Timby's MedSurg 14e

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UNIT 5 Caring for Clients With Respiratory Disorders

Oximetry may be done to monitor and record oxygen levels while a client sleeps. With OSA, oxygen levels drop during sleep and rise when the client wakens. Healthcare providers may have clients do portable monitoring at home, which is a home version of polysomnography. Medical and Surgical Management Treatment for sleep apnea focuses on improving the quality of nighttime sleep and daytime wakefulness as well as re ducing risks for cardiovascular problems. Depending on the severity of sleep apnea, clients may change their lifestyle, to include the following: • Lose weight • Exercise regularly • Quit smoking • Eliminate alcohol or other medications that depress respi rations and contribute to an inability to maintain an open airway • Use special pillows to keep clients in a side-lying position when sleeping • Use allergy medications or saline nasal spray to reduce congestion and dryness Another treatment is fitting the client for an oral appliance that assists in adjusting the lower jaw and tongue so that the airway remains open while the client is sleeping. A dentist or orthodontist fits the client for a custom-made oral appliance. Additional treatment includes the use of noninvasive positive pressure ventilation (NPPV), which is the applica tion of positive pressure via full face mask, nasal mask, or cannula with supplemental oxygen to enhance ventilation. There are two commonly used types: • CPAP : provides constant airway pressure during inspira tion and expiration • Bilevel positive airway pressure (BiPAP) : provides two lev els of pressure: inspiratory and expiratory airway pressures With this treatment, the client receives airway pressure either through their own inspirations or by machine-initiated inspirations. A set number of breaths are delivered. Clients are often not compliant because they do not like the continu ous pressure of CPAP or the varying pressures of BiPAP or do not like using equipment and oxygen every night. In addi tion, these methods do not completely eliminate the problem. A newer technology referred to as auto-titrating continu ous positive airway pressure (APAP) automatically adjusts airway pressure as needed. Side effects of positive pressure ventilation include dry mouth, rhinitis, and sinus congestion. Surgical procedures may be done to relieve the obstruc tion. The most common surgery is uvulopalatopharyngo plasty (UPPP), a surgical procedure to remove tissues in the throat, including the uvula, palate, and pharynx, to relieve obstruction. Modified procedures can be done with laser (laser-UPPP) or with radiofrequency energy (radiofrequency ablation) to reduce snoring. Jaw surgery involves maxillomandibular advancement, which involves moving the upper and lower parts of the jaw forward, in order to increase the space behind the tongue and

soft palate, which decreases the obstruction. This is gener ally done by an oral surgeon. Complications may include bleeding, mouth numbness, infection, or problems with the temporomandibular joint. For clients who experience mild OSA, a Pillar proce dure may be performed. It involves the insertion of three small polyester rods into the soft palate. These rods become stiff and add support to soft palate tissue, reducing its col lapse and, thus, decreasing snoring. Tracheostomy is a successful treatment. Clients may re ject this option, however, because of the trauma, the seem ingly barbaric nature of the procedure, and the alteration that it creates in appearance. Tracheostomy also may be technically difficult if the client is markedly obese. If a client chooses to have a tracheostomy, they might plug it during the day. Hypoglossal nerve stimulation therapy is an alternative surgical treatment for OSA. It was approved by the Food and Drug Administration in 2014. According to an article from the Mayo Clinic, a small impulse generator is implanted be neath the clavicle, and senses displacement of the tongue and adjusts its position, to decrease OSA (Mayo Clinic, 2021a). Medication sometimes is prescribed for central sleep apnea, and clients take such drugs at bedtime. The goal is to increase the respiratory drive and improve upper airway muscle tone. An example of a medication for this purpose is protriptyline (Vivactil, Triptil). Clients may also use low flow oxygen at night to relieve hypoxemia. Nursing Management Clients with sleep apnea are usually anxious and require reas surance and adequate instruction about their condition. The nurse provides thorough explanations of the disease process, polysomnography, and treatments referring clients to self-help groups or to appropriate counseling for weight loss or alcohol and substance misuse issues. The nurse collaborates with re spiratory therapists to instruct the client in the use of CPAP or other NPPV and furnishes the client with information about sleep apnea and its potential complications if not treated. LARYNGEAL CANCER With early detection, cancer of the larynx has a high po tential for cure. Preventive health measures focus on early consultation for persistent hoarseness and other changes in voice quality. Pathophysiology and Etiology In all, 12,650 new cases of laryngeal cancer (10,030 in males and 2,620 in females) were diagnosed in 2024, according to the American Cancer Society (2024). The rate of new instances of laryngeal cancer is falling by about 2% to 3% a year, most likely because fewer people are smoking (Huang et al., 2024). The cause of laryngeal cancer is unknown. Carcinogens such as tobacco, smokeless tobacco, secondhand smoke, al cohol, and industrial pollutants are associated with laryngeal cancer. In addition, chronic laryngitis, specific viruses such as the human papillomavirus (HPV), and acid reflux may be

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