DISC 5

Chapter_020.pptx

Chapter 20

Respiratory Function

Respiratory system responsible for gas exchange between environment and blood and involves two processes: ventilation and oxygenation

Processes of respiration, including rate and depth, are controlled by chemoreceptors in medulla oblongata, arch of the aorta, and in carotid artery and are sensitive to oxygen levels and pH.

Introduction

Ribs become less mobile and chest wall compliance decreases.

Osteoporosis and calcification of costal cartilage lead to increased rigidity and stiffness of thoracic cage.

Progressive loss of elastic recoil of lung parenchyma and conducting airways and reduced elastic recoil of lung and opposing forces of chest wall

Age-Related Changes in Structure and Function (1 of 4)

Lung becomes less elastic as collagenic substances surrounding alveoli and alveolar ducts stiffen and form cross-linkages that interfere with elastic properties of lungs.

Muscle strength declines with age, and respiratory muscles weaken.

Respiratory rates generally are faster and shallower.

Age-Related Changes in Structure and Function (2 of 4)

Decrease in surface area available for gas exchange, which contributes to the systemic reduction in partial pressure of arterial oxygen (PaO2)

Decrease in number and effectiveness of cilia in tracheobronchial tree

Decreased immunoglobulin A (IgA) in nasal respiratory mucosal surface that neutralizes viruses

Oxygen-carrying capacity of blood is reduced.

Age-Related Changes in Structure and Function (3 of 4)

PaO2 drops by 1 mmHg per year—PaO2 of 70 mmHg for a 70-year-old is relatively normal (“70 at 70”).

Ventilatory responses to hypoxia and hypercapnia may be diminished by 50%.

Vital capacity is decreased.

Age-Related Changes in Structure and Function (4 of 4)

Increased oxygen demands during exercise periods may well exceed the abilities of older patients, and for those with chronic obstructive pulmonary disease (COPD), activity intolerance is exacerbated.

Smoking damages lungs, respiratory infections become more likely.

The five As of smoking cessation: asking, advising, assessing, assisting, and arranging.

Factors Affecting Lung Function (1 of 2)

Obesity results in decrease in chest wall compliance and reduction in FRC, VC, and ERV.

And is a precursor to sleep apnea

Anesthesia and surgery increased risk of aspiration and postoperative immobility decreases ventilation and increases risk of airway clearance problems.

Factors Affecting Lung Function (2 of 2)

Alterations in breathing patterns, dyspnea, and coughing

Physiologic responses to hypoxemia and hypercapnia are blunted in older patients; compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer.

An early sign of respiratory problems is a change in mental status including subtle increases in forgetfulness and irritability.

Respiratory Symptoms Common in Older Patients (1 of 2)

Dyspnea at rest is most often associated with acute respiratory or cardiac illness.

Dyspnea on exertion may be related to immobility and respiratory muscle deconditioning.

Cough mechanism in older patients is altered because of loss of elastic recoil and decreased respiratory muscle strength.

Respiratory Symptoms Common in Older Patients (2 of 2)

Older patients usually do not complain of dyspnea until it begins to interfere with ADLs and then only if those activities are important to them.

Obstructive lung diseases: characterized by changes in expiratory airflow rates and obstruction of airway

Restrictive lung disease: characterized by decreased ability to expand chest, impaired inhalation, and decreased lung volumes

Respiratory Disease

Chronic inflammatory disease affecting airways; characterized by reversible airway obstruction, airway inflammation, and increased airway responsiveness to a variety of stimuli

Signs and symptoms: dyspnea, audible wheezing, palpitations, tachypnea, tachycardia, use of accessory muscles of respiration, pulsus paradoxus, diaphoresis, and chest hyperinflation

Obstructive Pulmonary Disease: Asthma

Prognosis is relatively good.

Treatment

Control asthma by reduction of impairment and risk

Long-term control medications taken on a daily basis: antiinflammatory agents, long-acting bronchodilators, leukotriene modifiers, and corticosteroids

Quick relief medications treat acute symptoms and exacerbations.

Medications administered through a stepwise approach

Asthma

Assess effect of respiratory symptoms on activities of daily living (ADLs), quantity of breathlessness on a scale of 1—10, presence of asthma triggers, and frequency of need for bronchodilator therapy

Physical exam

Can you name three nursing diagnoses for asthma?

