Adult Health 1 - 3320 -
MODULE 2- Respiratory Disorders
Presentation 1
Atelectasis
● Closure or collapse of alveoli
● Acute or chronic
● Most common is acute atelectasis, which occurs in the
postoperative setting, but also seen with immobile patients or
pts with shallow breathing patterns or patients with
emphysema
● Symptoms: insidious, increasing dyspnea, cough, and
sputum production
● Acute: tachycardia, tachypnea, pleural pain, and central
cyanosis if large areas of the lung are affected
● Chronic: similar to acute, pulmonary infection may be present
Assessment and Diagnosis
● Many patients are at risk- immobile, resp illness or had surgery
● When doing assessment may see - increased work of breathing and hypoxemia
● Decreased breath sounds and crackles over the affected area (auscultate, important to
document what sounds you may hear or not)
○ To listen to sounds, go to lippincott skills, heart and breath sounds
■ Link
■ Crackles
■ Rhonchi
■ Wheeze
■ Friction Rub
● Chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear
● Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen
(less than 90%)
● Hallmarks- tachypnea, dyspnea and mild to moderate hypoxia are hallmarks to severity
of atelectasis
Management
● General - aim to Improve ventilation and remove secretions (helping pt breathe better)
● First line measures:
○ Frequent turning, early ambulation, lung volume expansion maneuvers (incentive
spirometer, coughing and deep breathing) and coughing
● Management Multidisciplinary: ICOUGH (see chart
23-2)
, ○ I -Incentive spirometer,
○ C- coughing and deep breathing
○ O - Oral care- brushing and using mouthwash
○ U- Understanding- involves pt and staff education
○ G- Getting out of bed at least 3x a day
○ H- Head of bed elevation
● PEEP (positive and expiratory pressure, simple mask that expiratory resistance), CPAB
(continuous positive airway breathing), bronchoscopy (thoracentesis) - usually if first line
is not working
● Job as nurses to let doctor know if interventions are not working and they can decide if
more can be done
● Endotracheal intubation and mechanical ventilation - used in extreme cases if other
intervention not work
○ Chronic longterm collapse cases
● Thoracentesis to relieve compression
Nursing Interventions
● Prevention
○ Frequent turning- mobilize pulmonary secretions
■ positions
○ Early mobilization (such as after surgery, can be as simple as from bed to chair,
walking to bathroom, walking to hall)
○ Strategies to expand lungs and manage secretions
○ Incentive spirometer - expand lung
■ Proper technique
● The physician's order must specify Incentive Spirometry.
● Spirometry is a method that encourages the patient's
achievement of maximal inspiratory volumes to inflate the alveoli
and help prevent atelectasis by duplicating the yawn reflex. The
purpose is to enable patients with varying inspiratory capacities to
receive reinforcement in a planned program of inspiratory
maneuvers and gradually regain their pre-operative inspiratory
volume ability.
● Instruct patient to: Breathe out into the room with a complete
exhalation. Place mouthpiece in mouth, between teeth, and seal
lips around mouthpiece. Inhale as deeply and slowly as possible
from the mouthpiece. Continue to hold for three (3) seconds.
Relax, remove mouthpiece and let air out into the room.
● Repeat exercise. Each treatment should consist of at least ten
(10) deep inhalations, followed by three to five normal breathing
cycles. Instruct patient to remove mouthpiece from mouth after
each deep inhalation and post-inspiratory hold. 11 Have patient
rest as needed. 12 Follow the IS therapy with several cough/deep
MODULE 2- Respiratory Disorders
Presentation 1
Atelectasis
● Closure or collapse of alveoli
● Acute or chronic
● Most common is acute atelectasis, which occurs in the
postoperative setting, but also seen with immobile patients or
pts with shallow breathing patterns or patients with
emphysema
● Symptoms: insidious, increasing dyspnea, cough, and
sputum production
● Acute: tachycardia, tachypnea, pleural pain, and central
cyanosis if large areas of the lung are affected
● Chronic: similar to acute, pulmonary infection may be present
Assessment and Diagnosis
● Many patients are at risk- immobile, resp illness or had surgery
● When doing assessment may see - increased work of breathing and hypoxemia
● Decreased breath sounds and crackles over the affected area (auscultate, important to
document what sounds you may hear or not)
○ To listen to sounds, go to lippincott skills, heart and breath sounds
■ Link
■ Crackles
■ Rhonchi
■ Wheeze
■ Friction Rub
● Chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear
● Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen
(less than 90%)
● Hallmarks- tachypnea, dyspnea and mild to moderate hypoxia are hallmarks to severity
of atelectasis
Management
● General - aim to Improve ventilation and remove secretions (helping pt breathe better)
● First line measures:
○ Frequent turning, early ambulation, lung volume expansion maneuvers (incentive
spirometer, coughing and deep breathing) and coughing
● Management Multidisciplinary: ICOUGH (see chart
23-2)
, ○ I -Incentive spirometer,
○ C- coughing and deep breathing
○ O - Oral care- brushing and using mouthwash
○ U- Understanding- involves pt and staff education
○ G- Getting out of bed at least 3x a day
○ H- Head of bed elevation
● PEEP (positive and expiratory pressure, simple mask that expiratory resistance), CPAB
(continuous positive airway breathing), bronchoscopy (thoracentesis) - usually if first line
is not working
● Job as nurses to let doctor know if interventions are not working and they can decide if
more can be done
● Endotracheal intubation and mechanical ventilation - used in extreme cases if other
intervention not work
○ Chronic longterm collapse cases
● Thoracentesis to relieve compression
Nursing Interventions
● Prevention
○ Frequent turning- mobilize pulmonary secretions
■ positions
○ Early mobilization (such as after surgery, can be as simple as from bed to chair,
walking to bathroom, walking to hall)
○ Strategies to expand lungs and manage secretions
○ Incentive spirometer - expand lung
■ Proper technique
● The physician's order must specify Incentive Spirometry.
● Spirometry is a method that encourages the patient's
achievement of maximal inspiratory volumes to inflate the alveoli
and help prevent atelectasis by duplicating the yawn reflex. The
purpose is to enable patients with varying inspiratory capacities to
receive reinforcement in a planned program of inspiratory
maneuvers and gradually regain their pre-operative inspiratory
volume ability.
● Instruct patient to: Breathe out into the room with a complete
exhalation. Place mouthpiece in mouth, between teeth, and seal
lips around mouthpiece. Inhale as deeply and slowly as possible
from the mouthpiece. Continue to hold for three (3) seconds.
Relax, remove mouthpiece and let air out into the room.
● Repeat exercise. Each treatment should consist of at least ten
(10) deep inhalations, followed by three to five normal breathing
cycles. Instruct patient to remove mouthpiece from mouth after
each deep inhalation and post-inspiratory hold. 11 Have patient
rest as needed. 12 Follow the IS therapy with several cough/deep
