Atelectasis is a common complication of bed rest. Diminished breath sounds in the bases of the lungs are not normal findings — plan interventions to avoid atelectasis in your patients. Atelectasis is a natural phenomenon because patients are immobile. If the patient is not moving around, they’re in bed, and they have the head of the bed up 30 degrees, then secretions are going to collect in the bases. What tends to happen is that secretions pool in the bases in the back and atelectasis develops with diminished breath sounds.
Think about the patients on your floor. How many of them have diminished breath sounds in the bases? Probably all of them. But, it’s not a normal finding. Whenever you see that, whenever you document it, you need to record some resolution for atelectasis and diminished breath sounds. What is that resolution going to be? Mobilizing your patient, and if the patient can’t get up and ambulate, then you need to turn and position the patient and have them do their deep breathing exercises.
But rather than coupling deep breathing with coughing, because we’re talking about the bases here, and coughing tends to cause bronchial construction in the terminal bronchi.
That may trap the secretions. Have the patient do a forced expiration; that’s a forceful exhalation, and the way I like to describe it to patients is to tell them to pretend like you’re blowing out the candles on a birthday cake.
That’s deep breathing and forced exhalation. Coughing is better when you have the secretions in the higher airways. You can also have your patient use incentive spirometry.
Besides, the patient must remain hydrated to keep secretions loose, and they will continue to mobilize. Again, atelectasis is not a normal finding in your patient; you need to do something about it, and if you do, your patients will be in much better shape.