Asthma: Assessment and Diagnosis

Airway obstruction resulting from bronchospasm, excessive mucus production, tenacious secretions, adventitious breath sounds, or a combination of all of these

Decreased gas exchange resulting from alveolar–capillary membrane changes

Need for patient teaching resulting from lack of information and education about asthma

The patient will do the following:

Maintain a patent airway

Maintain arterial blood gas (ABG) values at baseline

Be able to demonstrate proper use of the PEFM

Be able to demonstrate relaxation techniques to control breathing

Be able to list the significant and reportable signs and symptoms

Asthma: Planning and Expected Outcomes

Educate on asthma self-management; basic facts about asthma; roles of medications; environmental control measures; the use of inhalers, spacers, and PEFMs; and a daily written action plan for management of exacerbations

Accommodate any neurologic changes such as altered senses, decreased fine motor movements, and memory loss.

Asthma: Intervention

Based on normal breath sounds and ability to clear secretions and maintain airways with a normal respiratory rate

Determine frequency of rescue inhaler use, success at avoiding triggers, and patient’s ability to monitor and address lifestyle changes

Asthma: Evaluation

Characterized by excessive mucous production with a chronic or recurrent cough on most days for a minimum of 3 months of the year for at least 2 consecutive years in a patient in whom other causes have been ruled out

Symptoms: persistent cough, dyspnea on exertion, purulent sputum, cyanosis, crackles on auscultation, tachycardia, pedal edema, unexplained weight gain, and a decreased PaO2 with a normal or elevated PaCO2

Obstructive Pulmonary Disease: Chronic Bronchitis

Characterized by progressive destruction of alveoli and their supporting structures

Physical signs: classic barrel chest appearance and use of accessory muscles of respiration

Clinical presentation: dyspnea on exertion or at rest, decreased weight, chronic cough with little sputum production, digital clubbing, hyperresonance of chest, elevated hemoglobin level, crackles, and wheezes

Obstructive Pulmonary Disease: Emphysema

Characterized by progressive airflow limitation that is not fully reversible where lung tissue becomes abnormally inflamed (chronic bronchitis and emphysema)

Progressive and ultimately fatal disease

Risk factors: age, male gender, reduced lung function, air pollution, exposure to secondhand smoke, familial allergies, poor nutrition, and alcohol intake

Obstructive Pulmonary Disease: COPD

Characteristic symptoms are chronic and progressive dyspnea, coughing, and sputum production.

Diagnosis is considered based on a history of exposure to tobacco smoke or other occupational irritants and progressive dyspnea, a chronic cough, and chronic sputum production.

Diagnosis should then be confirmed with spirometry testing.

COPD Signs and Symptoms, Diagnostic Tests, and Procedures

Include smoking cessation

Bronchodilators

Beta2-agonists

Anticholinergics

Glucocorticosteroids

Vaccines

Oxygen therapy

Surgical options

COPD Treatment

Evaluation effect of respiratory symptoms on ADLs; quantifying breathlessness on a scale of 1—10; identifying environmental and social factors that may be contributing to symptoms

Identify type of onset and any precipitating factors

Physical exam including percussion and auscultation

Can you name five nursing diagnoses for COPD?

COPD: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

The patient will do the following:

Maintain a patent airway

Maintain a stable weight

Maintain ABG values at baseline

Maintain a balanced intake and output

Effectively clear secretions

Demonstrate diaphragmatic and pursed-lip breathing

Demonstrate relaxation techniques to control breathing

Maintain a respiratory rate 16–25 breaths per minute

List significant and reportable signs and symptoms

COPD: Planning and Expected outcomes

Suggest pulmonary rehabilitation program.

Assist with smoking cessation.

Instruct on appropriate nutrition.

Teach diaphragmatic breathing and pursed-lip breathing, expectations of chest physiotherapy, pulmonary hygiene, medications, and proper use of inhalers.

Advise on home management of oxygen therapy.

Teach signs and symptoms of lung infection and exacerbation.

COPD: Interventions

Focuses on airflow as measured by spirometry, ability to accomplish ADLs, and minimization of exacerbations

COPD: Evaluation

The physical assessment on an older adult patients reveals the following: barrel chest, dyspnea on exertion, clubbing of the digits, and chronic cough and crackles in lower lung fields. These findings are consistent with which lung disorder?

Asthma

Emphysema

Pneumonia

Chronic bronchitis

Quick Quiz!

