Nursing Guide to Atelectasis: Nursing Diagnosis, Interventions, & Care Plans

Atelectasis describes the partial or complete collapse of lung tissue, resulting in reduced or absent aeration of alveoli. It can involve a small subsegment, an entire lobe, or rarely a whole lung. The physiologic consequence is impaired gas exchange due to loss of ventilated alveolar units, which contributes to ventilation perfusion mismatch and, in more severe cases, intrapulmonary shunt.  

Clinically, atelectasis ranges from an incidental imaging finding with minimal symptoms to a significant cause of hypoxemia and respiratory distress, particularly in postoperative patients, those with limited mobility, and critically ill patients. 

Atelectasis is best understood as a sign of an underlying process rather than a standalone diagnosis. Common triggers include airway obstruction from mucus plugging, compression from pleural effusion or pneumothorax, hypoventilation from pain or sedation, and loss of surfactant function in conditions such as acute respiratory distress syndrome (ARDS). Nursing care is pivotal because many contributing factors are preventable or modifiable through pulmonary hygiene, mobility promotion, effective analgesia coordination, and vigilant monitoring. 

In acute care settings, atelectasis is among the most common postoperative pulmonary complications. It frequently occurs within the first 24 to 72 hours after major surgery, especially upper abdominal and thoracic procedures, where diaphragmatic dysfunction, splinting due to pain, reduced functional residual capacity, and altered mucus clearance converge. In critical care units, atelectasis is also common in mechanically ventilated patients due to sedation, impaired cough, secretion retention, ventilator settings that do not provide adequate alveolar recruitment, and underlying lung disease. 

From a nursing perspective, atelectasis management integrates assessment, risk identification, prevention, targeted interventions (airway clearance, lung expansion therapies), and escalation when clinical status worsens. Nurses also coordinate interdisciplinary actions, including respiratory therapy for incentive spirometry and positive expiratory pressure therapies, physical therapy for early mobilization, and provider teams for evaluation of obstructive lesions or pleural pathology. 

Etiology and epidemiology 

Pathophysiology overview 

Atelectasis results when alveoli lose inflation. Mechanisms include: 

• Obstruction of airflow into distal airways, leading to absorption of alveolar gas and collapse.
• Compression of lung tissue from external pressure, reducing lung volume.
• Loss of surfactant leading to increased surface tension and alveolar instability.
• Fibrotic remodeling that prevents normal expansion. 

Once alveoli collapse, local hypoxia triggers pulmonary vasoconstriction, which can partially reduce shunt but also contributes to increased pulmonary vascular resistance. Collapsed segments also impair mucociliary clearance, increasing the risk of retained secretions, infection, and postoperative pneumonia. Persistent atelectasis can contribute to atelectasis-related fever and worsening oxygenation, particularly when large areas are involved. 

Types and common causes 

1) Obstructive (resorptive) atelectasis 
Occurs when an airway is blocked and air distal to the obstruction is absorbed into the blood, causing collapse. 

• Mucus plugs (postoperative, dehydration, inadequate cough, neuromuscular weakness)
• Foreign body aspiration
• Endobronchial tumor or external airway compression
• Blood clots or thick secretions 
  Clinical clues can include sudden desaturation, localized decreased breath sounds, and imaging showing volume loss with mediastinal shift toward the affected side. 

2) Compressive atelectasis 
External pressure on lung tissue prevents expansion. 

• Pleural effusion
• Pneumothorax
• Hemothorax
• Large intrathoracic masses
• Elevated diaphragm from abdominal distention, obesity, pregnancy, or ileus 
  This often causes dyspnea and may show mediastinal shift away from the affected side if a large effusion or pneumothorax is present. 

3) Adhesive atelectasis 
Loss or inactivation of surfactant results in alveolar collapse. 

• ARDS
• Severe pneumonia
• Near drowning
• Pulmonary edema
• Neonatal respiratory distress syndrome (surfactant deficiency) 
  This form can be diffuse and associated with significant hypoxemia. 

4) Cicatricial (contraction) atelectasis 
Fibrosis or scarring prevents expansion. 

• Postinfectious scarring
• Radiation fibrosis
• Interstitial lung disease 
  Management focuses on underlying fibrotic disease and supportive care. 

5) Subsegmental (plate-like) atelectasis 
Often transient, especially in postoperative and immobilized patients. 

• Shallow breathing from pain, sedation, or splinting
• Dependent areas of lung, especially bases 

Nursing prevention and early interventions are particularly effective here. 

