful to cough or
cause shallow breathing, including stomach pain
or rib fracture
 Smoking

17. SYMPTOMS
trouble breathing
sharp chest pain, especially when
taking a deep breath or coughing
rapid breathing
increased heart rate
Cyanosis of the lips, fingernails, or
toenails

18. PATHOPHYSIOLOGY
 Atelectasis may occur as a result of reduced
ventilation or any blockage that obstructs
passage of air to and from the alveoli, thus
reducing alveolar ventilation. After the trapped
alveolar air is absorbed into the bloodstream, no
additional air can enter into the alveoli because of
the blockage.

19. PATHOPHYSIOLOGY
 As a result, the affected portion of the lung
becomes airless and the alveoli collapse. Possible
causes are altered breathing patterns, retained
secretions, pain, alterations in small airway
function, prolonged supine positioning, increased
abdominal pressure, reduced lung volumes due to
musculoskeletal or neurologic disorders,
restrictive defects, and specific surgical
procedures (eg, upper abdominal, thoracic, or
open heart surgery).

21. DIAGNOSIS
CT scan. Since a CT is a more sensitive
technique than an X-ray, it may sometimes
help better detect the cause and type of
atelectasis.
Oximetry. This simple test uses a small
device placed on one finger to measure
blood-oxygen level. It helps determine the
severity of atelectasis.

22. DIAGNOSIS
 Ultrasound of the thorax. This noninvasive test
can help tell the difference between atelectasis,
hardening and swelling of a lung due to fluid in
the air sacs (lung consolidation), and pleural
effusion.
 Bronchoscopy. A flexible, lighted tube inserted
down the throat and allows the doctor to see what
may be causing a blockage, such as a mucus
plug, tumor or foreign body. This procedure may
also be used to remove the blockages.

23. TREATMENT
NON SURGICAL TREATMENT
Chest physiotherapy. This involves
moving the body into different positions and
using tapping motions, vibrations, or
wearing a vibrating vest to help loosen and
drain mucus. It’s generally used for
obstructive or postsurgical atelectasis.

24. TREATMENT
Bronchoscopy. A small tube is inserted
through the nose or mouth into the lungs to
remove a foreign object or clear a mucus
plug. This can also be used to remove a
tissue sample from a mass so that the
doctor can figure out what is causing the
problem.

25. TREATMENT
Breathing exercises. Exercises or
devices, such as an incentive spirometer,
that force one to breathe in deeply and
help to open up the alveoli. This is
especially useful for postsurgical
atelectasis.

26. TREATMENT
Drainage. If atelectasis is due to
pneumothorax or pleural effusion, the
doctor may need to drain air or fluid from
the chest.

27. TREATMENT
 SURGICAL TREATMENT
 Removal of airway obstructions may be done by
suctioning mucus or by bronchoscopy. During
bronchoscopy, the doctor gently guides a flexible
tube down the throat to clear the airways.
 If a tumor is causing the atelectasis, treatment
may involve removal or shrinkage of the tumor
with surgery, with or without other cancer
therapies (chemotherapy or radiation).

28. NANDA NURSING DIAGNOSIS FOR ATELECTASIS
Ineffective breathing pattern related to: Excessive mucus
production and thick, ineffective cough.
Impaired gas exchange related to: Lung volume reduction
Activity Intolerance related to: weak body condition (fatigue)
secondary to increased respiratory effort.

29. NANDA NURSING DIAGNOSIS FOR ATELECTASIS
Risk for fluid volume deficits related to: fever fluid loss, fluid
intake is less because of dyspnoea.
Acute Pain related to: lung inflammation
Anxiety related to: hospitalization (ICU)
Knowledge Deficit related to: lack of information about the
disease process, treatment procedures at the hospital.

30. THANK YOU  

31. PLEURAL EFFUSION

32. INTRODUCTION
A pleural effusion is an unusual
amount of fluid around the lung.
It can also be defined as a collection of
fluid in the pleural space, and is rarely
a primary disease process; it is usually
secondary to other diseases.

