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CHAPTER 20 Caring for Clients With Upper Respiratory Disorders

NURSING PROCESS FOR THE CLIENT WITH LARYNGEAL OBSTRUCTION (continued)

Acute Anxiety: Related to airway obstruction and decreased ability to breathe Expected Outcome: Client will demonstrate a decreased level of anxiety.

• Assess level of apprehension. Anxiety increases with respi ratory difficulties. Fear can interfere with ability to follow instructions. • Monitor for increased respiratory rate and irritability. These signs indicate increased anxiety.

• Provide brief explanations. Increased anxiety impairs ability to focus. • Reassure client that they are safe—stay with client. An anx ious client will benefit from the nurse’s calm and reassuring presence.

Knowledge Deficiency: About allergic reaction related to administration of contrast agent Expected Outcome: Client will verbalize understanding and need to report reaction to contrast agents and the need for alternative tests or prophylactic treatment prior to procedures.

• Teach the client to avoid the source of the allergic reaction by reading labels and asking if certain allergens are included in a treatment or procedure. Avoiding sources of the allergen prevents future allergic reactions. • Explain the nature of the allergic reaction: causes, symp toms, and complications. Having knowledge of the problem

and its potential issues assists the client to avoid the problem and to seek immediate treatment. • Teach the client to inform all healthcare providers of the allergic reaction. Informing healthcare providers is key to avoiding future exposure to the allergen or for prophylactic treatment prior to procedures.

Evaluation of Expected Outcomes

The airway is free of obstruction, and breathing patterns im prove. Client reports decreased anxiety and is able to verbalize knowledge and understanding of the allergic reaction, its cause

and treatment, and the necessity to avoid future exposure by informing healthcare providers.

OSA results from a reduced diameter of the upper air way, which may develop when the upper airway collapses secondary to the normally reduced muscle tone during sleep. The repeated apneic spells have serious effects on the car diopulmonary system. Clients with sleep apnea often have hypertension and are, therefore, at higher risk of cerebro vascular accident and myocardial infarction (MI) as well as heart dysrhythmia and heart failure. Assessment Findings During sleep, clients with OSA snore loudly, with cessation of breathing for at least 10 seconds. These episodes may oc cur many times within 1 hour, from as few as 5 to 30 times and up to a total of several hundred per night. Clients awaken suddenly as the PaO 2 level drops, usually with a loud snort. Other symptoms include daytime fatigue, morning head ache, inability to concentrate when awake, sore throat, en uresis, and erectile dysfunction. Partners may report that the client behaves differently and is not the same in personality and that the snoring progressively worsens. Box 20-1 re views symptoms of sleep apnea. Initial diagnosis is made according to the client’s reported symptoms. These include symptoms of sleep ap nea, such as loud snoring, gasping or snorting, morning headaches, or unusual tingling sensations or muscle jerk ing in the extremities. Sleep partners are sometimes better able to answer these questions. Clients may be asked to keep a sleep diary for a few weeks, recording how many hours of sleep a night, number of times waking up during the night and how long it takes to fall asleep, how rested

clients feel when they wake up, and if they experience sleepiness during the day. To determine the nature of the sleep apnea, clients un dergo polysomnography , which consists of tests that moni tor the client’s respiratory and cardiac status while asleep. Specifically, a polysomnogram records a client’s brain activ ity, eye movement, muscle movement, respiratory, and heart rates; the amount of air that moves in and out of the lungs; and the oxygen concentration in the blood. Clients stay overnight at a sleep study lab and have electrodes and other monitors placed on their scalps, face, chest, and extremities. If OSA is diagnosed during the first half of the sleep study, clients will be placed on continuous positive airway pressure (CPAP) for the rest of the night to determine whether the sleep patterns improve.

Symptoms of Sleep Apnea

BOX 20-1

• Loud snoring • Stop in breathing during sleep (can be reported by another person)

• Gasping for air during sleep • Awakening with a dry mouth • Morning headache • Difficulty staying asleep (insomnia) • Excessive daytime sleepiness (hypersomnia) • Difficulty paying attention while awake • Irritability

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