Atelectasis

1. Atelectasis

2. • Atelectasis is derived from the Greek words “ateles”
and “ektasis”, meaning incomplete expansion.
• Refers to closure or collapse of alveoli.

3. DEFINITION
Atelectasis is a complete or partial collapse of the
entire lung or area (lobe) of the lung. It occurs when
the tiny air sacs (alveoli) within the lung become
deflated or possibly filled with alveolar fluid.

5. Related Anatomy and Physiology

6. Related Anatomy and Physiology

7. NEONATAL ATELECTASIS ADULT/ ACQUIRED ATELECTASIS

8. RISK FACTOR
• Age — being younger than 3 or older than 60 years of age.
• Lung disease, such as asthma in children, COPD, bronchiectasis or cystic
fibrosis.
• Premature birth.
• Recent abdominal or chest surgery.
• Recent general anaesthesia.
• Respiratory muscle weakness, due to muscular dystrophy, spinal cord injury
or another neuromuscular condition.
• Confinement to bed with infrequent changes of position.

9. ETIOLOGY
• Atelectasis may be the result of a blocked airway (obstructive) or of
pressure from outside the lung (nonobstructive).

10. OBSTRUCTIVE ATELECTASIS CAUSES
• Mucus plug
• Foreign body
• Tumour in a major airway
• Blood clot

11. NON-OBSTRUCTIVE ATELECTSIS
CAUSES
• Injury
• Pleural effusion
• Pneumonia
• Pneumothorax
• Scarring of lung tissue
• Tumour

12. CLASSIFICATION OF
ATELECTASIS:
• Resorption Atelectasis
• Compression Atelectasis
• Contraction/Cicatrization Atelectasis

13. RESORPTION ATELECTASIS:
• Refers to the condition
where airway obstruction
cause the loss of pre-existing
air in the alveoli, leading
to alveolar collapse.

14. Causes
MUCUS PLUG FOREIGN BODY TUMOR

15. COMPRESSION ATELECTSIS:
•Compressive atelectasis refers to
collapse of the small airway or
alveoli deep to the pleura that
occurs when air or fluid in the
pleural cavity is under increased
pressure.

16. Causes
PNEUMOTHORAX HAEMOTHORAX

17. CONTRACTION/CICATRIZATION ATELECTASIS:
• It is a condition which occurs
due to diffuse contraction or
inflammation of the lung
parenchyma.

18. ROUNDED ATELECTASIS:
• Combination of contraction
and compression atelectasis.
• Occurs due to asbestos
exposure or possibly a pleural
effusion.

19. Due to etiological factors (Obstructive or non-obstructive)
Obstruction of passage of air
from & to alveoli
Trapped alveolar air absorbed
into bloodstream and outside
air cannot replaced the
absorbed air
Affected portion of alveoli
becomes airless
ATELECTASIS
Lung becomes airless
Lung contracts and air inside
lung is expelled out
Deposition of lot of collagen
fibres
Compression of the lung due to
increased pressure given by fluid
or tumor in the thoracic cavity
Causes air to expel from the lung
and prevents the lung/affected
part to expand
Affected portion of lung becomes
airless

20. CLINICAL MANIFESTATIONS
DYSPNEA COUGH WITH SPUTUM
PRODUCTION
CHEST PAIN

21. CENTRAL CYANOSIS ABSENT BREATH SOUNDS
LOW O2 SATURATION

22. DIAGNOSTIC EVALUATION
• History collection
• Physical examination
• Chest X-ray
• CT scan
• MRI
• Bronchoscopy (Diagnostic and therapeutic)
• Arterial Blood Gas analysis
• Positron-emission tomography

23. MANAGEMENT
• Goal: Re-expand the collapsed portion of the lung
MEDICAL MANAGEMENT
• Treatment of the underlying cause

24. BRONCHOSCOPY DRAINAGE
TREATMENT OF
TUMOUR

25. • BRONCHODILATORS
• INCENTIVE SPIROMETER
• CHEST PHYSIOTHERAPY
• POSITIONING
• POSITIVE END EXPIRATORY PRESSURE
• INTUBATION AND VENTILATION