ANS: B

Answer to Quick Quiz

Leading cause of cancer deaths

Risk factors: tobacco, marijuana use, recurring inflammation, exposure to asbestos, talcum powder, or minerals; radon exposure, heredity, vitamin A deficiency, and exposure to air pollution

Small-cell lung carcinoma (SCLC)—most lethal

Non–small-cell lung carcinoma (NSCLC)—slow growing less aggressive

Restrictive Pulmonary Disease: Lung Carcinoma (CA)

Initial workup: CBC, CEA level, CXR, CT scan, ABGs, PFTs, and ECG

Sputum cytology used to determine cell type

If metastasis is suspected additional tests are performed.

Fiberoptic bronchoscope obtains tissue confirmation of diagnosis.

Surgical diagnosis includes cervical mediastinoscopy, mediastinotomy, and thoracotomy.

Lung CA Diagnostic Tests and Procedures

Treatment is based on histologic analysis and staging.

Options include surgery, radiation therapy, and chemotherapy based on staging.

Management of pain, nausea, vomiting, and chemotherapy-related side effects

Lung CA Treatment

Identification of risk factors for lung cancer

Common early signs: coughing, chest pain, and hemoptysis

Assessment of anxiety level

Can you name five nursing diagnoses for lung CA?

Lung CA: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

The patient will do the following:

Maintain ABG values at baseline

Sustain spontaneous respiration

Verbalize their feelings about the diagnosis of lung cancer

Have good pain control

Report a decrease in the number of episodes of breathlessness

Lungs will be clear on auscultation

Maintain a stable weight

Report feeling a decrease in fatigue

Maintain a realistic level of activity

Lung CA: Planning and Expected Outcomes

Provide relief of pain, emotional support, counseling, and discussion of options.

Provide factual information concerning diagnosis, treatment, and prognosis.

Encourage attitude of realistic hope.

Acknowledging patient’s spiritual and cultural background

Encouraging verbalization of feelings, perceptions, and fears

Lung CA: Intervention

Assess how often symptoms occur, how patient has been able to incorporate changes into lifestyle, and how symptoms alter patient’s ADLs.

Determine success of pain management and level of patient comfort.

Assess signs of depression.

Lung CA: Evaluation

Caused by mycobacterium tuberculosis organism

Seen in populations living in close quarters and in those with little or no health care or preventive care

Number one fatal and communicable disease in the United States

Transmitted by inhalation of infected droplets aerosolized in air from cough or sneeze

Changes in immune system increase the risk for reactivation of TB.

Restrictive Pulmonary Disease: Tuberculosis (TB)

Skin testing is an unreliable indicator of TB because older adults are more likely to have false-negative results due to reduced immune system activity.

Chest x-ray

Additional testing for positive PPD, symptoms, and a positive CXR: CBC, erythrocyte sedimentation rate, chemistry panel, sputum test for AFB performed three times, and a bone marrow biopsy

TB Diagnostic Tests and Procedures

Standard four-drug anti-TB therapeutic regimen will cause a rapid reduction in the number of viable mycobacteria within 2 weeks.

Most common drugs: isoniazid, rifampin, ethambutol, streptomycin, and pyrazinamide

Monitoring of liver function on a monthly basis is recommended.

Multidrug resistant TB is on the rise.

Prognosis is good if the patient follows the medical regimen and maintains good nutrition.

TB Treatment and Prognosis

Signs and symptoms: fatigue, weight loss, weakness, night sweats, low-grade fever, purulent sputum, and sputum positive for AFB

With disease progression: hemoptysis, lung consolidation, crackles and wheezes on auscultation, upper-lobe patchy infiltrates, and cavitation on chest radiography

Can you name four nursing diagnoses for TB?

TB: Assessment and Diagnosis

Inadequate breathing pattern, resulting from decreased lung capacity

Need for health teaching, resulting from lack of knowledge about the disease process and therapeutic regimen

Noncompliance, resulting from lack of knowledge of disease process, lack of motivation, and long-term nature of treatment

Inadequate nutrition, resulting from chronic poor appetite, fatigue, and productive cough

The patient will do the following:

Demonstrate safe coughing techniques

Verbalize the medication regimen

Verbalize the side effects of the anti-TB medications

Verbalize the need for continued medication

State how TB is transmitted

Verbalize feelings related to social isolation

TB: Planning and Expected Outcomes

Educate about measures necessary to prevent further TB transmission.

Teach the importance of continued medication administration and good nutrition.

Inform patient on the drug side effects to report to the health care practitioner.

Provide psychological interaction and support.

