Respirations, stertorous
Respirations, stertorous: Excerpt from Nursing: Interpreting Signs and Symptoms
Characterized by a harsh, rattling, or snoring sound, stertorous respirations usually result from the vibration of relaxed oropharyngeal structures during sleep or coma, causing partial airway obstruction. Less commonly, these respirations result from retained mucus in the upper airway.
This common sign occurs in about 10% of healthy individuals; however, it's especially prevalent in middle-aged men who are obese. It may be aggravated by the use of alcohol or a sedative before bed, which increases oropharyngeal flaccidity, and by sleeping in the supine position, which allows the relaxed tongue to slip back into the airway. The major pathologic causes of stertorous respirations are obstructive sleep apnea and life-threatening upper airway obstruction associated with an oropharyngeal tumor or with uvular or palatal edema. This obstruction may also occur during the postictal phase of a generalized seizure when mucus secretions or a relaxed tongue blocks the airway.
Occasionally, stertorous respirations are mistaken for stridor, which is another sign of upper airway obstruction. However, stridor indicates laryngeal or tracheal obstruction, whereas stertorous respirations signal higher airway obstruction.
Action stat!
If you detect stertorous respirations, check the patient's mouth and throat for edema, redness, masses, or foreign objects. If edema is marked, quickly take the patient's vital signs, including oxygen saturation. Observe him for signs and symptoms of respiratory distress, such as dyspnea, tachypnea, accessory muscle use, intercostal muscle retractions, and cyanosis. Elevate the head of the bed 30 degrees to help ease breathing and reduce edema. Then administer supplemental oxygen by nasal cannula or face mask, and prepare to intubate the patient, perform a tracheostomy, and provide mechanical ventilation. Insert an I.V. catheter for fluid and drug administration, if prescribed, and begin cardiac monitoring.
History and physical examination
If you detect stertorous respirations while the patient is sleeping, observe his breathing pattern for 3 to 4 minutes. Do noisy respirations cease when he turns on his side and recur when he assumes a supine position? Watch carefully for periods of apnea and note their length.
If the patient isn't in severe respiratory distress, begin with the history. Question the patient about his snoring habits. Is his partner frequently awakened by his snoring? Does the snoring improve if the patient sleeps with the window open? Does he talk in his sleep or sleepwalk? Ask about signs of sleep deprivation, such as personality changes, headaches, daytime somnolence, or decreased mental acuity.
Perform the physical examination by first assessing the patient's level of consciousness and his orientation to time, place, and person. Observe spontaneous movements, and test muscle strength and deep tendon reflexes. Next, inspect the chest for deformities or abnormal movements such as intercostal retractions. Inspect the extremities for cyanosis and digital clubbing.
Now, palpate for expansion and diaphragmatic tactile fremitus, and percuss for hyperresonance or dullness. Auscultate for diminished, absent, or adventitious breath sounds and for abnormal or distant heart sounds. Do you note peripheral edema? Finally, examine the abdomen for distention, tenderness, or masses.
Medical causes
Airway obstruction.Regardless of its cause, partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypnea and, later, intercostal retractions and nasal flaring. If the obstruction becomes complete, the patient abruptly loses his ability to talk and displays diaphoresis, tachycardia, and inspiratory chest movement but absent breath sounds. Severe hypoxemia rapidly ensues, resulting in cyanosis, loss of consciousness, and cardiopulmonary collapse.
Obstructive sleep apnea.Loud and disruptive snoring is a major characteristic of obstructive sleep apnea, which commonly affects people who are obese. Typically, the snoring alternates with periods of sleep apnea, which usually end with loud gasping sounds. Alternating tachycardia and bradycardia may occur.
Episodes of snoring and apnea recur in a cyclic pattern throughout the night. Sleep disturbances, such as somnambulism and talking during sleep, may also occur. Some patients display hypertension and ankle edema. Most awaken in the morning with a generalized headache, feeling tired and unrefreshed. The most common complaint is excessive daytime sleepiness. Lack of sleep may cause depression, hostility, and decreased mental acuity.
Other causes
Endotracheal (ET) intubation, suction, or surgery.ET intubation, suction, or surgery may cause significant palatal or uvular edema, resulting in stertorous respirations.
Nursing considerations
▪ Monitor the patient's respiratory status carefully.
▪ Administer a corticosteroid or an antibiotic, as ordered.
▪ Administer cool, humidified oxygen to reduce palatal and uvular inflammation and edema.
▪ Prepare the patient for laryngoscopy and bronchoscopy (to rule out airway obstruction) or formal sleep studies, as necessary.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ Discuss with the patient the importance of weight loss and smoking cessation.
▪ Demonstrate the use of a positive airway pressure device, if indicated.
▪ Teach the patient how to elevate his head while sleeping.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Wheezing [Sibilant rhonchi] (Nursing: Interpreting Signs and Symptoms)
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