ATELECTASIS

MS.L.SOUNDARYA MSC.NURSING (PEDIATRICS)

DEFINITION

• IT is defined as the collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung. (or)

• Atelectasis is the collapse or airless condition of the lung with incomplete expansion.

Causes

1. congenital/ primary Atelectasis- preterm or LBW baby.

-due to immaturity of respiratory of muscle, alveolar ducts abnormality, any pulmonary disorders.

2. Acquired or secondary Atelectasis:

bronchial obstruction due to foreign body

excessive secretionsMucus plugsTumorsEnlargement of lymph nodes or heart pleural effusionPneumothorax, tension cyst

prolonged anesthesia or abdominal surgery.

PATHOPHYSIOLOGY

PRIMARY SECONDARYALVEOLI FAILS TO EXPAND# premature -Because of immaturity of diaphragm & other respiratory muscles, hypermoblity of the bones.# due to sedation of the mother before delivery or brain injury of the newborn# a mucus or meconium plug may cause atelectasis# neonates –lungs are not expanded normally, the acidosis becomes more severe, possibly with pH values of below 7.o

ALVEOLI COLLAPSE After they have once been expanded by air.

# this may occur when the infant or child has pulmonary disease or has aspirated mucus or a foreign body.

Clinical manifestations• Rapid bronchial occlusion with a large

area of lung collapse causes;• chest pain on the affected side, • retractions,• sudden onset of dyspnea, tachypnea,• Cyanosis, • Coughing,

• Rapid, shallow breathing• Hypotension, tachycardia,• fever, and shock may also occur. • Irritation in the right middle and

right lower lobe bronchi may cause -severe, hacking, nonproductive

cough.

DIAGNOSTIC EVALUATION

History collection Physical examination Chest x-ray CBP CUA sputum test c/s

AFB staining

CT-chest /CT- abdomen Bronchoscopy Radiography oximetry

COMPLICATIONS

• EMPHYSEMA • BRAIN ABCESS• FIBROSIS• INFECTIONS

PROGNOSIS• GOOD • POOR MAY FOUND IN MASSIVE

BACTERIAL ATELECTASIS

NURSING MANGEMENT• Early recognition of atelectasis•Semi fowlers positioning should be maintained.• oxygen therapy

Suction and postural drainage may be used to reduce the amount of mucus in the respiratory tract.

• Increased humidity in the environment can prevent the drying of secretions and the formations of bronchial plugs.•Prevent secondary infections.•Prevent respiratory distress.

NURSING DIAGNOSIS Ineffective breathing pattern related to:

• Hypoxia/inflammatory process• Neuromuscular impairment• Pain• Musculoskeletal impairment• Tracheobronchial obstruction• Perception or cognitive impairment• Anxiety• Decreased energy and fatigue• Decreased lung expansion

Ineffective airway clearance related to:–stasis of secretions associated with

decreased activity, depressed ciliary function resulting from the effect of anesthesia, and a weak cough effort–increased secretions associated with

irritation of the respiratory tract (can result from inhalation anesthetics and endotracheal intubation);

• Impaired gas exchange related to ventilation/perfusion imbalances associated with atelectasis/hypoventilation or ineffective clearance of secretions.

• Fluid volume excess related to pulmonary interstitium &alveoli as manifested by respiratory rate variation /by auscultation / investigation (chest)

Ineffective tissue perfusion r/t compromised blood flow r/t respiratory distress syndrome cyanosis of hands, feet, and around mouth.Ineffective thermoregulation r/t immature compensation for changes in environmental temperature. Imbalanced nutrition status less than body requirements r/t poor feeding behavior Risk for impaired parent-infant attachment r/t interruption of bonding process.

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