Critical Care Nursing Theory
Atelactasis
Atelectasis
Definition
- Closure or collapse of alveoli and often is described in relation to:a - X-ray findings
b - Clinical signs and symptoms.
Types of atelactasis
- Atelectasis may be acute or chronic
- It may cover a broad range of pathophysiologic changes, from
microatelectasis (which is not detectable on chest x-ray) to macroatelectasis
with loss of segmental, lobar, or overall lung volume.
Acute atelectasis, ( most common)
- Which occurs frequently in:a- Postoperative setting
b- Immobilized and have a shallow, monotonous breathing pattern.
c- Obstruction of airflow by excess secretions or mucus plugs
Dr. Abdul-Monim Batiha-
Assistant Professor Of Critical Care Nursing
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Critical Care Nursing Theory
Atelactasis
- Chronic airway obstruction that impedes or blocks air flow to an area of
the lung (eg, obstructive atelectasis in the patient with lung cancer that is
invading or compressing the airways).
- This type of atelectasis is more insidious and slower in onset.
The most common cause of atelectasis is airway obstruction that results from
retained exudates and secretions. This is frequently observed in the
postoperative patient.
Clinical Manifestations
- The development of atelectasis usually is insidious.
- Signs and symptoms include cough, sputum production, and low-grade
fever.
- Fever is universally cited as a clinical sign of atelectasis, but there are few
data to support this.
- Most likely the fever that accompanies atelectasis is due to infection or
inflammation distal to the obstructed airway.
- In acute atelectasis involving a large amount of lung tissue (lobar
atelectasis), marked respiratory distress may be observed. In addition to the
above signs and symptoms, dyspnea, tachycardia,
- Tachypnea, pleural pain, and central cyanosis (a bluish skin type that is a
late sign of hypoxemia) may be anticipated.
- The patient characteristically has difficulty breathing in the supine position
and is anxious.
Signs and symptoms of chronic atelectasis
- They are similar to those of acute atelectasis. Because the alveolar collapse
is chronic, infection may occur distal to the obstruction.
Dr. Abdul-Monim Batiha-
Assistant Professor Of Critical Care Nursing
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Critical Care Nursing Theory
Atelactasis
- Thus, the signs and symptoms of a pulmonary infection also may be
present.
Assessment and Diagnostic Findings
- Decreased breath sounds and crackles are heard over the affected area.
- In addition, chest x-ray findings may reveal patchy infiltrates or
consolidated areas.
- Atelectas is is usually diagnosed by:- Chest x-ray: Post-surgical atelectasis will be bibasal in pattern.
- Physical assessment in the dependent, posterior, basilar areas of the lungs.
- Computed tomography
- Bronchoscopy
- Depending on the degree of hypoxemia:1- Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin
with oxygen (less than 90%)
2- A lower-than-normal partial pressure of arterial oxygen (PaO2).
Nursing Measures for Prevention
1- Frequent turning,
2- Early mobilization,
3- Strategies to expand the lungs and to manage secretions,
4- Deep-breathing maneuvers (at least every 2 hours).
- The performance of these maneuvers requires a patient who is alert and
cooperative.
- Patient education and reinforcement are key to the success of these
interventions.
- The use of incentive spirometry or voluntary deep breathing enhances lung
expansion, decreases the potential for airway closure, and may generate a
cough.
Dr. Abdul-Monim Batiha-
Assistant Professor Of Critical Care Nursing
3
Critical Care Nursing Theory
Atelactasis
- Secretion management techniques may include directed cough, suctioning,
aerosol nebulizer treatments followed by chest physical therapy (postural
drainage and chest percussion), or bronchoscopy.
- In some settings, a metered-dose inhaler (MDI) is used to dispense a
bronchodilator rather than an aerosol nebulizer treatment.
Management
- The goal in treating the patient with atelectasis is to improve ventilation
and remove secretions.
-The strategies to prevent atelectasis, which include frequent turning, early
ambulation, lung volume expansion maneuvers (eg, deep-breathing
exercises, incentive spirometry), and coughing also serve as the first-line
measures to minimize or treat atelectasis by improving ventilation.
- Patients who do not respond to first-line measures or who cannot perform
deep-breathing exercises, other treatments such as:1- Positive expiratory pressure
2- PEP therapy (a simple mask and oneway valve system that provides
varying amounts of expiratory resistance [usually 5 to 15 cm H2O]),
3- Continuous or intermittent positive pressure-breathing (IPPB),
4- Bronchoscopy may be used.
- Before initiating more complex, costly, and labor-intensive therapies,
the nurse should ask several questions:
- Has the patient been given an adequate trial of deep breathing exercises?
- Has the patient received adequate education, supervision, and coaching to
carry out the deep-breathing exercises?
- Have other factors been evaluated that may impair ventilation or prohibit a
good patient effort (eg, lack of turning, mobilization; excessive pain;
excessive sedation)?
Dr. Abdul-Monim Batiha-
Assistant Professor Of Critical Care Nursing
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Critical Care Nursing Theory
Atelactasis
If the cause of atelectasis is bronchial obstruction from secretions,
1- The secretions must be removed by coughing or suctioning to permit air
to re-enter that portion of the lung.
2- Chest physical therapy (chest percussion and postural drainage) may also
be used to mobilize secretions.
3- Nebulizer treatments with a bronchodilator medication or sodium
bicarbonate may be used to assist the patient in the expectoration of
secretions.
If respiratory care measures fail to remove the obstruction, a
bronchoscopy is performed.
- Severe or massive atelectasis may lead to acute respiratory failure,
especially in a patient with underlying lung disease.
- Endotracheal intubation and mechanical ventilation may be necessary.
- Prompt treatment reduces the risk for acute respiratory failure or
pneumonia.
- If atelectasis has resulted from compression of lung tissue, the goal is to
decrease the compression.
- With a large pleural effusion that is compressing lung tissue and causing
alveolar collapse, treatment may include:a- Thoracentesis ( removal of the fluid by needle aspiration)
b- Insertion of a chest tube.
- The measures to increase lung expansion described above also are used.
Dr. Abdul-Monim Batiha-
Assistant Professor Of Critical Care Nursing
5
Critical Care Nursing Theory
Atelactasis
Management of chronic atelectasis focuses on removing the cause of :a- The obstruction of the airways
b- The compression of the lung tissue.
- For example, bronchoscopy may be used to open an airway obstructed by
lung cancer or a nonmalignant lesion, and the procedure may involve
cryotherapy or laser therapy.
- The goal is to reopen the airways and provide ventilation to the collapsed
area.
- In some cases, surgical management may be indicated
Preventing Atelectasis
- Change patient’s position frequently, especially from supine to upright
position, to promote ventilation and prevent secretions from accumulating.
- Encourage early mobilization from bed to chair followed by early
ambulation.
- Encourage appropriate deep breathing and coughing to mobilize secretions
and prevent them from accumulating.
- Teach/reinforce appropriate technique for incentive spirometry.
- Administer prescribed opioids and sedatives judiciously to prevent
respiratory depression.
- Perform postural drainage and chest percussion, if indicated.
- Institute suctioning to remove tracheobronchial secretions, if indicated.
Dr. Abdul-Monim Batiha-
Assistant Professor Of Critical Care Nursing
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