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Respiratory DysfunctionChapters 29-32
Epistaxis *nose bleed
An acute hemorrhage from the nasal cavity, nostrils, or nasopharynx
•Etiology
•Dryness
•Decrease humidity
•Picking/blowing nose
•Rhinitis/sinusitis
•Allergies
•Facial trauma
•Hypertension
•Cocaine use
•Trauma
•Hypertension
•Blood dysgrstia (cancer)
•Inflammation
•Tumors
•NG suctioning
•Treatment/Prevention
•Pressure applied to site
•Leaning forward slightly while pinching the soft outer portion of the nose for 5-
10 minutes
•Humidifier or Vaseline to keep mucous membranes moist
•Avoid straining, bending over, blowing nose forcefully
Notes:
Can happen anteriorly (front of nose) or posteriorly (back of nose)
oAnteriorly
Easier to treat
DO NOT pinch nose and tilt head bac k
This can cause blood to go down the esophagus into stomach
which can lead to vomiting
Pinch nose and lean fwd. for 10 minutes!!
oUse a humidifier
oAvoid straining – bending over or blowing
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Obstructive Sleep Apnea (OSA)
•Sleep apnea : cessation in breathing while sleeping.
•Must occur a minimum of 5x/hour (can be hundreds/night)
• lasts from 10sec – greater than 1 minute with each episode.
•Risk Factors
•Obesity
•Oropharyngeal edema
•Family history
•Hypothyroidism
•short neck with recessed chin
•Enlarged tonsils, adenoids, uvula
•Cigarette smoking and alcohol or sedative use
•Big tonsils and big adenoids
•Big uvula – hanging ball thing in the back of throat
Notes:
During sleep the neck muscles relax and the toung and other muscles become displaced
oResult the upper airway becomes obstructive, but the chest movement is not
impaired
Decrease gas exchange-----increases the blood level of carbon dioxide
Decreases ph!! Goes down
Changes in the ABG’s, stimulate the neuro centers
oWakes the patients (happens usually after 10 seconds of apnea)
Pt corrects, but when the pt falls asleep again it happens again
This can happen every 5 minutes!!
oPatient is not getting enough sleep!!
•Complications
•HTN
•Stroke
•Hypertension affects up to 60% of pts with apnea!!
•Cognitive deficits----lack of 02
•Weight gain
•Diabetes
•Pulmonary disease
•Cardiovascular disease
•Excessive daytime sleepiness, irritability, inability to concentrate
•Patient can develop cor pulmonale
•Scarring of the lung tissue
• (hypertrophy) –failure of the right ventricle
•DEATH! –if body is unable to wake the patient up!
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Notes:
Hypoxia (low O2 levels) affect all the cells in the body
Cells in the brain for sure!!
Long term complications--- can be severe
oLung, heart and brain are affected
OSA
•Assessment
•Waking up tired
•Loud snoring
•Maybe not be aware of—co sleepers may be like YOU SNORE
•Morning headaches
•Daytime somnolence
•Tiredness = problems at work
•Irritability/personality changes
•Grouchy = personality changes
•Diagnostic Tests
•STOP-Bang Sleep Apnea Questionnaire
•Yes or no questions to 8 items
•S-snoring, t-tiredness, o- observed as stopped breathing during sleep, p-
(pressure) treatment for high BP (many pts have hypertension who
have sleep apnea), B-body mass index (BMI greater than 35), A- age
greater than 50, N-neck circumference greater than 40 cms, G-gender
males (more at risk)
•3 or less yes =low risk
•Greater than 3=greater risk
•HIGH validity (easy to ask and comprehend)
•ABG and TSH level
•Sleep study: : observation and measurement of the client during sleep.
•Hooked up to many monitors
•Evaluate depth of sleep
•How much respitory effort
•What O2 stats are
•How much muscles are moving (use EEG)
•Use: EEG, ECG, Pulse-ox, electromyograph (EMG)
Notes:
Higher levels of carbon dioxide—so pH will go down
Check TSH levels to rule out hypothyroidism (similar signs)
What does the OSA patient look like? Well, patients are often unaware that they have sleep
apnea. Screen patients who have daytime sleepiness or wake up tired, and especially those Powered by TCPDF (www.tcpdf.org)
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