what would you have done??

nightmare, RN · Jun 28, 2007

Is this lady large? I would have repositioned her on her side to see if the apnoea continued.Usually people with sleep apnoea breath better on their sides.If it continued then I might consider phoning doctor for advice.

As an aside we had a Down's syndrome gentleman who just sadly passed away quietly in his sleep.Coroners verdict was death by natural causes caused by the Down's syndrome.

SuesquatchRN, BSN, RN · Jun 28, 2007

As long as her resps stayed in that range I would have charted it and told oncoming in the morning.

ajaxgirl · Jun 28, 2007

Is this lady large? I would have repositioned her on her side to see if the apnoea continued.Usually people with sleep apnoea breath better on their sides.If it continued then I might consider phoning doctor for advice.
As an aside we had a Down's syndrome gentleman who just sadly passed away quietly in his sleep.Coroners verdict was death by natural causes caused by the Down's syndrome.

Not large. I did reposition her, it didn't help.

ajaxgirl · Jun 28, 2007

As long as her resps stayed in that range I would have charted it and told oncoming in the morning.

Wouldn't the O2 sat have worried you?

nightmare, RN · Jun 28, 2007

Could have been cheyne-stokes respiration.So what happened to her?

ajaxgirl · Jun 28, 2007

Could have been cheyne-stokes respiration.So what happened to her?

I thought the same thing. I dont know what happened since I haven't worked for a couple of nights.

SuesquatchRN, BSN, RN · Jun 28, 2007

Wouldn't the O2 sat have worried you?

It sounded like Cheyne-Stokes to me, too. As to the sat, I would have slapped O2 on her at 2L per min - we have standing orders. If she stayed that low after O2 I MIGHT have called the doc in the absence of any history. No cold, no nothing? I mean, she just started breathing funny?

nightmare, RN · Jun 28, 2007

Did a quick Google and aparently it's not uncommon.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=6444353&dopt=Abstract

ajaxgirl · Jun 28, 2007

It sounded like Cheyne-Stokes to me, too. As to the sat, I would have slapped O2 on her at 2L per min - we have standing orders. If she stayed that low after O2 I MIGHT have called the doc in the absence of any history. No cold, no nothing? I mean, she just started breathing funny?

She wouldn't keep O2 on.

ktwlpn, LPN · Jun 28, 2007

LTC resident, 60 yrs old, no resp issues, has down's syndrome, no HX of sleep apnea
No CPR, but is to be transferred to hospital-as per care directives
During night shift her breathing looks erratic, she is sleeping but resps are labored. they seem to stop then restart. They stop for a few seconds then a loud snore, then restart. She is using accessory muscles to breathe. This is not normal for her. All VS are normal-resps are 18 but they are slow, then fast. She has had a cough for a few days, chest sounds ok.
O2 SAT was variable. Depending on resps it ranged from 79-95. Her normal sats are 95%.
What would you have done???

Interesting scenario-it's rare (but is getting more common) for Down's pts. to live such long lives.I would have done a full assessment and put her on some o2 and repositioned her side to side.Often if they won't tolerate a nasal cannula or a mask I'll prop a mask up with stuffed animals.That always works. I would have made sure my supervisor was aware and probably would have called the family first to clarify the advance directive before I called the doc and made him aware (if the family insisted on hosptilization) Then I would leave a voicemail for social services and a message for the charge nurse because they need to educate this family,IMHO...Please update us when you can...

SuesquatchRN, BSN, RN · Jun 28, 2007

She wouldn't keep O2 on.

That's such a problem with my less-than-with-it folks.

Bring her to the nurses' station in a geri chair to monitor.