Atelectasis and lobar collapse of mid and lower zones of R lung secondary to sputum plug, sputum retention in R upper zone ? due to chest infection ? due to reduced MCT function due to intubation exacerbated by smoking status. P on cough. Hyperinflation of L lung ? due to emphysemous changes in lungs or due to increased compliance of L lung due to high PIP value and increased VT delivered to this lung. ? renal failure.
The chest x-ray indicates atelectasis and lobar collapse in the lower and the middle zone of the right lung as increased density can be seen here on the x-ray (Tarrac 2009). Atelectasis is a partial collapse of the lung due to closure of the alveoli which impairs or completely prevents gas exchange in the affected area…show more content… Sputum is indicated from the coarse crackles heard on auscultation in the right upper zone (Wyka 2002). Given the site of the surgery in the abdomen, transverse surgical incision and the length of his surgery increases Mr. Wrens risk of post-operative pulmonary complications (PPC) as his respiratory muscle function will be reduced due to direct injury to the respiratory muscles and anaesthetic reducing respiratory muscle function making normal breathing and clearance techniques such as coughing more difficult (Siafakas 1999).
Atelectasis is causing reduced ventilation perfusion (V/Q) as oxygen is not getting into the mid and lower zone of the right lung to transfer into the blood stream, there is a pulmonary shunt here (Wyka 2002), consequently Mr. Wrens oxygen saturation and PaO2 have dropped despite his positive inspiratory pressure (PIP) being increased. This is leading to reduced oxygen in the blood returning to the heart to be pumped around the body, as the body tissues need oxygen to survive it is critical that Mr. Wrens blood oxygen levels be returned to normal (Hough 2001). Atelectasis is also preventing CO2 from perfusing from the capillaries into the alveoli to be excreted consequently Mr. Wrens high PaCO2 (Wyka 2002). His blood pH is also high, this combined with the increased