Epidemiology and high-risk populations 

Atelectasis is common across inpatient settings and is particularly prevalent in: 

• Postoperative patients, especially after upper abdominal or thoracic surgery
• Patients receiving opioids, sedatives, or general anesthesia
• Older adults due to reduced chest wall compliance and cough effectiveness
• People with chronic lung disease (COPD, asthma, bronchiectasis)
• Patients with neuromuscular disorders or reduced consciousness
• Obesity and obstructive sleep apnea, which reduce functional residual capacity
• Patients with prolonged immobilization
• Mechanically ventilated patients, particularly with low lung volumes or inadequate recruitment 

Risk is amplified by inadequate pain control, dehydration, poor nutrition, smoking, and lack of mobilization. Nurses can mitigate many of these through proactive prevention bundles. 

ICD-10 code 

The ICD-10-CM code selection depends on whether atelectasis is acquired, neonatal, or otherwise specified. Common codes include: 

Acquired atelectasis 

• J98.11 Atelectasis
• J98.19 Other pulmonary collapse 

Neonatal atelectasis 

• P28.0 Primary atelectasis of newborn
• P28.1 Other and unspecified atelectasis of newborn 

Tip: Nursing documentation supports accurate coding when it clearly reflects clinical findings (hypoxemia, work of breathing, breath sounds), interventions (incentive spirometry coaching, airway clearance, positioning), and response (improved SpO₂, improved breath sounds, improved imaging). 

Diagnosis 

Clinical presentation 

Symptoms and signs depend on extent, acuity, and the patient’s cardiopulmonary reserve. 

Common symptoms 

• Dyspnea, especially with exertion or when larger areas are involved
• Increased work of breathing, tachypnea
• Cough that may be weak or ineffective
• Chest discomfort or pleuritic pain if associated with pleural pathology 

Common assessment findings 

• Decreased breath sounds over affected area
• Dullness to percussion with lobar collapse or effusion
• Reduced chest expansion on the affected side
• Fine crackles that may clear with deep breathing
• Hypoxemia on pulse oximetry or ABG
• Low-grade fever in postoperative settings (atelectasis can contribute, but infection should be considered) 

Severe presentations 

• Marked hypoxemia with cyanosis
• Respiratory distress with accessory muscle use
• Altered mental status due to hypoxia or hypercapnia in high-risk patients 

Differential considerations 

Atelectasis can mimic or coexist with other pulmonary processes. Differential diagnoses include: 

• Pneumonia
• Pulmonary edema
• Pulmonary embolism
• COPD or asthma exacerbation
• Pleural effusion
• Pneumothorax
• Aspiration syndromes 

Nursing vigilance is important because a patient may initially appear stable but deteriorate, particularly after surgery, sedation changes, or reduced mobility. 

Diagnostic testing 

1) Bedside assessment and monitoring 

• Continuous pulse oximetry when unstable
• Respiratory rate, pattern, and work of breathing
• Lung auscultation trends rather than one-time findings
• Pain scoring and sedation level, because splinting and hypoventilation are key drivers
• Incentive spirometry volumes and ability to perform deep breaths
• Cough strength and sputum characteristics
• Mobility tolerance and orthostatic symptoms 

2) Laboratory 

• ABG isn’t always needed but can clarify severity and CO₂ retention in COPD, obesity hypoventilation, or neuromuscular weakness.
• CBC may be obtained if infection is suspected.
• Basic metabolic panel for hydration and electrolyte balance, which can affect muscle strength and respiratory effort. 

3) Imaging 

• Chest radiograph is the first-line imaging tool in most settings.
  • Common findings include volume loss, displacement of fissures, elevated hemidiaphragm, crowding of vascular markings, and mediastinal shift toward the collapsed area.
  • Subsegmental atelectasis often appears as linear or plate-like opacities, commonly at the lung bases.
• Chest CT provides greater detail and is helpful when the diagnosis is uncertain, when there is suspicion of obstruction (tumor, foreign body), or when complications are suspected.
• Lung ultrasound can identify atelectasis and differentiate it from pleural effusion at bedside in experienced hands. This is particularly useful in ICUs and for rapid assessment of response to interventions. 

4) Bronchoscopy 
Bronchoscopy is diagnostic and therapeutic for obstructive atelectasis due to mucus plugging, foreign body, or suspected endobronchial lesion. Nurses play a key role in pre-procedure preparation, patient education, airway monitoring, and post-procedure observation. 

