Oxygenation and Sleep-Rest Disorders: Nursing Care of the Patient with Sleep Apnea PDF

Oxygenation and Sleep- Rest Disorders: Nursing Care of the Patient with Sleep Apnea NURS 1250/1610 Victoria Leonetti, MSN, RN Emily Raddell, MSN, RN Student Course Learning Outcomes Provide Demonstrate Relate Explain Provide safe, D...

Oxygenation and Sleep- Rest Disorders: Nursing Care of the Patient with Sleep Apnea NURS 1250/1610 Victoria Leonetti, MSN, RN Emily Raddell, MSN, RN Student Course Learning Outcomes Provide Demonstrate Relate Explain Provide safe, Demonstrate Relate the Explain patient- intermediate impact of quality management of centered, levels of critical improvement care concepts evidence-based thinking & measures to for adult nursing care clinical improved patients guided by the reasoning to patient care Caritas provide quality philosophy patient care Pathophysiology & Etiology: Sleep Apnea (obstructive)- “OSA” Breathing disorder characterized by a narrowing of the upper airway that impairs normal ventilation during sleep (complete/partial airway obstruction) Blocked by soft palate, tongue, and uvula Apnea- significant reduction or cessation of breathing while sleeping Unofficially, >10-20 seconds of breathing pauses followed by loud snore or awakening Can happen hundreds of times each night 5 or more apneic episodes per hour is diagnostic Repeated disruption of deep sleep Increases blood CO2 levels, decreased in blood pH (ACIDOTIC) >12 million people affected- significant!! (18-25 million estimated) Pathophysiology and Etiology- OSA  OBESITY Men > Women Men- 14% Women- 5% Risk Thick neck >17 inches in males Factors >16 inches in females Enlarged tongue, uvula, tonsils, adenoids Possible genetic- thought to run in families Small upper airway Recessed chin Diabetes, hypertension, cigarette smoking  Snoring Gasping during sleep Frequent nighttime awakenings Clinical Five or more apneic episodes per hour Manifestatio lasting 10-20 seconds each ns Irritability Morning headaches Daytime drowsiness Diagnostic Tests STOP-BANG score assessment: Diagnostic Tests Diagnostic Tests Polysomnography, Polysomnogram- “sleep study” Measures: Air flow Blood oxygen levels Heart rate Breathing patterns Eye/leg movements Electroencephalogram (EEG) also used to monitor brain waves associated with NREM and REM sleep patterns Nonpharmacologic Therapy Weight reduction Avoid alcohol Smoking cessation Avoid supine position for sleeping Encourage side-lying position Continuous positive airway pressure (CPAP) Prevents collapse and obstruction of the airway to relieve apneic episodes Bi-level positive airway pressure (BiPAP) Produces less pressure during exhalation and more pressure during inhalation Surgery Tonsillectomy Adenoidectomy Partial removal of the soft palate, uvula, and posterior lateral pharyngeal wall Uvulopalatopharyngoplasty (UPPP) Surgery options usually considered only if nonpharmacologic therapies not tolerated or effective