Case Study #2
Sleep Apnea
SR is a 59-year-old man who comes to the clinic because his wife complains “my snoring is
difficult to live with.”
1. As the clinic nurse, what routine information would you want to obtain f
...
Case Study #2
Sleep Apnea
SR is a 59-year-old man who comes to the clinic because his wife complains “my snoring is
difficult to live with.”
1. As the clinic nurse, what routine information would you want to obtain from the patient?
• Routine information that would need to be obtained is as follows:
o How long the snoring has been an issue
o If SR takes any medications
o What position does he normally sleep at night?
o His normal daily routine and sleeping routine (this includes the time he
goes to sleep as well as well as how long he sleeps every night)
o His diet during the week
o Any breathing difficulty during the daytime
After interviewing SR you note the following: SR is under considerable amount of stress.
He owns his own business. The stress of overseeing his employees, meeting deadlines, and
carrying out negotiations as led to poor sleep habits. He sleeps 3 to 4 hours per night. He
keeps himself going by drinking2 quarts of coffee and smoking 3 to 4 packs of cigarettes
per day. He has gained 50 pounds over the 2 years, leading to a current weight of 250
pounds. He complains of difficulty staying awake, wakes up with headaches on most
mornings, and has mid-morning somnolence. He states that he is depressed and irritable
most of the time and reports difficulty concentrating and learning new things. He has been
involved in three auto accidents in the past year.
SR vitals signs are 164/90, 92,18, and SPo2 90% on room air. His examination findings are
normal except for a few bruises over the right side of the rib cage. You inquire about the
bruises and SR reports that his jabs him with her elbow several times every night. In her
own defense the wife states “well he stops breathing and I get worried, so I jab him to make
him start breathing again. If I don’t jab him, I find myself listening for his next breath and
I can’t go to sleep.” You suspect sleep apnea
2. Identify two main types of apnea and explain the pathology of each.
• The two main types of apnea is obstructive and central. “Obstructive sleep apnea
(OSA) is a breathing disruption during sleep that last at least 10 seconds and
occurs a minimum of five times in an hour.” (Ignatavicius 2018, pg. 559). With
this type of apnea the airway is blocked either by the tongue and soft palate or air
passages narrowing when the muscles relax during sleep. As a result, the air
becomes physically blocked from entering the lungs and causes distress similar to
being choked. This in turn awakens the brain, and to essentially awaken the
airway muscles so normal airflow can occur. This continues patterned of disrupted
sleep prevents deep sleep which is needed for best rest.
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• Central sleep apnea occurs when the brain sometimes fails to awake the breathing
muscles in the chest. Breathing muscles will work only when the brain gives them
the signal to breathe therefore in this type the muscles of the chest and diaphragm
fail temporarily.
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