Red flags requiring urgent escalation 

Escalate promptly to the provider team or rapid response when any of the following occur: 

• Rapidly increasing oxygen requirement
• Persistent SpO₂ below target despite supplemental oxygen and initial interventions
• New or worsening altered mental status
• Signs of impending respiratory failure: fatigue, inability to speak full sentences, rising CO₂ in susceptible patients
• Suspected pneumothorax (sudden pleuritic pain, unilateral absent breath sounds, hypotension)
• Hemodynamic instability
• Suspected airway obstruction that does not respond to coughing and suctioning 

Management 

Management is individualized based on cause, severity, and setting. The primary goals are to re-expand alveoli, improve ventilation, mobilize secretions, address the underlying cause, and prevent recurrence. 

Initial supportive management 

Optimize oxygenation 

• Administer supplemental oxygen per protocol and titrate to ordered targets.
• In COPD or chronic hypercapnia, follow individualized targets to avoid excessive oxygen administration. 

Positioning 

• Upright positioning promotes diaphragmatic excursion and lung expansion.
• Consider lateral positioning with the healthy lung dependent when appropriate for oxygenation, while balancing secretion clearance goals and hemodynamics. 

Hydration 

• Adequate hydration helps reduce secretion viscosity, when clinically appropriate and not contraindicated by heart or renal failure. 

Pain control 

• Coordinate multimodal analgesia to enable deep breathing and mobility.
• Monitor for opioid related hypoventilation and sedation. 

Lung expansion therapies 

Incentive spirometry 

• Effective for postoperative and immobilized patients when performed correctly and consistently.
• Nursing coaching is essential: slow deep inhalation, hold, controlled exhalation, repeat sets as ordered.
• Track volumes and encourage progressive improvement. 

Deep breathing and coughing 

• Teach diaphragmatic breathing and huff coughing techniques.
• Splint incisions with a pillow after abdominal surgery. 

Positive expiratory pressure (PEP) devices 

• Support airway clearance and alveolar recruitment. 

Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) 

• Consider for patients with significant hypoxemia, obesity hypoventilation, sleep apnea, or postoperative atelectasis not responding to basic measures.
• Requires close monitoring for tolerance, aspiration risk, and hemodynamic impact. 

Recruitment maneuvers and ventilator adjustments 

• In mechanically ventilated patients, clinicians may adjust PEEP and tidal volume strategies to minimize atelectasis and improve recruitment while avoiding overdistension.
• Nurses monitor oxygenation, hemodynamics, ventilator synchrony, comfort, sedation needs, and skin integrity from interfaces. 

Airway clearance strategies 

Suctioning 

• Oral and nasopharyngeal suctioning for patients with weak cough or retained secretions.
• Inline suctioning for intubated patients, with preoxygenation as indicated. 

Chest physiotherapy 

• Percussion, vibration, and postural drainage, often coordinated with respiratory therapy. 

Nebulized therapies 

• Bronchodilators if bronchospasm is present.
• Mucolytics in selected patients when ordered. 

Early mobilization 

• One of the most effective interventions for secretion mobilization and lung expansion.
• Nursing coordination with physical therapy is central. 

Treating specific underlying causes 

Obstruction 

• Encourage effective cough, hydration, and mobilization.
• If mucus plugging persists or there is suspicion of foreign body or tumor, bronchoscopy may be required. 

Pleural effusion 

• Management depends on size and symptoms.
• Providers may order diagnostic thoracentesis or therapeutic drainage.
• Nursing responsibilities include monitoring respiratory status, preparing the patient, maintaining positioning, and post-procedure assessments for pneumothorax and bleeding. 

Pneumothorax 

• Requires urgent evaluation.
• Management may include supplemental oxygen, observation for small stable pneumothorax, or chest tube placement for larger or unstable cases.
• Nurses monitor for respiratory distress, chest tube function, subcutaneous emphysema, and pain control. 

Hypoventilation due to sedation or neuromuscular weakness 

• Review sedating medication burden and collaborate on adjustments.
• Consider noninvasive ventilation support as ordered.
• In high-risk patients, monitor for rising CO₂, somnolence, and poor respiratory effort. 

Surfactant related causes and ARDS 

• Management focuses on underlying critical illness, lung protective ventilation strategies, and supportive care. 

Prevention strategies 

Many atelectasis cases are preventable, especially postoperative and immobilization-associated atelectasis. Prevention bundles often include: 

• Preoperative smoking cessation counseling when possible
• Lung expansion exercises, incentive spirometry education pre- and post-op
• Early ambulation and progressive mobility
• Adequate analgesia, including regional anesthesia when appropriate
• Head of bed elevation
• Regular repositioning
• Hydration and secretion management
• Oral care and aspiration precautions when indicated 

Nursing care plan 

This plan is designed to be adapted to the patient’s setting (postoperative unit, ICU, step-down, rehabilitation) and etiology (obstructive, compressive, adhesive). 

