Atelectasis Nursing Diagnosis and Nursing Care Plan

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Atelectasis Nursing Care Plans Diagnosis and Interventions

Atelectasis NCLEX Review and Nursing Care Plans

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.

Atelectasis Nursing Diagnosis

Nursing Care Plan for Atelectasis 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.

Atelectasis Nursing 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 for Atelectasis 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.

Atelectasis Nursing 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.

Nursing Care Plan for Atelectasis 3

Risk for Ineffective Airway Clearance

Nursing Diagnosis: Risk for Ineffective Airway Clearance related to tracheobronchial obstruction by mucus plug secondary to recent surgery due to atelectasis.

Desired Outcomes:

  • The patient will be able to induce effective coughing techniques to expel the secretions.
  • The patient will be able to exhibit normal oxygenation and breathing pattern.
  • The patient will be able to fully recover from the surgery and perform effective interventions to prevent atelectasis and other complications.
Atelectasis Nursing InterventionsRationale
Assess airway for patency.Maintaining an open airway is always the priority. Normal secretions tend to build up in a patient who recently had surgery due to the medications given.
Document vital signs including oxygen saturation and characteristics of respirations.  Check breath sounds via auscultation.Provides baseline data of the patient’s status for monitoring and comparison. Any changes in the vital signs may signify improvement or deterioration in the patient’s condition.
Assess the patient’s ability to swallow or cough.This will determine the patient’s ability to protect and clear their airway through coughing. Patients who have undergone surgery are prone to aspiration due to diminished gag reflex.
Assist the patient in semi or high Fowler’s positioning as tolerated.This position promotes lung expansion and reduces the accumulation of secretions in the airway and lungs.
Assist the patient in performing deep breathing exercises, such as breathing deeply and slowly using the diaphragm and then exhaling slowly through the mouth. The patient may also use a medical device like incentive spirometry.Deep breathing exercises facilitate maximum lung expansion. Incentive spirometry measures progress in breath volume after surgery.
Educate the patient about proper coughing techniques such as the use of the diaphragm and two strong coughs from the chest. Use pillows or hand splints while coughing.Promote effective excretion of mucus. Splinting promotes effective coughing by upward diaphragm movement increasing abdominal pressure.
Assist the patient in ambulation and frequent position changes with proper body alignment.Ambulation improves circulation and perfusion, mobilizing and preventing the pooling of secretions. Frequent changing of position relieves pressure on the diaphragm. Both promote lung expansion and prevent atelectasis.
Assess the patient for pain including pain scale, facial grimace, and guarding behavior. Administer pain medication as needed.Postoperative pain must be taken into consideration as this may affect the treatment progress such as ineffective breathing, ambulation, and changing of position.
Educate the patient about chest physiotherapy or postural drainages such as percussion and vibration.This airway clearance technique is used to drain secretions from the lungs by loosening the mucus through manual percussion and vibration.
Encourage an increase in clear fluid intake as tolerated. Offer minimal amounts frequently using a small cup or straw in an upright position.Keeps the patient hydrated and helps liquefy the secretions taking into consideration aspiration precautions.
Perform nasotracheal suctioning, as necessary.Helps evacuate thick mucus plugs obstructing the airway. This will also clear the lungs of residual secretions.
Document characteristics of the sputum and send samples to the laboratory for sputum culture as ordered.A sputum culture can detect bacteria to be treated with an effective antibiotic.
Administer supplemental oxygen as ordered with as maintained humidity as possible.Help normalize respirations and oxygen saturation. Humidity minimizes mucosal dryness while oxygenating the patient.
Administer steam inhalation or nebulization as ordered.Helps liquefy the secretions and bronchodilation.
Administer medications as ordered, such as bronchodilators, mucolytics, expectorants, or antibiotics. Document the effectiveness or side effects of these medications.These medications will aid in opening the airway, liquefying the mucus making it easier to cough up, and treatment of infection, respectively.
Consider referral to respiratory therapy.Trained professionals can facilitate more advanced intervention and plan treatment changes based on the patient’s response and needs.
Educate the patient and significant others about warning signs to seek treatment promptly such as changes in breathing or signs of infection.Complications may arise and cause sudden changes in the patient’s condition. Prompt treatment must be given to avoid serious and life-threatening conditions.

Nursing Care Plan for Atelectasis 4

Risk for Infection

Nursing Diagnosis: Risk for Infection related to respiratory secretion stasis secondary to atelectasis

Desired Outcomes:

  • The patient will have a reduced risk of developing an infection.
  • The patient will verbalize awareness on how to reduce the risk of acquiring an infection.
  • The patient will demonstrate ways to prevent the spread of infection.
Atelectasis Nursing InterventionsRationale
Document and monitor vital signs.This will serve as baseline data for comparison and early detection of a disease or condition. An increase in temperature may suggest an infection.
Assess the patient’s immunization status specifically pneumococcal and influenza vaccine. Encourage the patient and significant others to get a shot if they do not have any.This will determine the patient’s acquired active immunity which reduces the risk of developing pneumonia. Stress the importance of getting a protection shot for the whole family.
Assess the patient’s risk, history, or a present condition that may cause a possible infection.This will help the nurse and primary care provider prepare a possible treatment plan and prevent those conditions from happening.
Demonstrate and stress the importance of frequent and proper handwashing including the patient’s significant others.Handwashing is proven to reduce the transmission and acquisition of infection. Significant others must also practice and make it a habit to do proper handwashing to protect themselves and others.
Encourage the patient to ambulate and change position frequently.Frequent turning and ambulation prevent the pooling of secretions and mobilize secretions.
Demonstrate and stress the importance of good pulmonary hygiene such as deep breathing exercises, incentive spirometry, postural drainage, percussion, vibration, and suctioning as needed.Pulmonary hygiene or pulmonary toilet are good exercises that help maintain clear airways, ensuing enough oxygen delivery.  Demonstration to the patient and significant others increases compliance with positive outcomes.
Educate the patient and significant others about the use of personal protective equipment (PPE) such as facemask and gloves.Personal protective equipment gives extra protection for the patient and significant others from possible health and safety risk. This can also prevent the transmission and spread of infection.
Encourage limited contact with others. Educate the patient and significant others about isolation precautions.Limited contact with other people reduces exposure to infectious pathogens. Isolation precautions stop the spread of infectious diseases from one person to another, especially the immunocompromised patient.
Encourage resumption of activities of daily living in moderation with rest periods in between activities.Resumption of activities helps the patient gain a sense of independence and promotes faster recovery. Adequate rest helps in building the body’s natural defenses and resistance to infection.
Encourage adequate fluid intake.Promote good circulation to all systems of the body supporting the healing process.
Encourage adequate food and nutrition-rich food such as fruits, vegetables, lean meat, and fibers.A healthy body increases the immune system promoting faster healing and preventing infections.
Administer medications as ordered. Stress the importance of adhering to antibiotic therapy if there is any.It is important to follow the exact dosage and duration of medication administration to ensure efficacy and prevent drug resistance and complications of infections.
Encourage intake of vitamins and supplements such as vitamin D, zinc, and probiotics.Intake of these vitamins and supplements helps in boosting the immune system.
Educate the patient about the possible infection, transmission, complications, and interventions that may help.Informing the patient about disease processes raises understanding and confidence in following the guidelines and treatment plan.
Educate the patient and significant others about the importance of lifestyle modifications such as smoking cessation, alcohol moderation, and exercise.Good health habits and staying active make life better and more comfortable. Explaining how these aspects affect recovery makes participation and compliance most likely to happen.

Nursing Care Plan for Atelectasis 5

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to hypoxemia secondary to atelectasis as evidenced by shortness of breath and verbalization of lack of energy and tiredness.

Desired Outcomes:

  • The patient will be able to perform usual activities without shortness of breath and tiredness.
  • The patient will be able to perform techniques that may help control breathing and reduce energy consumption during activities.
  • The patient will be able to verbalize feelings of independence and increase self-esteem.
Atelectasis Nursing InterventionsRationale
Assess the patient’s baseline cardiopulmonary status.Make sure that cardiopulmonary status is stable before initiating any activity.
Administer supplemental oxygen as ordered. Discontinue the oxygen therapy once normal oxygen saturation between 95-100% is achieved.The initial treatment of choice for hypoxemia is oxygen therapy which must be given urgently to prevent deterioration and serious harm to the patient.
Document and monitor vital signs during rest and performance of any activity. Use a portable pulse oximeter to monitor oxygen saturation during activities.This will serve as baseline data for comparison and detection of triggers, exacerbations, and relieving factors. A portable pulse oximeter is a reliable device that determines early desaturation while performing activities.
Assess the patient’s nutritional and hydration status.Inadequate food and water intake may result in low energy reserve and inadequate tissue perfusion.
Assist the patient in performing deep breathing exercises, such as breathing deeply and slowly using the diaphragm and then exhaling slowly through the mouth.Deep breathing exercises facilitate maximum lung expansion. This is also used as a relaxation technique to calm the patient while focusing on his/her breathing.
Assess the patient’s activities of daily living.This can help in determining energy-consuming activities that must be lessened or taken in moderation.
Gradually increase the patient’s activities from passive to active range of motion as tolerated.Gradual progressive endurance of activities helps prevent overexertion and exhaustion.
Provide rest periods in between activities. Ensure adequate rest during the night.Adequate rest especially at night helps the body regain adequate energy that will be needed during the day.
Assist the patient with activities of daily living as tolerated.This will promote independence and the return of usual activities to the previous state.
Educate the patient about conscious-controlled breathing techniques such as pursed-lip breathing and diaphragmatic breathing.These techniques promote maximum lung expansion and help the patient control breathing during increased activities or physical and emotional stress.
Assess the patient’s mobility status. Educate about the use of assistive devices such as cane, walker, braces, or wheelchair as needed.This will help in determining the need for assistive devices and which device to use.
Educate the patient about energy conservation techniques such as frequent position changes, pushing rather than pulling, sliding rather than lifting, and placing items within reach.This helps conserve energy for the much more needed task that requires energy consumption and prolonged activities.
Establish a goal and plan activities with the patient that is realistic and attainable.Planning of activities must be done to ensure that energy-consuming activities will be done during the patient’s peak of energy. This will also increase the patient’s self-esteem and independence.
Assess the patient’s emotional response to activity limitations including verbal and non-verbal cues.Frustrations can cause limitations in the patient’s activities and compliance with the treatment.
Provide support and positive encouragement to the patient and significant others.Patients may fear the health effect of overexertion. Reassure the patient and continue supervising until recovery is achieved.
Consider referral to respiratory therapy.Trained professionals can facilitate more advanced intervention and plan treatment changes based on the patient’s response and needs.

More Atelectasis Nursing Diagnosis

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

Nursing Stat Facts
Nursing Stat Facts

Gulanick, M., & Myers, J. L. (2022). 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. (2020). 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

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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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