What is a key initial management step to enable deep breathing and coughing in a patient at risk for atelectasis?

• A. Pain control to permit deep breathing and coughing.
• B. Bronchodilator inhaler only.
• C. Immediate intubation.
• D. No intervention.

Answer: (A)

Pain control is essential because pain from surgery or chest injury often causes a patient to breathe shallowly and to cough less effectively. When the chest wall is painful, taking slow, deep breaths and performing a productive cough becomes difficult, which leads to insufficient ventilation of the lungs and can cause alveolar collapse, or atelectasis. By adequately controlling pain, the patient can take deeper breaths and generate a more effective cough, which helps re-expand collapsed alveoli, improve ventilation, and clear secretions.

Bronchodilators may help if bronchospasm is contributing, but they don’t remove the barrier created by pain. Immediate intubation is unnecessary unless there is respiratory failure. Doing nothing would leave the patient vulnerable to atelectasis. So the first step is to ensure adequate analgesia to enable deep breathing and coughing.