what would you have done??

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.

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

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.

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?

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

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.

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?

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

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.

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...

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.

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???

It appears the biggest concern is what the oximeter reading is, which would make my FIRST instinct to recheck the SAT rate w/ another machine, especially since vital signs are all normal.

One of my favorite Dr's taught me when I was a brand new nurse "Always ask yourself before you panic.. "Does he/she LOOK sick (in distress) of some kind". Don't ever use just a machine to tell you how sick someone is.

I would have rechecked SAT on different machine, put head of bed up, put oxygen on, determined if LOC is different than usual, checked nailbeds. From the OP, I'm not sure this was really a big deal - maybe undiagnosised sleep apnea?