01.03 Alveoli & Atelectasis

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In this lesson we're going to talk about alveoli and atelectasis and what atelectasis is and how we recognize it and treat it.

But first let's review that the alveoli are the functional unit of the lungs. This is where all of the oxygenation and gas exchange occurs. You can see the pulmonary artery makes its way in and around the alveoli in these capillary beds, the gas exchange occurs, and the oxygenated blood leaves the lungs via the pulmonary vein. So any condition that impacts the functioning of these alveoli is going to impact oxygenation and gas exchange.

So what is atelectasis? Well in simple terms atelectasis is a collapsed lung or lobe of a lung. When that happens the alveoli deflate. Deflated alveoli can’t participate in gas exchange. This is really common after surgery because patients are drowsy and in pain and are taking very shallow breaths. It is also common when patients have excessive secretions because the airflow can't get deep into the alveoli because the secretions are in the way.

So what does this look like in patients? Well first, if no air is moving into those alveoli then you will hear diminished breath sounds on that side. Remember breath sounds are caused by moving air so if the air doesn't move you won't be able to hear anything. A lot of times the patients will also have chest pain when they breathe because of the effect of that collapsed lung on that side. They may also develop a fever and the X-ray will show collapse. You can see here on this x-ray this patient's right lung is collapsed. Air shows up black on an X-ray so you can see there's little to no air moving into the right lung because all of the alveoli are deflated - that’s why it looks white. And of course if the alveoli are deflated then oxygenation and gas exchange are not occurring as effectively, therefore you will also see a decreased SpO2.

When it comes to treatment for atelectasis the number one goal is to reinflate the alveoli. One of our options is CPT or Chest Physiotherapy. The goal of CPT is to vibrate the patient's chest to mobilize secretions and get them out. This is done in a number of ways including a vest that is wrapped around the patient and vibrates, you may have seen respiratory therapist doing percussion therapy by cupping their hands and pounding on the patient's chest, and these days even our beds can vibrate to help with this. The second option is IPPB or intermittent positive-pressure breathing. This is a non-invasive positive pressure breathing treatment that is done through a mask and a positive pressure machine. A few times a day for usually about 10 minutes at a time they will get these positive pressure breaths to help open up those deep airways and the alveoli. The respiratory therapist could even add a nebulizer treatment during this process. Again this is non-invasive, it's just a mask.

The other thing that we use frequently as nurses is the IS or incentive spirometer. Patients will take slow, controlled, deep breaths through this device in order to get larger and larger volumes of air into their lungs. The higher volume, the more we are able to open up the alveoli. As nursing students this is probably one of the first patient teaching experiences you will have and it's one of the best because it can be confusing for patients. They need to breathe in slowly and deeply to raise this blue float. I can’t tell you how many patients I have who just want to blow into it. But eventually they’ll get it, and as they get better at it we will keep increasing their goal volume.

And then of course position changes will help to mobilize secretions. You may have heard people talk about turn cough deep breathe. That is one of the least invasive and easiest interventions we can do as nurses to help improve atelectasis and reinflate alveoli. Keep in mind if your patient is post-op you might need to be giving them pain medication so that they can take deeper breaths.

As far as nursing concepts for atelectasis the two priority nursing Concepts in this case are oxygenation and gas exchange. Make sure you're monitoring their spo2 as well as their blood gases if they're available, teaching and encouraging incentive spirometer, turn cough deep breathe, and administering any medications needed to facilitate the process.

So to recap, Atelectasis is one of the most common problems we see in patients that are hospitalized. It is the collapsing of a lung and the deflating of the alveoli because of shallow breathing post-op or excessive secretions. The number one goal is to reinflate the alveoli so we encourage deep breathing and other therapies to increase the pressure and volume of breaths. Because atelectasis affects the alveoli, it also affects oxygenation and gas exchange so we need to make sure we're monitoring our patients closely.

We hope you feel confident with Atelectasis and how to manage it. Now go out and be your best selves today and as always happy nursing!
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