TB: Intervention

Assessment of medication compliance

Evaluate compliance with public health measures

Monitoring of hepatic and renal function and repeated sputum cultures for AFB

Evaluate for depression

TB: Evaluation

Inflammation of lung parenchyma, usually associated with filling of the alveoli with fluid

Can be viral, bacterial, or caused by aspiration

Extremely serious illness that often results in death

Increased risk of mortality related to the normal age-related deterioration of the immune system, increased likelihood of chronic illnesses, weakened cough reflex, and decreased mobility

Atypical symptoms such as altered mental status, dehydration, and a failure to thrive may also be seen.

Pneumonia

Lower respiratory tract infection that has an onset in community or within first 2 days of hospitalization

Classic symptoms: fever, coughing, sputum production, general feelings of fatigue and malaise, and shortness of breath

Do not always exhibit a fever and coughing but often have: dehydration, confusion, and a respiratory rate greater than 26 breaths/min

Streptococcus pneumoniae is the leading cause.

Community-Acquired Pneumonia (CAP)

New-onset pneumonia seen in patients who: Was hospitalized in an acute care facility after 2 days or longer within 90 days of the infection; resided in a long-term care facility; received recent intravenous antibiotic therapy, chemotherapy, or wound care within a month of the current infection; or was seen in a hemodialysis facility

Ventilator-associated pneumonia (VAP) occurs more than 48 hours after endotracheal intubation.

Health Care–Associated Pneumonia (HCAP)

Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli most often cause nosocomial pneumonia.

Older adults more likely to be in high-risk areas: residential centers, hospitals, and extended care facilities

Nosocomial Pneumonia

Viral pneumonia most often associated with a history of the influenza A virus

Aspiration pneumonia is associated with: stupor, coma, cardiopulmonary resuscitation, alcohol or drug intoxication, neurologic illness, nasogastric feeding, and general anesthesia

Other Pneumonias

Diagnosis based on history and signs and symptoms

Laboratory sampling includes total white WBC, blood cultures, Gram stain, and sputum culture.

CXR—anterior, posterior, and lateral

Pneumonia Diagnostic Tests and Procedures

Administration of appropriate antibiotics, hydration, good nutrition, and rest

Length of treatment with antibiotics can range from 10 to 14 days, depending on the causative organism.

Severity of the illness, site of acquisition, age, and presence of comorbid illnesses are all considerations in determining initial antibiotic therapy.

Pneumonia Treatment

Clinical improvement usually occurs between 3 and 5 days.

Most common cause of death in older adults because of altered immune response related to aging, underlying chronic disease, and diminished cough reflex

Pneumonia Prognosis

History of fatigue, malaise, decreased appetite and fluids, and a viral infection

Fever, chills, shortness of breath, sputum production, and an abnormal chest examination

Complete respiratory assessment

Assess for dehydration and confusion

Be alert to signs and symptoms of an increasing severity of illness and potential need for intensive care

Can you name five nursing diagnoses?

Pneumonia: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

The patient will do the following:

Maintain a patent airway

Maintain a PaO2 of 80 mmHg by ABG analysis or an SaO2 greater than 90% by pulse oximetry

Have decreased complaints of fatigue

Have clear lungs on auscultation

Be able to clear secretions effectively

Be able to sleep through the night without episodes of breathlessness or coughing

Maintain baseline vital signs and weight

Pneumonia: Planning and Expected Outcomes

Maintenance of hydration, promotion of effective airway clearance, and proper positioning

Monitoring fluid status, vital signs, and oxygenation parameters

Maintaining a clean environment, and assisting patient with airway clearance by encouraging coughing or by suctioning

Provide early vaccination.

Assess for potential for aspiration.

Pneumonia: Intervention

Achievement of expected outcomes, return of sputum to preinfection color and consistency, and return to baseline respiratory status

Monitor patient for adequate hydration by assessing vital signs, body weight, and tissue turgor.

Monitor patient’s lungs for adventitious lung sounds and use of accessory muscles of respiration.

Pneumonia: Evaluation

History of foreign travel is imperative to determine if he or she had exposure or close contact within 10 days of symptoms with a person known to have or suspected of having SARS.

Signs and symptoms: temperature over 100.4°F, coughing, shortness of breath, dyspnea, or hypoxemia

Treatment is usually supportive.

Severe Acute Respiratory Syndrome (SARS)

Most common form of PE caused by the increased capillary hydrostatic pressure that results from myocardial infarction, mitral stenosis, decreased myocardial contractility, left ventricular failure, or a fluid overload

Acute cardiogenic PE presentation: acute shortness of breath, orthopnea, frothy, blood-tinged sputum, cyanosis, diaphoresis, and tachycardia

Cardiogenic Pulmonary Edema (PE)

Diagnosis is based on clinical presentation and diagnostic testing ABG measurements.