26. SURGICAL MANAGEMENT
LUNG TRANSPLANT
LOBECTOMY

27. NURSING MANAGEMENT

28. NURSING DIAGNOSIS: Ineffective breathing pattern related to excessive mucus production and
bronchoconstriction as evidenced by dyspnea, tachypnea, nasal flaring and altered chest excursion.
• DESIRED OUTCOME: Improvement in breathing pattern.
• NURSING INTERVENTIONS:
 Monitor respiratory and oxygenation status to determine any changes in status.
 Auscultate breath sounds, noting areas of decreased or absent ventilation and presence of adventitious sounds.
 Position to minimize respiratory efforts (e.g., elevate the head of the bed and provide overbed table for patient to
lean on) to reduce oxygen needs.
 Encourage slow deep breathing, turning and coughing to promote effective breathing pattern.
 Monitor for respiratory muscle fatigue to provide additional support if needed.
 Initiate and maintain supplemental oxygen to improve respiratory status.
 Administer medications (e.g., bronchodilators and inhalers) that promote airway patency and gas exchange.
 Provide suctioning as needed for patients who are intubated or unable to clear their own secretions.
 Offer reassurance and emotional support because the patient’s limited breathing capacity may frighten him.

29. NURSING DIAGNOSIS: Impaired gas exchange related to atelectasis as evidenced by low oxygen
saturation, shortness of breath, cough, rapid, shallow breathing.
• DESIRED OUTCOME: The patient will maintain optimal gas exchange as evidenced by respiratory rates between
12 to 20 breaths per minute, oxygen saturation within the target range and verbalize ease of breathing.
• NURSING INTERVENTIONS:
 Assess the patient’s vital signs, especially the oxygen saturation and characteristics of respiration atleast every 4
hours. Also monitor the results of ABG analysis.
 Administer supplemental oxygen carefully as prescribed.
 Elevate the head of the bed. Assist patient to assume semi-fowlers position.
 Teach patient how to use incentive spirometer
 Provide pain medication to support deep breathing.
 Turn the patient atleast every 2 hourly, as tolerated, encourage to mobilize as tolerated.
 Encourage patient to cough/deep breath.
 Assess oxygen saturation
 Assess lung sounds

30. NURSING DIAGNOSIS: Ineffective Airway Clearance related to increased production of sputum.
• DESIRED OUTCOME: Patient achieves patent airway.
• NURSING INTERVENTIONS:
 Auscultate breath sounds, record the presence of abnormal breath sounds, eg wheezing, crackles, also assess
for bronchial spasms.
 Assess the frequency and depth of breathing and chest movement.
 Give fluids at least 2500 ml / day, unless contraindicated, offer warm water to mobilize secretions.
 Observe color of skin, mucous membranes and nails for signs of cyanosis, which indicates hypoxemia.
 Give medication as indicated to relaxes smooth muscle and reduce local congestion.
 Provide respiratory treatment, eg, chest physiotherapy, postural drainage and percussion.

31. NURSING DIAGNOSIS: Self-care deficit related to fatigue secondary to increased work of breathing and insufficient
ventilation and oxygenation.
• DESIRED OUTCOME: Independence in self-care activities.
• NURSING INTERVENTIONS:
 Encourage patient to coordinate diaphragmatic breathing with activity (e.g., walking, bending)
 Pace activities of daily living to alternate with rest periods to reduce fatigue and dyspnea.
 Educate patient about postural drainage if appropriate

32. NURSING DIAGNOSIS: Acute pain related to lungs inflammation.
• DESIRED OUTCOME: Reduced pain level.
• NURSING INTERVENTIONS:
 Assess pain score to identify the intensity of pain.
 Administer adequate Analgesics to control pain.
 Humidify inspired air and encourage adequate fluid intake to mobilize secretions.
 Use Postural drainage and chest percussion to remove secretions.

33. COMPLICATIONS
• Secondary infections e.g. pneumonia, lung abscess
• Respiratory failure

34. PREVENTION
 Change patient’s position frequently
 Encourage early mobilization from bed to chair followed by early ambulation.
 Encourage appropriate deep breathing and coughing Educate appropriate technique for
incentive spirometry.
 Administer prescribed opioids and sedatives judiciously to prevent respiratory depression.
 Perform postural drainage and chest percussion
 Institute suctioning to remove tracheobronchial secretions
• Multidisciplinary, evidence-based standardized intervention programs, such as IGOUGHSM hold
promise in preventing atelectasis

35. ICOUGH
INCENTIVE SPIROMETRY
COUGHING AND DEEP
BREATHING
ORAL CARE TWICE A DAY
UNDERSTANDING
(PATIENT AND STAFF
EDUCATION)
GETTING OUT OF BED
ATLEAST 3 TIMES DAILY
HEAD-OF-BED ELEVATION
I
C
O
U
G
H

36. PROGNOSIS