After surgery, pain, anesthesia and lying still make patients take shallow breaths, so small areas of the lung collapse and stop exchanging air. It is the most common lung problem after an operation, usually in the first 2 to 3 days, and it can lead to pneumonia if not reversed.
Key symptoms
- Mild shortness of breath or fast breathing
- Low-grade fever in the first days
- Weak cough and shallow breathing because of pain
- Often no symptoms, only lower oxygen readings
What you find on exam
- Reduced breath sounds and crackles at the lung bases
- Dullness to percussion over the collapsed area
- Respiratory rate and oxygen saturation
- Pain control and ability to cough deeply
Tests
- Chest X-ray: linear or plate-like shadows, raised diaphragm, shift toward the collapse
- Pulse oximetry, and a blood gas if oxygen is low
- Blood count and cultures if pneumonia is suspected
- CT angiography if a pulmonary embolism is a concern
Treatment basics
- Incentive spirometer 10 times an hour while awake
- Deep breathing, coughing and splinting the incision
- Early walking and sitting upright
- Good pain control so the patient can breathe deeply
- Oxygen as needed; chest physiotherapy or CPAP in persistent cases
Red flags
- Oxygen saturation that keeps falling despite oxygen
- High fever with purulent sputum
- Sudden chest pain and breathlessness suggesting a clot
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.