Interferences with Ventilation Objectives Describe causes, pathophysiology, clinical manifestations, therapeutic interventions, & nursing management of patients with obstructive pulmonary disease of the upper and lower airway Describe causes, pathophysiology, clinical manifestations, therapeutic interventions, & nursing management of patients with obstructive pulmonary disease of the upper and lower airway Sleep apnea, asthma in child & adult, emphysema, chronic bronchitis, COPD Sleep apnea, asthma in child & adult, emphysema, chronic bronchitis, COPD

Interferences with Ventilation Chronic Airflow Problems Nonreversible Obstructive Upper Airway Disorder Nonreversible Obstructive Upper Airway Disorder Obstructive sleep apnea Obstructive sleep apnea Breathing disruption during sleep that lasts at least 10 seconds at least 5 times in an hour. Breathing disruption during sleep that lasts at least 10 seconds at least 5 times in an hour. Cause: upper airway obstruction by the tongue. Cause: upper airway obstruction by the tongue.

Obstructive Sleep Apnea (OSA)

Clinical Manifestations: insomnia, daytime sleepiness; witnessed apneic episodes; snoring; morning headaches; impaired concentration & memory Clinical Manifestations: insomnia, daytime sleepiness; witnessed apneic episodes; snoring; morning headaches; impaired concentration & memory Dx: Polysomnography (sleep study) – multiple episodes of apnea or hypopnea (airflow diminished % with respiratory effort) Dx: Polysomnography (sleep study) – multiple episodes of apnea or hypopnea (airflow diminished % with respiratory effort) Combination of ECG, EEG, EMG, and pulse oximetry Combination of ECG, EEG, EMG, and pulse oximetry

Obstructive Sleep apnea (OSA) TX: TX: Non-surgical: Avoid sedatives & alcohol 2-4 hrs prior to sleep; compliance with nCPAP / BiPAP Non-surgical: Avoid sedatives & alcohol 2-4 hrs prior to sleep; compliance with nCPAP / BiPAP nCPAP – continuous + airway pressure cm H2O pressure nCPAP – continuous + airway pressure cm H2O pressure BiPAP – bilevel + airway pressure – delivers higher pressure during inspiration & lower pressure during expiration BiPAP – bilevel + airway pressure – delivers higher pressure during inspiration & lower pressure during expiration APAP – autotitrating positive airway pressure APAP – autotitrating positive airway pressure Medications: Modafinil (Provigil) controls narcolepsy – promotes daytime wakefulness Medications: Modafinil (Provigil) controls narcolepsy – promotes daytime wakefulness Surgical: Surgical: Adenoidectomy; Uvulectomy; or remodeling of the entire posterior oropharynx Adenoidectomy; Uvulectomy; or remodeling of the entire posterior oropharynx Tracheostomy may be needed for severe OSA Tracheostomy may be needed for severe OSA

Obstructive Sleep Apnea (OSA) Collaborative Care Assessment : VS; pulse oximetry; observation during sleep – snoring heavily; safety when changing position; daytime sleepiness; assess effectiveness of positive-pressure ventilation during use. Assessment : VS; pulse oximetry; observation during sleep – snoring heavily; safety when changing position; daytime sleepiness; assess effectiveness of positive-pressure ventilation during use. Interventions: Coordinate with respiratory therapy to apply positive-pressure ventilation ; NPO when using the apparatus; Interventions: Coordinate with respiratory therapy to apply positive-pressure ventilation ; NPO when using the apparatus; Education: Sleep cycles; medication; safety; equipment care. Education: Sleep cycles; medication; safety; equipment care.