Atelectasis

Atelectasis Nursing Care Plans Diagnosis and Interventions

Atelectasis NCLEX Review Care Plans

Nursing Study Guide on Atelectasis

Atelectasis is a lung condition that is described as a partial or complete collapse of the lung or parts of the lung.

It specifically affects the lung alveoli wherein they either become deflated or filled with alveolar fluid.

Alveoli are tiny air sacs inside the lungs where gas exchange occurs.

Atelectasis is a common breathing complication after surgery, but it can also arise because of other respiratory conditions like cystic fibrosis, lung tumors and other forms of chest injuries.

Atelectasis can be mild and not need any treatment, however, some cases may be serious and will need immediate medical care.

Signs and Symptoms of Atelectasis

Mild atelectasis may not show any symptoms at all. Depending on the severity of the collapse, the symptoms may manifest as follows:

  • Difficulty breathing
  • Rapid, shallow breathing
  • Wheezing
  • Coughing

Causes of Atelectasis

Atelectasis can be classified as obstructive and nonobstructive.

Obstructive atelectasis occurs when there’s occlusion in the airways of the lungs.

On the other hand, nonobstructive atelectasis occurs when the collapse is caused by a pressure to the alveoli from outside the lung.

General anesthesia is the most common cause of atelectasis. The mechanism of action of drugs used in general anesthesia alters the individual’s breathing pattern which may affect gas exchange. This mechanism can cause the alveoli to deflate and collapse.

Obstructive atelectasis may occur due to the following:

  • Mucus plug – mucus is naturally secreted in the airways, however, build up of mucus can result to occlusion of the airways and may cause respiratory problems. Mucus plug can occur during surgery due to the inability to excrete it through coughing. In addition, drugs given during surgery may make the breathing less deep making it easier for mucus to collect in the airways. Mucus plug is also commonly related to other respiratory problems like cystic fibrosis and asthma attack.
  • Foreign body – obstructive atelectasis can occur when there is a foreign body occluding the airways. This may occur as a result of accidental inhalation of small objects specially in children.
  • Tumor inside the airway – An abnormal growth of tissues in the airway can also be the reason for obstructive atelectasis.

Nonobstructive atelectasis can have the following causes:

  • Injury – chest trauma from a fall, car accident, or anything similar, can alter the breathing ability of an individual. Change in breathing can be a result of pain, or trauma surrounding the lungs.
  • Pleural effusion – pleural effusion is a lung condition that is characterized by the build-up of fluid in the pleura which is a space between the lining of the lung and chest wall.
  • Pneumonia – Some cases of pneumonia infection cause atelectasis.
  • Pneumothorax – this is a respiratory condition where there is leakage of air into the space between the lungs and chest wall.
  • Lung tissue scarring – scarring could be caused by surgery, a lung condition, or trauma. Scars in the lung tissue can cause limited lung expansion leading to atelectasis.
  • Tumor in the lung – a lung tumor or any growth around the lungs can cause pressure which may limit the inflation and deflation of the lung during gas exchange.

The risk factors for developing atelectasis are as follows:

  • Old age
  • Conditions related to difficulty swallowing
  • Conditions related to reduced ability for position changes
  • Other lung diseases
  • Recent abdominal or chest trauma or surgery
  • Use of general anesthesia
  • Conditions which may affect breathing such as spinal cord injuries, muscular dystrophy, or neuromuscular conditions
  • Pain that may affect breathing
  • Cigarette smoking

Complications of Atelectasis

  1. Hypoxemia. This refers to having low oxygen level in the blood. This may occur as a result of disruption to the gas exchange process in the collapsed alveoli.
  2. Pneumonia. The risk of pneumonia is present in atelectasis because of the possible mucus build up.
  3. Respiratory failure. The degree of atelectasis can cause respiratory failure which can be life threatening.

