Nursing Assessment for Predicting Obstructive Sleep Apnea: Community Hospital Approach

Angela P. Halpin, MN, CNS, RN; Jennifer M. Bunting, AAS; Paul A. Selecky, MD; Suzette G. Bosveld, RN, BSN, MSN, CCNS, NP-C; Derrick Hong, MD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2008;8(1) 

In This Article

Application

Nursing practice implications are expanded with additions of the latest sleep pattern questions on the patient history portion of a nursing assessment. These questions provide opportunities for nurses to explore other causative factors that may contribute to the sleep disturbance. Nurses provide unique interventions and patient education as the condition of OSA is discussed. This assists nurses' inferences and enhances clinical conclusions on the status of an individual's ability to react positively to the treatment plan.

Sleep disturbances is a North American Nursing Diagnosis Association (NANDA) nursing diagnosis.[19] Nurses are involved in diagnosing sleep disturbances through appropriate questioning, assessment, and observations.[23,24] Astute assessment and early detection by the nurse are initial steps in implementing appropriate interventions to minimize risk for poor health outcomes for critically ill patients.[21,25]

It is also noted in the literature that adequate oxygen flow to the tissues aids in healing and can, in some cases, prevent infections. In the perianesthesia care unit (PACU) at this community hospital, oxygen therapies are widely utilized. Troubleshooting patients for potential inadequate oxygen distributions has led nurses to identify patients at risk for postoperative OSA with identified predictors that are based on the latest assessment tools and nursing policy. Post assessment, nurses convey findings to physicians for appropriate orders, which may include sleep oximetry if criteria findings warrant the test. Thus, CPAP orders have been obtained in the PACU, increasing adherence to the standards for the postanesthesia period as per the American Society of Perianesthesia Nursing standards.[26]

Standards for evaluation for OSA have provided tools for adoption into practice for physicians. However, in conjunction with hospital leadership, physicians have to evaluate practice in their settings to examine the correct application. Currently, nurses communicate their findings to the physicians on the basis of screening criteria. Upon discharge, notes are written to the physicians about recommendations on patient instructions that promote the physician-patient communication. However, for specialties such as anesthesiology, coordination on care decisions related to results and findings are relayed to the surgical team members, including the surgeons, recovery room staff, and -- ultimately -- the physicians who will manage care postoperatively.

Although physicians in critical care or on surgical teams, including the anesthesiologist, can rule out risk by knowledge of the patient's OSA risk, medical physicians and nurses play key roles in opening the door to discussions with patients and families about the risk via education. Physicians continue to determine whether and how to discuss weight control suggestions, medications, and/or diagnostic tests as prerequisites to procedures or treatments. Together with physicians and ancillary services, nursing interventions to rule out risk for OSA are very beneficial.

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