33. INTRODUCTION
The pleura is a thin membrane that
lines the surface of the lungs and the
inside of the chest wall. With pleural
effusion, fluid builds up in the space
between the layers of your pleura.
Normally, the pleural space contains a
small amount of fluid (5 to 15 mL),
which acts as a lubricant that allows
the pleural surfaces to move without
friction.

35. TYPES OF PLEURAL EFFUSION
 Transudative pleural effusions
 This type is caused by fluid leaking into the pleural
space as a result of either a low blood protein count
or increased pressure in the blood vessels. Its most
common cause is congestive heart failure.
 Exudative effusions
 This type is caused by:
 blocked lymph or blood vessels
 inflammation
 tumors
 lung injury

36. TYPES OF PLEURAL EFFUSION
Uncomplicated pleural effusions contain
fluid without signs of infection or
inflammation. They’re much less likely to
cause permanent lung problems.
Complicated pleural effusions, however,
contain fluid with significant infection or
inflammation. They require prompt
treatment that frequently includes chest
drainage.

37. CAUSES
Leaking from other organs. This usually
happens if one has congestive heart failure.
But it can also come from liver or kidney
disease, when fluid builds up in the body
and leaks into the pleural space.

38. CAUSES
Cancer. Usually lung cancer is the problem,
but other cancers that have spread to the
lung or pleura can cause it, too.
Infections. Some illnesses that lead to
pleural effusion
are pneumonia or tuberculosis.

39. CAUSES
Pulmonary embolism. This is a blockage
in an artery in one of the lungs, and it can
lead to pleural effusion
Autoimmune conditions. Lupus or
rheumatoid arthritis are some diseases that
can cause it.

40. PATHOPHYSIOLOGY
In certain disorders, fluid may accumulate
in the pleural space to a point at which it
becomes clinically evident. The effusion
can be a relatively clear fluid, or it can be
bloody or purulent. An effusion of clear fluid
may be a transudate or an exudate.

41. PATHOPHYSIOLOGY
 A transudate occurs when factors influencing the
formation and reabsorption of pleural fluid are
altered, usually by imbalances in hydrostatic or
oncotic pressures. The finding of a transudative
effusion generally implies that the pleural
membranes are not diseased.
 An exudate usually results from inflammation by
bacterial products or tumors involving the pleural
surfaces.

42. SYMPTOMS
 chest pain
 dry cough
 fever
 difficulty breathing when lying down
 shortness of breath
 difficulty taking deep breaths
 persistent hiccups
 difficulty with physical activity

43. DIAGNOSIS
Chest X-ray. Pleural effusions appear
white on X-rays, while air space looks
black.
CT scan
chest ultrasound

44. DIAGNOSIS
pleural fluid analysis: The doctor will
remove fluid from the pleural
membrane area by inserting a needle
into the chest cavity and suctioning the
fluid into a syringe. The procedure is
called a thoracentesis.
bronchoscopy
pleural biopsy

45. TREATMENT
Thoracentesis. If the effusion is large, the
doctor may take more fluid than she needs
for testing, just to ease your symptoms.

46. TREATMENT
Tube thoracostomy (chest tube). The
doctor makes a small cut in your chest wall
and puts a plastic tube into your pleural
space for several days.
Pleural drain. If pleural effusions keep
coming back, the doctor may put a long-
term catheter through the skin into the
pleural space. One can then drain the
pleural effusion at home.

47. TREATMENT
Pleurodesis. The doctor injects an
irritating substance (such as talc
or doxycycline) through a chest tube
into the pleural space. The substance
inflames the pleura and chest wall,
which then bind tightly to each other
as they heal. Pleurodesis can prevent
pleural effusions from coming back in
many cases.

48. TREATMENT
Pleural decortication. Surgeons can
operate inside the pleural space,
removing potentially dangerous
inflammation and unhealthy tissue. To
do this, the surgeon may make small
cuts (thoracoscopy) or a large one
(thoracotomy).

49. NURSING INTERVENTIONS FOR PLEURAL EFFUSION
Ineffective airway clearance related to decreased lung
expansion.
Goal: a patent airway / inadequate
Nursing Intervention:
Give oxygenation in accordance with the program.
 Provide a comfortable sleeping position.
 Monitor vital signs.
 Teach effective cough.
 Teach resistant chest when coughing.