Diagnosis of Atelectasis

  • Medical history – history taking is important to identify possible causes of atelectasis. The presence of signs and symptoms and of possible trauma will be asked.
  • Physical examination – the physician or medical staff will complete a thorough physical assessment to note the presence of symptoms and possible extent of damage caused by atelectasis.
  • CT scan – This imaging procedure is often requested to identify the degree of severity of atelectasis. It is also a good way to identify the possible presence of complications that will likely need immediate attention.
  • Oximetry – this is a simple procedure where a machine called pulse oximeter is placed on one of the patient’s fingers to measure the blood oxygen level. It helps the medical staff identify the severity of atelectasis.
  • Ultrasound of the thorax – this imaging procedure is non-invasive and can help identify atelectasis from other lung problems like pleural effusion.
  • Bronchoscopy – this procedure involves the insertion of a tube down the individual’s throat to see the possible causes of obstructive atelectasis like mucus plug, presence of a foreign object, and presence of a tumor.

Treatment of Atelectasis

The treatment options for atelectasis are based on the causes of the condition. While some cases of atelectasis may not need any treatment, some serious cases may need surgery for treatment.

  1. Chest physiotherapy – this form of treatment involves techniques that assist the individual to control their breathing and improve gas exchange.
    1. Incentive spirometry through deep breathing exercises can increase the removal of secretions and help lung expand.
    1. Positioning that will aid drainage by gravity can also help drain mucus build-up. The patient’s head can be positioned lower than the chest.
    1. Percussion – this procedure involves tapping the chest to loosen mucus build-up.
  2. Surgery – in some cases, surgery may be required to remove obstructions.
  3. Breathing treatments – the use of breathing aids may be necessary in some cases. A continuous positive airway pressure (CPAP) machine is often helpful in patients with atelectasis to maintain a normal blood oxygen level usually after surgery.

Nursing Care Plans for Atelectasis

Nursing Care Plan 1

Nursing Diagnosis: Ineffective Breathing Pattern related to atelectasis as evidenced by shortness of breath, SpO2 level of 85%, respiratory rate of 27, cough, rapid and shallow breathing, chest pain when breathing, cold and clammy skin, and restlessness

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Auscultate for breath sounds.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds may be absent or diminished in the portion of the lung that has collapsed.
Assist the patient in performing daily chest physiotherapy. Refer to a chest physiotherapist as indicated.   This form of treatment involves techniques that assist the individual to control their breathing and improve gas exchange.
Attach the patient to a CPAP machine. Ensure to educate the patient and caregiver or relative about it and gain consent prior to performing the procedure.A continuous positive airway pressure (CPAP) machine is often helpful in patients with atelectasis to maintain a normal blood oxygen level usually after surgery.
Administer the prescribed antibiotic/antiviral medications.Antibiotics or antivirals: To treat the underlying pneumonia infection if this is the cause of lung collapse.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Teach the patient to splint the painful or uncomfortable body part when coughing or performing deep breathing exercises.To provide support to the abdominal and respiratory muscles, reducing trauma and enhancing breathing and comfort.

Nursing Care Plan 2

Nursing Diagnosis: Impaired Gas Exchange related to atelectasis as evidenced by shortness of breath, SpO2 level of 85%, cough, respiratory rate of 29 bpm, and rapid, shallow breathing

Desired Outcome: The patient will maintain optimal gas exchange as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs, especially the oxygen saturation and characteristics of respirations at least every 4 hours. Also, monitor the results of ABG analysis.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. ABG Analysis: To check if there is an increase in PaCO2 and a decrease in PaO2, which are the signs of hypoxemia and respiratory acidosis.
Administer supplemental oxygen carefully, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Turn the patient at least every 2 hours, as tolerated. Encourage to mobilize as tolerated.To prevent the complications of immobility such as thromboembolism that may worsen the atelectasis.
Monitor the chest drain for any abnormalities.In cases of atelectasis due to pneumothorax or hemothorax, a chest drain may be required to remove air in the pleural space and allow the lung to re-expand and heal.

Other possible nursing diagnoses:

  • Risk for Respiratory Failure
  • Activity Intolerance
  • Anxiety
  • Fatigue

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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