U Assessment

HISTORY. Assess the patient for such preoperative risk factors as obesity, pre-existing respiratory problems, and smoking. Because surgical patients are at risk, be alert for component of the postoperative history that may contribute to atelectasis: a decrease in total lung volume because of pain and splinting, changes in breathing patterns from incisional discomfort or medications, advanced age, and a need for an increased fraction of inspired oxygen (FiO2). Other factors include use of narcotic analgesics that depress the respiratory drive, immobility, a decrease in consciousness, muscular weakness, hypotension, sepsis, and use of a nasogastric tube.

PHYSICAL EXAMINATION. The patient may appear asymptomatic if small areas of the lung are involved, or they may appear acutely ill with extreme shortness of breath and clinical signs of oxygen deficit such as confusion, agitation, rapid heart rate, and even combative behavior when large areas are affected. Suprasternal, substernal, and intercostal retractions may be present, depending on the severity of atelectasis. Percussion reveals a dullness over the affected lung area. When the patient's breath sounds are auscultated, you may hear decreased breath sounds or even find breath sounds to be absent. In addition, many patients have fine, late inspiratory crackles and coarse crackles or wheezes with airway obstruction.

PSYCHOSOCIAL. The patient with atelectasis may be very anxious if breathing becomes too difficult. If the atelectasis is a result of foreign body aspiration by a child, the parents may be upset and guilty. Determine the patient's and parents' abilities to cope with the stressful situation.

Diagnostic Highlights

Test Normal Result

Abnormality with Condition

Explanation

Chest x-ray Clear lung fields

Areas of increased density at the site of alveolar collapse

Air-filled lungs are radiolucent (x-rays pass through tissue, which appears as a dark area) but collapsed areas appear more dense. Findings may occur on the second day after the occurrence of atelectasis

Other Tests: Pulmonary function tests (PFTs); arterial blood gases (ABGs); fiberoptic bronchoscopy.

112 Atelectasis

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