50. NURSING INTERVENTIONS FOR PLEURAL EFFUSION
Fluid volume deficit related to diaphoresis
Goal: balance of body fluids
Nursing Intervention:
Vital signs every 6 hours.
 Compress with warm water.
 Record intake and output.
 Collaboration with doctors for antibiotics.

51. NURSING INTERVENTIONS FOR PLEURAL EFFUSION
Activity Intolerance related to dyspnea and fatigue
Goal: clients obtain energy
Nursing Intervention:
Assess the activity patterns.
 Limit activity.
 Aids to overcome weaknesses.
 Schedule breaks.
 Physiotherapy consultation.

52. THANK YOU 

53. PULMONARY EMBOLISM

54. INTRODUCTION
A pulmonary embolism is a blood clot
that occurs in the lungs.
It can damage part of the lung due to
restricted blood flow, decrease oxygen
levels in the blood, and affect other
organs as well. Large or multiple blood
clots can be fatal.
The blockage can be life-threatening.

55. CAUSES
 Injury or damage: Injuries like bone fractures or
muscle tears can cause damage to blood vessels,
leading to clots.

56. CAUSES
 Inactivity: During long periods of inactivity,
gravity causes blood to stagnate in the
lowest areas of your body, which may lead to
a blood clot. This could occur if one is sitting
for a lengthy trip or if lying in bed recovering
from an illness.
 Medical conditions: Some health conditions
cause blood to clot too easily, which can lead
to pulmonary embolism. Treatments for
medical conditions, such as surgery or
chemotherapy for cancer, can also cause
blood clots.

57. RISK FACTORS
cancer
a family history of embolisms
fractures of the leg or hip
hypercoagulable states or genetic
blood clotting disorders, including
Factor V Leiden, prothrombin gene
mutation, and elevated levels of
homocysteine

58. RISK FACTORS
a history of heart attack or stroke
major surgery
obesity
a sedentary lifestyle
age over 60 years
taking estrogen or testosterone

59. SYMPTOMS
anxiety
clammy or bluish skin
chest pain that may extend into your
arm, jaw, neck, and shoulder
fainting

60. SYMPTOMS
irregular heartbeat
lightheadedness
rapid breathing
rapid heartbeat
restlessness
spitting up blood
weak pulse

61. DIAGNOSIS
chest X-ray: This standard, noninvasive
test allows doctors to see your heart and
lungs in detail, as well as any problems
with the bones around your lungs.
electrocardiography (ECG): This test
measures your heart’s electrical activity.
MRI: This scan uses radio waves and a
magnetic field to produce detailed images.

62. DIAGNOSIS
 CT scan: This scan gives your doctor the ability to
see cross-sectional images of your lungs. A special
scan called a V/Q scan may be ordered.
 pulmonary angiography: This test involves making
a small incision so your doctor can guide
specialized tools through your veins. Your doctor
will inject a special dye so that the blood vessels of
the lung can be seen.

63. DIAGNOSIS
duplex venous ultrasound: This test
uses radio waves to visualize the flow
of blood and to check for blood clots in
your legs.
venography: This is a specialized X-
ray of the veins of your legs.
D-dimer test: A type of blood test.

64. TREATMENT
 anticoagulants: Also called blood thinners, the
drugs heparin and warfarin prevent new clots
from forming in your blood. They can save
your life in an emergency situation.
 clot dissolvers (thrombolytics): These drugs
speed up the breakdown of a clot. They’re
typically reserved for emergency situations
because side effects may include dangerous
bleeding problems.

65. TREATMENT
vein filter: The doctor will make a small
incision, then use a thin wire to install
a small filter in your inferior vena cava.
The vena cava is the main vein that
leads from your legs to the right side of
your heart. The filter prevents blood
clots from traveling from the legs to the
lungs.

66. TREATMENT
clot removal: A thin tube called a
catheter will suction large clots out of
your artery. It isn’t an entirely effective
method because of the difficulty
involved, so it’s not always a preferred
method of treatment.

67. TREATMENT
open surgery: Doctors use open
surgery only in emergency situations
when a person is in shock or
medications aren’t working to break up
the clot.

68. THANK YOU 