Care of Patients with Non-Infectious Upper Respiratory Problems Flashcards
Cyclical obstruction of the upper airway that occurs during sleep secondary to muscle relaxation - because relaxed when sleeping and muscles relaxed; not going to relax and obstruct and stay that way will be cyclical; relax and be obstructed and client wakes up because obstructed upper airway and go back to sleep and once deeper sleep relax enough and obstruct again and cycle cont throughout night
Sleep apnea: Breathing disruption during sleep that lasts at least 10 seconds (is sleep apnea) and occurs a minimum of 5 times in an hour - quite a bit
When the airway is obstructed apnea occurs and the patient is awakened and breathe again and cycles throughout the night
Apnea increases blood CO2 and leads to acidosis: Severe obstructive sleep apnea not able get rid CO2 - not able exchange gases and build it up and can have resp acidosis when have chronic severe sleep apnea; have resp acidosis and high CO2 levels can make you more sedated which worsens obstructive sleep apnea
Patho
Most common cause is upper airway obstruction by the soft palate or tongue - obstructive sleep apnea
Can have a neurological cause - central sleep apnea
Contributing factors:
causes/contributing factors
Obesity - most common cause; also have larger neck, increase in tissue around neck and cause obstructions; overweight and diagnosed with sleep apnea work on weight reduction
Large uvula - enlarged can cause obstruction
Short neck
Smoking - increase risk of sleep apnea
Enlarged tonsils or adenoids - can possibly obstruct
Oropharyngeal edema - can cause the obstruction
Contributing factors:
One more diff diagnoses because people not know what happens when sleeping and person reports might have sleep apnea not pat but person sleep with: snore, wake up a lot
Patient is often unaware
Persistent daytime sleepiness/lethargy - related to fact not sleeping well at night and sleep constantly getting interrupted
Wakes up tired - related to fact not sleeping well at night and sleep constantly getting interrupted
Frequent disruptions in sleep
Snoring - big one; if snore a lot may have sleep apnea
Irritability and personality changes - high CO2 levels occur over time and not sleeping adequately
Takes awhile for diagnosis for clients; lot screening for sleep apnea at annual check ups because over time have sig effects on resp sys and on CV sys and detrimental - need identify and address it
s/s
Epworth Sleepiness Scale
Polysomnography (full “sleep study”)
Overnight strip oximetry
Assessment
Question survey to assess how much daytime sleepiness person has; diff scenarios where person without excessive sleepiness not fall asleep and how likely that person would
Screening tools - not tell have sleep apnea but have excessive daytime sleepiness
Epworth Sleepiness Scale
Monitors EEG (neurological activity in brain), ECG, pulse oximetry, and EMG (muscle func); brain, heart, resp, muscles - check everything
Monitors type of sleep, depth and rate of breathing, oxygen saturation, and muscle movement - give specific diagnosis if having sleep apnea or apnea and how long lasts and often
If on breathing machine - NPP machine - come in and do repeat sleep study while on machine prescribed and see if decreased apnea
Diagnose and come up with treatment plans; done in sleep lab; come in overnight and bring as much normal pillow
Polysomnography (full “sleep study”)
Monitors for oxygen desaturation during sleep
O2 sat on pat and sleep overnight and monitors how much desaturate because with apnea O2 levels go down records how many times desturation, how long, and how long takes to recover; screening
Only a preliminary test
Overnight strip oximetry
Change in sleep position - elevated sig decrease number episodes
Weight loss - first things advise clients do if overweight and sometimes all need
Position-fixing devices to prevent subluxation of the tongue & neck structures - devices in back of throat to keep tongue from going back and obstructing and decrease enlargement in neck structures
Drug therapy approved for sleep apnea Modafinil (Attenance, Provigil) - not treat obstructive sleep apnea; stimulant - more functional during day
Severe apnea may require non invasive positive-pressure ventilation (NIPPV)
Nonsurgical interventions
Decreases obstruction
Position-fixing devices to prevent subluxation of the tongue & neck structures - devices in back of throat to keep tongue from going back and obstructing and decrease enlargement in neck structures
Treats daytime sleepiness not the OSA
Drug therapy approved for sleep apnea Modafinil (Attenance, Provigil) - not treat obstructive sleep apnea; stimulant - more functional during day
Keeps airway open - + pressure - blown into airway - keeping it from collapsing or obstructed
CPAP
BiPAP
APAP
Proper fit of mask is essential and imp - in order for pats to feel comfy when using NIPPV machines is have good mask - number masks available - depends on client; everyone diff; whatever mask best for client and airway pressure needed; comfort really imp; careful of pressure on skin and making sure all sites look ok; if mask not sealed and air leaking + pressure not as effective or get there - hear alarms; use own mask is preferable to pats
Can blend in O2 through machine so get O2 and + pressure
Severe apnea may require non invasive positive-pressure ventilation (NIPPV)
(continuous positive airway pressure)
one continuous pressure set at and what be at
First thing try use but if sleep apnea not improve go to BiPAP
CPAP
(bilevel positive airway pressure)
two different pressures for inhalation and exhalation
Little more like ventilator for life support; severe enough sleep apnea may need bilevel settings at home; can be done at home
BiPAP
(automatic positive airway pressure)
machine adjusts pressure based on patient needs
Pressure set depending on how pat breathing - more pressure if needed; lot more high tech machine; used in hospital a bit; some go home; more in inpat
Can use at home
APAP