Biomarker, B-type natriuretic peptide (pro-BNP) may be drawn to help provide additional data for cardiogenic vs. noncardiogenic pulmonary edema.

Hemodynamic measurements reveal decreased cardiac output, increased pulmonary artery pressure, and right-sided heart pressure in biventricular failure.

Cardiogenic PE Diagnostic Tests and Procedures

Reduce preloading and after loading and correct the underlying process if possible.

Supplemental oxygen administration

Diuresis and pulmonary/cardiac dilation

Morphine reduces anxiety which reduces oxygen demand.

Peripheral vasodilation

Inotropic support

Cardiogenic PE Treatment

Good when symptoms are easily reversed and cardiac complications are controlled

Cardiac or lung disease increases risk for complications.

Extensive rehabilitation and physical therapy may assist older adults to return to independent living and baseline ADLs.

Cardiogenic PE Prognosis

Pulmonary edema results from a variety of noncardiac causes.

Includes: Adult respiratory distress syndrome (ARDS), reexpansion pulmonary edema, and neurogenic pulmonary edema

Other causes include: Posttraumatic head injury, salicylate toxicity, pulmonary embolus, and opioid overdose

Noncardiogenic PE

Diagnosis is based on clinical presentation and diagnostic testing.

ABG

Biomarker, B-type natriuretic peptide (pro-BNP) helps provide additional data for cardiogenic vs. noncardiogenic pulmonary edema.

Hemodynamic measurements

ARDS Diagnostic Tests and Procedures

Supplemental oxygen therapy, ventilation support, and maintenance of hemodynamics

Neuromuscular blocking agents, sedatives, and narcotics

Positive end-expiratory pressure added to mechanical ventilation to improve oxygenation

Pulmonary artery catheter used to monitor fluid volume status

Fluids and vasopressors may be indicated for maintenance of adequate blood pressure.

ARDS Treatment

Fair to poor with a mortality rate is approximately 30%–60%.

If mechanical ventilation is not required, the prognosis is good to fair.

ARDS Prognosis

Evaluate respiratory and cardiac status

Identify predisposing factors

Assess for signs and symptoms

Can you name at least six nursing diagnoses for PE?

PE: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

The patient will do the following:

Maintain ABG values and oxygenation within normal limits

Have a cardiac output within normal values

Verbalize feelings related to the illness

Maintain a patent airway and balanced intake and output

Communicate effectively if receiving mechanical ventilation

Maintain skin integrity

Sustain spontaneous ventilation without mechanical ventilation

Have stable hemodynamics

PE: Planning and Expected Outcomes

Daily weights, energy-conserving ADLs, elevation of the feet and legs, reduction in or elimination of sodium intake, and use of diuretics

Assess respiratory status

Position patient to facilitate ventilation/perfusion efforts

Discussion about patient’s wishes in regard to high-technology medical care and advanced directives

Supplemental oxygen, mechanical ventilation, and nursing measures to promote oxygen balance

PE: Intervention

Based on improvement in clinical picture, resolution of symptoms, and prevention of further complications

Monitor vital signs, cardiac function, and oxygenation status for stability and improvement.

Monitor older adult’s reaction to frightening therapies and invasive interventions.

Evaluate daily weight and intake and output.

Monitor the patient’s subjective measure of dyspnea.

PE: Evaluation

Blockage of pulmonary arteries by a thrombus, fat, or air embolus from a deep vein thrombosis

Occlusion of lung with a large embolus causes pulmonary infarction, necrosis of lung tissue.

Clinical presentation: coughing, dyspnea at rest, hypotension, hypoxia, hemoptysis, tachycardia, anginal or pleuritic chest pain, decreased PaO2, and S3 or S4 gallop

Pulmonary Emboli

Diagnosis based on ventilation/perfusion lung scan (VQ scan) or pulmonary angiography

ABG measurements

ECG

Chest x-ray

D-dimer

Pulmonary Emboli Diagnostic Tests and Procedures

Heparin is drug of choice.

Thrombolytic therapy in patients with extensive pulmonary emboli and hemodynamicaly unstable

Long-term with warfarin

Recurrent pulmonary emboli are candidates for Greenfield vena cava filters.

Prognosis is variable.

Pulmonary Emboli Treatment and Prognosis

Identify risk factors.

