Respiratory System Disorders

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

3. Respiratory
system

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.

13. Obstructive Causes

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

27. X- ray
Interpretations

28. BY, Shristi Shrestha

32. • Treatment of the underlying cause
BY, Shristi Shrestha

33. Bronchial Obstruction: due to secretions
Nasotracheal & Oral Suctioning

36. Pleural Effusion Management

37. Postoperative Atelectasis
Management
• Avoid narcotics as much
as possible.
• Ambulation(if
hemodynamically stable)
• Vigorous Chest
physiotherapy

38. Management
• Nebulized bronchodilators and humidity

39. Management
• Chest physiotherapy

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

44. Surfactant Therapy

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.

46. BY, Shristi Shrestha

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