Nursing considerations 

• Patient safety first: assess stability before mobilization, use gait belts, coordinate assistance, and monitor oxygen needs during activity.
• Standard precautions: secretion management and suctioning require appropriate PPE; follow facility policy for aerosol generating procedures when relevant.
• Interdisciplinary coordination: respiratory therapy, physical therapy, occupational therapy, anesthesia pain services, and the provider team.
• Sedation and analgesia balance: adequate pain control supports deep breathing, but excessive sedation worsens hypoventilation. Frequent reassessment is essential.
• Equity and comfort: teach techniques using plain language; involve interpreters and caregivers; validate anxiety and provide calm coaching.
• Device-related care: monitor for skin breakdown from oxygen devices, CPAP masks, and securement devices. 

Assessment 

Subjective data 

• Dyspnea, chest tightness, difficulty taking deep breaths
• Pain severity and location, especially with inspiration or coughing
• Fatigue, anxiety, sleep disruption
• Cough effectiveness and sputum volume or thickness
• Recent surgery type, anesthesia history, and baseline pulmonary function
• Smoking history and occupational exposures
• History of COPD, asthma, sleep apnea, neuromuscular disease
• Ability and willingness to ambulate
• Nausea or dizziness that may limit mobility 

Objective data 

• Vital signs: RR, HR, BP, temperature
• SpO₂ trends at rest and with activity
• Work of breathing: accessory muscle use, nasal flaring, ability to speak
• Lung auscultation: diminished sounds, crackles, localized changes
• Chest wall movement symmetry
• Cough strength and ability to clear secretions
• Incentive spirometry technique and achieved volumes
• Mobility assessment: bed mobility, transfers, gait tolerance
• Sedation assessment and respiratory drive
• ABG results when obtained
• Imaging results: CXR, CT, ultrasound findings
• For ventilated patients: ventilator parameters, peak pressures, compliance trends 

Nursing diagnosis/risk for 

Common nursing diagnoses relevant to atelectasis include: 

1. Impaired gas exchange related to alveolar collapse and ventilation perfusion mismatch as evidenced by hypoxemia and increased oxygen requirements.
2. Ineffective airway clearance related to retained secretions, weak cough, pain, or decreased level of consciousness.
3. Ineffective breathing pattern related to pain, anxiety, sedation, or diaphragmatic dysfunction.
4. Acute pain related to surgical incision, pleural irritation, or musculoskeletal strain with coughing.
5. Activity intolerance related to dyspnea and decreased oxygenation with exertion.
6. Risk for infection related to impaired secretion clearance and postoperative status.
7. Risk for aspiration related to decreased consciousness, dysphagia, or vomiting, especially if noninvasive ventilation is used.
8. Anxiety related to dyspnea, unfamiliar devices, and fear of breathing difficulty.
9. Risk for impaired skin integrity related to oxygen devices, CPAP interfaces, and immobility. 

Interventions 

Airway and breathing interventions 

Positioning 

• Elevate head of bed unless contraindicated.
• Reposition at least every 2 hours or per facility protocol.
• Encourage upright sitting for meals and pulmonary exercises. 

Incentive spirometry coaching 

• Demonstrate correct technique.
• Set a realistic goal based on baseline.
• Encourage scheduled use (for example, 10 breaths hourly while awake, per orders and local protocol).
• Document volumes and patient adherence. 

Deep breathing, splinted coughing, and huff cough 

• Teach and supervise techniques.
• Provide incision splinting support with a pillow. 

Secretion mobilization 

• Encourage adequate fluids if appropriate.
• Coordinate chest physiotherapy and PEP devices.
• Provide humidification when ordered to reduce secretion viscosity. 

Suctioning 

• Assess need and perform safely.
• Monitor for vagal response, desaturation, and mucosal trauma.
• For intubated patients, use closed suction systems per protocol. 

Oxygen therapy 

• Titrate oxygen to goals.
• Use appropriate delivery devices and ensure correct fit.
• Monitor for nasal dryness and skin breakdown. 

Noninvasive ventilation support 

• If CPAP or BiPAP is ordered, ensure mask fit, monitor tolerance, assess aspiration risk, and monitor hemodynamics.
• Provide patient coaching to reduce anxiety and improve adherence. 

