A nurse is working on a medical/surgical unit and is giving an in-service on patients at risk for Atelectasis.
Identify which of the following patients are at risk for Atelectasis.

Choice A rationale

Patients with COPD and a smoking habit are at high risk for atelectasis due to chronic inflammation and excessive mucus production. Smoking impairs ciliary function, making it difficult to clear secretions from the bronchioles. These retained secretions can plug the smaller airways, leading to the collapse of the distal alveoli. The underlying structural lung damage in COPD also contributes to poor ventilation and gas exchange, further predisposing these individuals to alveolar collapse.

Choice B rationale

Abdominal surgery significantly increases the risk for atelectasis because the patient often experiences shallow breathing due to incisional pain. This lack of deep inspiration prevents the full expansion of the lungs, especially the lower lobes. Furthermore, general anesthesia and the use of postoperative opioid analgesics can suppress the cough reflex and decrease the production of surfactant. Without adequate surfactant and regular deep breathing, the alveoli lose their surface tension and collapse.

Choice C rationale

Viral rhinitis typically involves inflammation of the upper respiratory tract and does not usually lead to atelectasis unless it progresses to a lower respiratory infection or causes significant airway obstruction. Coughing fits actually help to keep the lower airways clear of mucus by creating high expiratory flow rates. While uncomfortable, the primary pathology of viral rhinitis is localized to the nasal passages and pharynx, rather than the deep alveolar structures involved in atelectasis.

Choice D rationale

Gangrene of the toe is a localized necrotic process usually caused by peripheral vascular disease or infection. It does not directly affect the pulmonary system or the mechanics of breathing. Unless the patient becomes septic or is placed on prolonged bed rest without movement, the presence of gangrene on a distal extremity does not pose a direct risk for the development of atelectasis. The risk profile for atelectasis is primarily focused on respiratory and mobility factors.

Choice E rationale

Obesity and kidney failure are both risk factors for atelectasis. Obesity causes the chest wall to be heavy and restricts the movement of the diaphragm, leading to reduced lung volumes and shallow breathing. Kidney failure can lead to fluid volume overload and pulmonary congestion. This excess fluid can compress the alveoli from the outside or lead to decreased lung compliance, making it harder for the patient to maintain fully inflated alveoli during normal respiration.