Obstructive Sleep Apnea (OSA) is the repeated blockage of upper airway when a person is asleep. It is the most common type of apnea during which the diaphragm and chest muscles open the obstructed airways and pull air into the lungs. This loss of breath reduces the flow of oxygen to vital organs causing irregular heartbeat (Force & American Academy of Sleep Medicine, 2009). A person usually snores loudly at night with interruption by a silent period when they are not breathing, they wake up not refreshed in the morning, headaches that are hard to treat, feel sleepy or drowsy all day and they tend to indicate a significantly short memory thus very forgetful. A person with OSA is likely to develop depression, high blood pressure which is difficult to treat and leg swelling. The diagnosis involves physical examination of patients by evaluating the upper airway in patients with OSA symptoms (Force & American Academy of Sleep Medicine, 2009). The findings may include narrowing of the lateral airway walls, enlarged tonsils, pulmonary hypertension, large degree of overjet, and congestive heart failure. To assess for OSA, one should be alert of these signs and symptoms: dry throat, loud snoring, excessive daytime sleepiness, poor concentration, morning headaches, frequent nocturnal awakening, erectile dysfunction, and cardiac arrhythmias (Parati, Lombardi et al., 2013). The nursing interventions include evaluating the sleeping patient, administering supplemental oxygen, raising the head of the bed, positioning the patient on his/her side, being alert of sedating medication, monitoring oxygen levels with a pulse oximeter, and monitoring the respiratory status (Force & American Academy of Sleep Medicine, 2009).
Pneumonia is caused by the inflammation of the lungs’ air sacs. Either one lung or both may be inflamed at the same time. The air sacs – also known as alveoli – fill with pus causing a cough with phlegm, fever and breathing difficulties. Pneumonia is caused by various organisms including viruses, fungi and bacteria. It is more serious for young children, people older than 65 years and those with weakened immune systems (Force & American Academy of Sleep Medicine, 2009). Its symptoms vary depending on the causative factor, the patient’s age and overall health of the patient. They include chest pain when you breathe or cough, fatigue, shortness of breath, cough which produces phlegm, fever & sweating, and nausea, vomiting or diarrhea. It is diagnosed by use of physical signs and a chest X-ray but the underlying cause may be difficult to confirm.
Bacteria are the most common causative agent of pneumonia and therefore antibiotics are used to treat it because they have a high cure rate. The type of antibiotics administered to the patient depend on the age and the severity of the symptoms. Pneumonia caused by a virus are treated by an antiviral medicine e.g. zanamivir or oseltamivir so as to relieve the symptoms. Pneumonia is a treatable short-term illness but is also a serious complication of a long-term illness such Chronic Obstructive Pulmonary Disease (COPD) (Force & American Academy of Sleep Medicine, 2009). When treated at home – as is in most cases – the treatment includes antibiotics which are given by mouth as tablets and liquids, paracetamol to reduce fever, pain relieving medication and rest. Treatment in the hospital involves antibiotics given via a drip into a vein, intravenous fluids to correct hydration if the patient is too sick to eat, physiotherapy which helps to clear sputum from lungs and oxygen therapy which ensures oxygenated blood gets to all the body organs (Parati, Lombardi et al., 2013).
Treatment for OSA include therapies e.g. a machine for delivering air pressure when a patient is asleep through a mask placed over the nose, oral appliances that are designed to keep the throat open, and surgery which is done after the other treatment options have failed. The goal of the surgery is to enlarge the airway that may be blocking the upper air passages. For mild cases of OSA, the doctor will only recommend lifestyle changes such as to quit smoking and weight loss (Parati, Lombardi et al., 2013).
One diagnosis is not sufficient to definitively diagnose pneumonia. Therefore, combined features improve the diagnostic with the addition of new point-of-care tests helping to attain an acceptable accuracy for the diagnosis of bacterial pneumonia (Parati, Lombardi et al., 2013). The tests recommended for pneumonia are chest X-ray which helps to determine extent of the infection, blood tests are used to confirm the type of organism causing the infection, pulse oximetry which measures the level of oxygen in blood, and sputum test which takes samples of sputum to help pinpoint the cause of infection (Force & American Academy of Sleep Medicine, 2009).
The symptoms that evaluate a patient for OSA are sleepiness that affects the patient’s life, breath-holding episodes while sleeping, children are snoring a lot and irritably, and sleepiness on-the-job places. The doctor performs a physical examination to check for indications which include upper body obesity, abnormalities in the soft palate or upper airways, and a wide neck measurement. The doctor then rules out OSA if it is not obvious after the physical examination (Parati, Lombardi et al., 2013).
Force, A. O. S. A. T., & American Academy of Sleep Medicine. (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 5(3), 263.
Parati, G., Lombardi, C., Hedner, J., Bonsignore, M. R., Grote, L., Tkacova, R., & McNicholas, W. T. (2013). Recommendations for the management of patients with obstructive sleep apnoea and hypertension. European Respiratory Journal, 41(3), 523-538.