Pain and sedation optimization 

• Assess pain at rest and with coughing or movement.
• Coordinate multimodal analgesia to enable deep breaths and mobility.
• Monitor sedation level and respiratory rate after opioid administration.
• Encourage nonpharmacologic pain relief: splinting, repositioning, cold or heat therapy if appropriate, relaxation techniques. 

Mobility and activity 

Implement progressive mobility plans: 

• Dangle, chair transfers, short walks, increased distance as tolerated.
• Preoxygenate if needed for exertion and monitor SpO₂ during activity.
• Cluster care to avoid fatigue while still promoting frequent movement.
• Coordinate with PT and OT and engage family support when safe. 

Monitoring and escalation 

• Trend SpO₂, RR, work of breathing, and lung sounds at defined intervals.
• Monitor for fever, leukocytosis, and purulent sputum suggesting pneumonia. 

Escalate for: 

• Worsening hypoxemia or increased oxygen requirement
• New hemodynamic instability
• Suspected pneumothorax or large effusion
• Failure to improve with standard interventions
• Concern for airway obstruction requiring bronchoscopy 

Patient-centered education and emotional support 

• Explain what atelectasis is in simple terms: “Some air sacs are not fully open.”
• Connect interventions to outcomes: “deep breaths and movement help reopen the lung.”
• Use teach-back to confirm understanding.
• Address anxiety with calm reassurance and breathing coaching. 

Expected outcomes 

By discharge or end of the acute episode, the patient is expected to achieve: 

• Improved oxygenation, with SpO₂ at baseline or ordered target on minimal or no supplemental oxygen.
• Improved ventilation signs: reduced tachypnea, decreased work of breathing, improved breath sounds in affected regions.
• Effective airway clearance: productive cough when appropriate, reduced secretion retention, improved lung expansion exercises performance.
• Improved incentive spirometry volumes relative to baseline, with correct technique.
• Increased mobility tolerance: progression in ambulation distance and reduced dyspnea during activity.
• Stable vital signs and no evidence of progression to pneumonia or respiratory failure.
• Demonstrated understanding of home strategies: breathing exercises, mobility, pain control plan, and return precautions. 

Individual/caregiver education 

Core teaching points 

What atelectasis means: partial lung collapse that reduces oxygen transfer, often reversible with targeted actions. 

Why it happens: shallow breathing, mucus plugging, immobility, pain, sedation, or pressure from fluid or air in the pleural space. 

How to help the lungs reopen 

• Use incentive spirometry as instructed.
• Practice deep breathing and coughing.
• Get out of bed and walk as soon as it is safe, even short frequent walks help.
• Sit upright rather than lying flat for long periods. 

Pain control supports breathing 

• Take prescribed pain medications as directed so you can breathe deeply and move.
• Avoid taking extra sedating medications not approved by the care team. 

Hydration and secretion management 

• Drink fluids as allowed.
• Use humidification if prescribed.
• Follow airway clearance techniques taught by the team. 

When to seek help urgently 

• Worsening shortness of breath
• New chest pain, especially sudden and sharp
• Fever with productive cough and worsening symptoms
• Confusion, severe fatigue, or bluish discoloration of lips or fingertips 

Caregiver guidance 

• Encourage mobility and breathing exercises at scheduled intervals.
• Help with positioning and ambulation safety as instructed.
• Monitor for red flags and ensure follow-up appointments are kept.
• Support smoking cessation and avoidance of secondhand smoke exposure. 

Additional Information

Resources 

• Agency for Healthcare Research and Quality (patient safety and postoperative care resources): https://www.ahrq.gov/
• American Lung Association (breathing and lung health resources): https://www.lung.org/
• CMS ICD-10-CM resources: https://www.cms.gov/medicare/coding-billing/icd-10-codes
• ICD10Data code lookup: https://www.icd10data.com/ICD10CM/Codes
• MedlinePlus (patient education on lung conditions): https://medlineplus.gov/
• National Heart, Lung, and Blood Institute (respiratory education): https://www.nhlbi.nih.gov/ 

References 

• American Lung Association. (n.d.). Lung health education resources. https://www.lung.org/
• Centers for Medicare and Medicaid Services (CMS). (Updated March 2026). ICD-10-CM code set resources. https://www.cms.gov/medicare/coding-billing/icd-10-codes
• ICD10Data. (2026). ICD-10-CM code lookup for J98.11, J98.19, P28.0, P28.1. https://www.icd10data.com/ICD10CM/Codes
• MedlinePlus. (n.d.). Health information resources on respiratory conditions. https://medlineplus.gov/
• National Heart, Lung, and Blood Institute. (n.d.). Respiratory health resources. https://www.nhlbi.nih.gov/