Cpap? - page 2
Anybody here have any personal experience with CPAP? I need to know because it's probably in my not-too-distant future........I had an appointment with a sleep specialist yesterday, and he's about... Read More
Mar 16, '05Yes, the ultimate goal of all this is, honestly, to be eligible for, and to go through, weight-loss surgery. I'm still very, very nervous about it, but I'm just about convinced after 20+ years of being severely overweight and repeatedly dieting, only to get bigger and bigger, that I've done all that's humanly possible. Now it's time to look into what's medically possible, and while I will probably NEVER be skinny even with surgery, I can at least get to, and hopefully stay at, a weight that's functional for me.
I'm at my wits' end, I'm telling you. I've done every single thing a person can do to lose weight, and now my metabolism's so screwed up I can't lose more than 40 pounds, and when I finally give up in frustration, I gain 50 back. I'm almost as heavy as I was 3 years ago, when I hit my top weight of 336#, and I just can't do this anymore.........it's too hard on me physically, and I hate myself when I look in the mirror. All of my doctors are behind the effort now to get me approved for the surgery, and it's my decision.........now I just have to get past the fear of having something go terribly wrong, or dying. Of course, the way I'm going, I could die anyway from an MI or a stroke........these calamities are no respectors of age or social status, and I've had warnings that one or even both could be coming down the pike someday soon if I don't do SOMETHING to get a good portion of this weight off.
In the meantime, until I can get this approved by insurance and store up some time off to get it done, I'm going to avail myself of all the medical help I'm being offered. It's time to settle this, once and for all.
Thanks to all who've posted.
Apr 4, '05I'm glad you brought up the subject of sleep apnea and CPAPs, mjlrn. In the operating room, we automatically assume that anyone who is grossly overweight (particularly 40ish males) and has a short, thick neck, "weak" chin (often disguised by a beard) and/or a history of GERD is a potential candidate for serious airway management problems, and probably has sleep apnea, even if he or she has not been diagnosed. Don't know? Ask. Not all patients will volunteer the info without being asked directly, or may be embarrassed about it. Seeing that a patient takes Prilosec is a clue that he has GERD. Seeing a surgical history of UPPP (uvulapalatopharyngoplasty) is a clue that he has sleep apnea, and probably still sleeps with a CPAP, and will always need to.
I think that all nurses in ALL settings (particularly ER, before giving conscious sedation--these patients can desaturate rapidly, and you really should have the crash cart and emergency drugs (a given) readily available with a bag-valve-mask, as well as RT standing by, ready to intubate if one crashes, perhaps during a "simple" closed reduction.) In reality, this patient is safer in the hands of an anesthesia provider, being that he or she is an ASA 3. I wish that all sleep apnea patients would wear Medic-Alert bracelets stating that they sleep with CPAPs--doing so would make their patient care planning much safer for them.
I am not afraid to say that I do not feel comfortable doing moderate sedation on sleep apnea patients, (no matter WHO thinks I am being a pain!)
Endo lab, OR, pre-op and med-surg nurses, as well, need to be aware of this condition and do a very careful and advocate for vigorous repiratory managaement of these patients. This includes asking about snoring at home; how many pillows they sleep with; whether they need to sleep semi-upright in a recliner (many GERD patients do having a family member bring in his or her CPAP machine, or asking the admitting doctor to order an RT consult for them, so that CPAP can be set up in the room and be available for sleep that night. Their beds should ideally be placed in semi-Fowlers, or a "beach chair" position. Also, continuous audible pulse oximetry is a must with these patients, particularly when they are being medicated for post-op pain with narcotics----they are morse sensitive to narcotics by ALL routes (not just PCA or PCEA) then non-sleep apnea patients are.
Sleep apnea patients can desaturate and die in no time if they are sleeping without a CPAP when they are accustomed to doing so--to take that risk is just too dangerous. I assume every obese patient has sleep apnea and/or GERD, and make sure to include getting him or her a CPAP, just as I would make sure any patient with risk factors for DVT will get antiembolic stockings and an SCD machine, as one of my nursing interventions when formulating a care plan. I just go ahead and do it as an independent nursing intervention, and get the order later, if need be. Of course, in surgery, we are more at liberty to proceed that way than nurses on the floors might be, (and the equipment is more readily available) which is why I think med-surg RNs must be much more aggressive patient advocates, in order to give good patient care and safeguard your licenses. Can't be too careful, and you know how doctors and nursing managers and hospital administration like to point fingers.
mjlrn, if you need a referral to an excellent and empathetic bariatric surgeon, p.m. me---I used to work with one of the best in the entire country. He is one of the pioneers. I have a friend who is also an RN who works in the O.R. where he works; he did her surgery, and she is now very passionately involved in helping advocate for other candidates for the surgery (teaching, post-op support groups, nutrition counseling, etc.) She weighed well over 400 at the time; now must weigh around 150-160.Last edit by stevierae on Apr 4, '05