Respiratory assessment and obstructive sleep apnea

Nursing responsibilities after a bronchoscopy

keep patient NPO until gag reflex returns, monitor for recovery from sedation

Normal findings after bronchoscopy

dry cough, sore throat, blood-tinged sputum/mucus

What are 3 serious life-threatening complications that require immediate provider notification?

hemorrhage, pneumothorax, and bronchospasms

Normal respiratory assessment findings

Normal respiratory pattern, No obvious respiratory distress, Able to speak normally, No significant accessory muscle use, Normal skin color, Symmetric chest movement

Abnormal respiratory assessment findings

Increased work of breathing, Accessory muscle use, Difficulty speaking because of breathing, Abnormal respiratory pattern, Respiratory distress, Abnormal skin color, Asymmetric chest movement

Increased tactile fremitus

lung consolidation

Decreased tactile fremitus

air or fluid blocking sound transmission

Hyperresonance

excess air

Dullness

fluid, consolidation, atelectasis

Crackles

discontinuous clicking or rattling like salt on a hot pain

Coarse crackles

low-pitched (sound blowing thru straw under water)

Fine crackles

high-pitched, end of expiration, alveoli “snap” open

Wheezing

high-pitched, musical or low-pitched rattling

Stridor

upper airway high-pitched disruption in larynx or trachea

Pleural friction rub

grating inflammation between visceral and parietal pleura

Obstructive sleep apnea clinical manifestations

frequent arousals during sleep, insomnia, excessive daytime sleepiness, witnessed apneic episodes, snoring, morning headache, irritability

Obstructive sleep apnea risk factors

overweight, thick/large neck, small airway, enlarged tonsils/adenoids, older age, high BP, chronic nasal congestion, smoking, male, diabetes, family history, asthma

OSA complications can result in

hypertension, cardiovascular changes, poor concetration/memory, impotence, depression

Diagnosis for OSA is based on what?

PSG- plysomnography

Mild sleep apnea management

sleeping on one side, elevate HOB, avoiding sedatives and alcohol 3-4 hrs before sleep, weight loss, oral appliance

Severe sleep apnea management (>15 apnea/hypopnea events/hr)

CPAP, BiPAP, surgery

What are two surgeries for severe sleep apnea?

uvulopalatopharyngoplasty and genioglossal advancement and hyoid myotomy

What are examples of positive airway pressure devices for sleep apnea?

nasal mask, nasal pillows, full face mask (pressure to nose and mouth)