Definition:

Atelectasis refers to closure or collapse of alveoli and often is described in relation to x-ray findings and clinical signs and symptoms. Atelectasis may be acute or chronic and may cover a broad range of pathologic changes, from microatelectasis (which is not detectable on chest x-ray) to macroatelectasis with loss of segmental, lobar, or overall lung volume. In acute atelectasis, the lung has recently collapsed and is primarily notable only for airlessness. In chronic atelectasis, the affected area is often characterized by a complex mixture of airlessness, infection, widening of the bronchi (bronchiectasis), destruction, and scarring (fibrosis).

Risk Factor:
o o o o o o o o o o Altered breathing patterns Retained secretions Alteration of small airway function Prolonged supine positioning Increased abdominal pressure Reduced lung volume due to musculoskeletal or neurologic disorders Restrictive defects Specific surgical procedures (e.g., upper abdominal, thoracic, or open heart surgery) Obstruction to the airway (mechanical or foreign body) Hypoventilation (V/Q imbalance)

Pathophysiology:
Atelectasis may occur in adults 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. The trapped alveolar air becomes absorbed into the bloodstream, and no additional air can enter into the alveoli because of the blockage. As a result, the affected portion of the lung becomes airless and the alveoli collapse. This may result from altered breathing patters, 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 (e.g., upper abdominal, thoracic, or open heart surgery). Persistent low lung volumes, secretions or a mass obstructing or impeding airflow, and compression of lung tissue may all cause collapse or obstruction of the airways, which leads to atelectasis.

Clinical Manifestation:
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 ateclectasis, 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 previous mentioned signs and symptoms, dyspnea, tachycardia, tachypnea, pleural pain and central cyanosis (bluish skin hue that is a late sign of hypoxemia) may be anticipated. Patients characteristically have difficulty breathing in the supine position and are anxious. In chronic atelectasis, signs and symptoms are similar to those of acute atelectasis. The chronic nature of the alveolar collapse predispose patients to infection distal to the obstruction. Therefore, the signs and symptoms of a pulmonary infection also may be present.

Assessment and Diagnostic Findings:

When clinically significant atelectasis develops, it is generally characterized by increased work of breathing and hypoxemia. The patient may demonstrate an increased respiratory rate and appear to labor with breathing. Decreased breath sounds and crackles are heard over the affected area. In addition, chest x-ray findings may reveal patchy infiltrates or consolidated areas. In patients who are confined to bed, atelectasis ismusually diagnosed by chest x-ray or identified by physical assessment in the dependent, posterior, basilar areas of the lungs. Depending on the degree of hypoxemia, pulse oximeter (SpO) may demonstrate a low aturation of hemoglobin with oxygen (less than 90%) or a lower-than-normal partial pressure of arterial oxygen (PaO).

Medical Management:
o o Prophylactic Antibiotic Meter-dose Inhaler

o o

Continually monitor hypoxemia Arterial Blood Gas (ABG) Positive End Expiratory Pressure

Nursing Management:
Nursing measures to prevent atelectasis include frequent turning, early mobilization, and strategies to expand the lungs and to manage secretions. Voluntary deep-breathing maneuvers (at least every 2 hours) assist in preventing and treating atelectasis. The performance of these maneuvers requires the patient to be alert and cooperative. Patient education and reinforcement are the key to the success of these interventions. The use of incentive spirometry or involuntary deep breathing enhances lung expansion, decreases the potential for airway closure, and may generate a cough. Secretion management techniques include directed cough, suctioning, aerosol nebulizer treatments followed by chest physical therapy (postural drainage and chest percussion), and bronchoscopy. In some settings, a meter-dose inhaler is used to dispense a bronchodilator rather than a aerosol nebulizer. Administer prescribe opiods and sedatives judiciously to prevent respiratory depression. Reference: brunner and sudart medical surgical nursing, vol. 1, pp: 625-628.