What are the care instructions for a patient with atelectasis?

Atelectasis Patient Care Instructions

The most effective management of atelectasis includes deep breathing exercises, early mobilization, adequate pain control, and airway clearance techniques to prevent complications and improve oxygenation. 1, 2

Assessment and Monitoring

• Monitor arterial blood gases and oxygen saturation to assess improvement in oxygenation
• Obtain follow-up chest radiographs to document resolution of atelectasis
• Watch for signs of persistent atelectasis which can lead to pneumonia and hypercapnic respiratory failure 2

Non-Pharmacological Interventions

Positioning and Mobilization

• Position patient with head of bed elevated 30 degrees (beach chair position) to optimize lung expansion 2
• Encourage early mobilization to improve ventilation 1, 2
• Consider lateral positioning with affected lung uppermost to improve ventilation-perfusion matching

Breathing Exercises

• Instruct patient to perform deep breathing exercises every 1-2 hours while awake
• Teach incentive spirometry use: 10 breaths every hour while awake
• Encourage sustained maximal inspiration (holding breath for 3-5 seconds) to increase inspiratory volume 1

Airway Clearance Techniques

• Perform airway clearance techniques 1-2 times daily with a trained respiratory therapist 2
• For patients with ineffective cough (peak cough flow <160 L/min):
  • Teach manually assisted cough techniques using thoracic or abdominal compression 1
  • Consider mechanical insufflation-exsufflation devices if available 1
  • Teach air stacking techniques to increase maximum insufflation capacity 1

Secretion Management

• Ensure adequate hydration to thin secretions
• Consider oro-nasal suctioning only when other methods fail to clear secretions 1
• For thick secretions, consider humidification of inspired air 1

Pharmacological Interventions

• N-acetylcysteine: Consider nebulized N-acetylcysteine for patients with abnormal, viscid mucous secretions causing atelectasis 3
• Ensure adequate pain control, especially in post-operative patients, to allow effective deep breathing and coughing
• Administer bronchodilators if bronchospasm is present

Advanced Interventions

Non-Invasive Ventilation

• Consider CPAP or non-invasive positive pressure ventilation if conservative measures fail to improve oxygenation 2
• Apply PEEP (10-15 cm H₂O) to prevent alveolar collapse and recruit collapsed lung units 2

Alveolar Recruitment Maneuvers

• Consider alveolar recruitment maneuvers to reopen collapsed alveoli 2, 4
• Monitor hemodynamics closely during recruitment maneuvers as they may cause transient instability 2

Bronchoscopy

• Consider bronchoscopy when atelectasis persists despite conservative measures, particularly for removing persistent mucous plugs 2, 5

Prevention Strategies

• Avoid high concentrations of oxygen (>80%) when possible, as this can worsen atelectasis 6, 7
• Administer vaccinations against influenza and pneumococcus for patients with chronic conditions 2
• For patients at high risk (e.g., post-operative, neuromuscular weakness):
  • Implement prophylactic respiratory care protocols
  • Consider respiratory muscle strength training 2

Special Considerations

• For intubated patients: Maintain adequate PEEP, perform periodic hyperinflation, and ensure proper suctioning technique 1
• For patients with neuromuscular weakness: Focus on assisted cough techniques and consider mechanical insufflation-exsufflation devices 1
• For post-operative patients: Emphasize early mobilization, adequate pain control, and incentive spirometry 4

Early intervention is critical as delayed treatment can lead to persistent atelectasis, pneumonia, and respiratory failure 2.