Atelectasis - a respiratory disorder

Atelectasis is derived from the Greek words “ateles” and “ektasis”, meaning incomplete expansion. 
Refers to closure or collapse of alveoli.

1. ATELECTASIS Presented by : SHIVANGI SHARMA

2. Respiratory System

3. DEFINITION Atelectasis is derived from the Greek words “ ateles ” and “ ektasis ”, meaning incomplete expansion.  Refers to closure or collapse of alveoli.

4. Cont… 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

5. ETIOLOGY Atelectasis may be the result of a blocked airway (obstructive) or of pressure from outside the lung (no obstructive). Almost everyone who has surgery has some atelectasis from anesthesia.

6. Obstructive Atelectasis   Most common type Due to a physical blockage of airflow Obstruction can occur at the level of the larger or smaller bronchus Causes Mucus plug. Foreign body- Atelectasis is common in children who have inhaled an object, such as a peanut or small toy part, into their lungs. Tumor in a major airway- An abnormal growth can narrow the airway. Blood clot.

7. Obstructive Atelectasis

8. Non Obstructive Atelectasis When alveoli collapse due to factors acting via other mechanisms. Least common Causes Injury- Chest trauma from a fall or car accident. Pleural effusion. Pneumonia- Different types of pneumonia, an infection of your lungs, may temporarily cause atelectasis. Pneumothorax. Tumor- A large tumor can press against and deflate the lung.

9. RISK FACTORS Age — being younger than 5 or older than 60 years of age. Any condition that interferes with spontaneous coughing, yawning and sighing. Lung disease, such as asthma in children, COPD , bronchiectasis or cystic fibrosis . Premature birth . Recent abdominal or chest surgery . Recent general anesthesia . Respiratory muscle weakness , due to muscular dystrophy, spinal cord injury or another neuromuscular condition. Any cause of shallow breathing

10. CLASSIFICATION OF ATELECTASIS

11. Compression Atelectasis Compression atelectasis occurs from the lesion of the thorax compresses the lungs. It takes place in congenital emphysema.

12. Absorption Atelectasis Refers to the condition where the reduction of nitrogen concentration in the lungs causes a collapse.

13. Relaxation Atelectasis Relaxation or passive atelectasis results when pleural effusion or Pneumothorax eliminates contact between parietal pleura and visceral pleura.

14. Adhesive Atelectasis Adhesive atelectasis results from surfactant deficiency. This is observed particularly in acute respiratory distress syndrome (ARDS).

15. Cicatrization Atelectasis It results from the severe scarring of the parenchyma and caused by the necrotizing pneumonia.

16. Rounded Atelectasis Occurs as a consequence of diseases with chronic pleural scarring, especially asbestos-related pleural disease and TB.

17. CLASSIFICATION OF ATELECTASIS

18. Cont… 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).

19. Pathophysiology

20. Cont… 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 compliance & recoil Resulting in atelectasis

21. 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

22. Diagnostic Measures • Auscultation: Decreased breath sounds and crackles over the affected area. • Pulse oximetry (SpO2) less than 90% ABG Analysis -Provides information about respiratory and metabolic acid/base balance. -Adequacy of oxygenation

23. Cont… Chest x-ray findings -Sharply-defined opacity obscuring vessels without air- bronchogram -Volume loss resulting in displacement of diaphragm, fissures, hili or mediastinum

24. Management Treatment of the underlying cause   a.) Bronchial Obstruction: due to secretions Nasotracheal & Oral Suctioning  

25. Cont… b.) Pleural Effusion Management

26. Cont… Bronchoscopy   Bronchoscopy: If airway obstruction is caused by a foreign body, mucous plug, or tumor, Fiberoptic Bronchoscopy may be used to remove the blockage and correct the obstruction.   Incentive Spirometry An incentive spirometry may be used to encourage deep breathing exercises.

27. Cont… Bronchodilators Bronchodilators medication may be given by the nebulizer. These help expand the airways. Examples are Albuterol , Metaproterenol .   Chest Physiotherapy Postural drainage and chest percussion (Chest physiotherapy) is helpful. This allows mucus to drain more easily.

28. SURGICAL MANAGEMENT   Surgical management: If atelectasis is chronic, it can be difficult to get the lungs to re-expand. - Removal of the involved part of the lung via LOBECTOMY or segmental resection may then be needed.  

29. Postoperative A telec tasis Managem e nt Avoid narcotics as much as possible. Ambulation(if hemodynamically stable) Vigorous Chest physiotherapy

30. NURSING DIAGNOSIS Ineffective breathing pattern related to Excessive mucus production. Impaired gas exchange related to Lung volume reduction. Activity intolerance related to weak body condition secondary to increased respiratory effort. Acute pain related to lungs inflammation.

31. Cont… Anxiety related to hospitalization. Knowledge deficit related to lack of information about the disease process, treatment procedures at the hospital. Risk for fluid volume deficits related to fever, fluid loss