Clinical signs and symptoms: sudden dyspnea, chest pain, restlessness, a weak, rapid pulse, tachypnea, and tachycardia

Can you name three nursing diagnoses for pulmonary emboli?

Pulmonary Emboli: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

The patient will do the following:

Maintain ABG values within normal limits

Maintain adequate respiratory muscle function

Be able to sustain spontaneous ventilation without mechanical ventilation

Maintain adequate oxygenation

Have adequate pain control

Maintain adequate cardiac output

Maintain adequate vital signs

Pulmonary Emboli: Planning and Expected Outcomes

Monitor tissue oxygen delivery, signs and symptoms of respiratory failure, laboratory values, hemodynamic parameters, and respiratory pattern.

Initiate heparin therapy.

Reassure patient and monitor vital signs.

Intravenous fluids and vasopressors if necessary

Monitor for bleeding complications.

Promote mobility as soon as medically possible.

Antiembolic stockings, passive and active ROM

Educate on anticoagulant therapy.

Pulmonary Emboli: Intervention

Based on successful achievement of expected outcomes

Monitor patient’s response to oxygen therapy, respiratory support, and effective pain management and relief by using a pain scale.

Monitor patient for follow-up care with INR blood draws, dietary restrictions, and medication compliance.

Pulmonary Emboli: Evaluation

Disorder of breathing during sleep due to periodic reduction (hypopnea) or cessation (apnea) of breathing due to an obstruction of the upper airway

Results in partial awakening with a startle response of snorts and gasps, which move tongue and soft palate and relieve obstruction

Can have chronic affects on the cardiovascular system

Cycle of apnea and arousal may occur as many as 200–400 times in 8 hours of sleep.

Obstructive Sleep Apnea Syndrome (OSAS)

Obesity is a dominant risk factor.

Other risk factors include family history, genetic syndrome, smoking, alcohol use, employment requiring shift rotation or sleep restrictions, medications, and ethnicity.

OSAS Risk Factors

Diagnosis of OSAS is made based on the history and the objective measurement in tandem with polysomnography (PSG) in the sleep laboratory.

Sleep study criteria include more than five episodes of obstructive apnea longer than 10 seconds in duration per hour of sleep and one or more of the following: frequent arousal from sleep, bradycardia, tachycardia, and arterial oxygen desaturation associated with apneic episodes.

OSAS Diagnostic Tests and Procedures

Teaching patient to avoid alcohol or sedatives at bedtime, humidify air, and wear dental device to keep jaw forward; weight loss should also be encouraged.

Nasal continuous positive airway pressure (CPAP)

Surgical interventions include tracheotomy or uvulopalatopharyngoplasty.

Weight loss and daily use of nasal CPAP are essential for a good prognosis.

OSAS Treatment and Prognosis

Assess for the presence of chronic loud snoring, gasping or choking episodes during sleep, excessive daytime sleepiness, automobile or work-related accidents attributed to fatigue, and personality changes or cognitive difficulties

Clinical signs: obesity, systemic hypertension, nasopharyngeal narrowing, and, in rare cases, pulmonary hypertension and cor pulmonale

Can you name three nursing diagnoses for OSAS?

OSAS: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

The patient will do the following:

Verbalize a feeling of rest and well-being

Verbalize an improvement in quality of life

Report an absence of sleepy episodes during the day

Have increased ability to concentrate and endurance

Maintain adequate vital sign

Maintain adequate oxygenation and ventilation during sleep

Achieve or maintain appropriate body weight

OSAS: Planning and Expected Outcomes

Monitoring patient’s sleep pattern, noting physiologic and psychologic circumstances that interrupt sleep

Implementing sleep-promoting therapies such as massage, lifestyle changes, bedtime routines, and use of CPAP

Assist patient with nutrition counseling, weight reduction, and exercise plans

OSAS: Intervention

Based on achievement of expected outcomes and improvement in patient’s perception of sleep

Evaluate patient’s daytime somnolence and ability to complete ADLs, note frequency of naps, and monitor for lower extremity edema, fluid retention, and weight gain.

OSAS: Evaluation

The nurse is teaching the patient and his spouse about OSA. What needs to be included in the teaching? (Select all that apply.)

Take a mild sedative to help you stay asleep.

Avoid alcohol prior to bedtime.

Use the CPAP machine every night.

Try to lose excess weight.

Try to take a nap every day.

Quick Quiz!

ANS: B, C, D

Answer to Quick Quiz