Symptoms » Orthopnea » Book Sections

Apnea

Apnea is the cessation of spontaneous respiration and is usually a life-threatening emergency that requires immediate intervention to prevent death. It may occur as a temporary and self-limiting event, such as Cheyne-Stokes and Biot’s respirations.

Apnea usually results from one or more of six pathophysiologic mechanisms, each of which has numerous causes. Its most common causes include trauma, cardiac arrest, neurologic disease, aspiration of foreign objects, bronchospasm, and drug overdose. (See Causes of apnea.)

Act Now: Upon discovering a patient with apnea, immediately begin resuscitative measures. Place the patient in a supine position. Open the airway using the head tilt/chin lift technique, and look, listen, and feel for spontaneous respirations. (If there’s suspected head, neck, or spine trauma, use the jaw thrust maneuver to open the airway). If breaths are absent, begin artificial ventilation. If apnea was prolonged, full cardiac arrest may be present. Palpate the patient’s carotid pulse, and if absent, begin chest compressions.

For an infant or a child, the airway is opened in the same manner as an adult. For a child, a carotid pulse is palpated, and for an infant, a brachial pulse is palpated.

Assessment

History

When the patient is stabilized, obtain a history from the family. Determine the onset and events immediately preceding the event. Determine if there were related events, such as headache, chest pain, muscle weakness, sore throat, or dyspnea. Ask about a history of respiratory, cardiac, or neurologic disease and about allergies and drug use.

Physical examination

Inspect the head, face, neck, and trunk for soft-tissue injury, hemorrhage, or skeletal deformity. Don’t overlook obvious clues, such as oral and nasal secretions reflecting fluid-filled airways and alveoli, or facial soot and singed nasal hair suggesting thermal injury to the tracheobronchial tree.

Auscultate over all lung lobes for adventitious breath sounds, particularly crackles and rhonchi. Percuss the lung fields for increased dullness or hyperresonance. Auscultate the heart for murmurs, pericardial friction rub, and arrhythmias. Assess for cyanosis, pallor, jugular vein distention, and edema. If appropriate, perform a neurologic assessment. Evaluate the patient’s level of consciousness (LOC), orientation, and mental status; test cranial nerve function and motor function, sensation, and reflexes in all extremities.

Pediatric pointers

Premature infants are especially susceptible to periodic apneic episodes because of central nervous system (CNS) immaturity. Other common causes of apnea in infants include sepsis, intraventricular and subarachnoid hemorrhage, seizures, bronchiolitis, and sudden infant death syndrome.

In toddlers and older children, the primary cause of apnea is acute airway obstruction from aspiration of foreign objects. Other causes include acute epiglottiditis, enlarged tonsils and adenoids, croup, asthma, and systemic disorders, such as muscular dystrophy and cystic fibrosis. Therefore, in children and infants who have been ill with fever and develop signs of respiratory impairment, immediate access to the health care system is of primary importance. Emergency intubation may be required.

Geriatric pointers

In elderly patients, increased sensitivity to analgesics, sedative-hypnotics, or any combination of these drugs may produce apnea, even with normal dosage ranges.

Medical causes

Airway obstruction

Occlusion or compression of the trachea, central airways, or smaller airways can cause sudden apnea by blocking the patient’s airflow and producing acute respiratory failure.

Brain stem dysfunction

Primary or secondary brain stem dysfunction can cause apnea by destroying the brain stem’s ability to initiate respirations. Apnea may arise suddenly (as in trauma, hemorrhage, or infarction) or gradually (as in degenerative disease or a tumor). Apnea may be preceded by a decreased LOC and by various motor and sensory deficits.

Neuromuscular failure

Trauma or disease can disrupt the mechanics of respiration, causing sudden or gradual apnea. Associated findings include diaphragmatic or intercostal muscle paralysis from injury, or respiratory weakness or paralysis from acute or degenerative disease.

Parenchymatous lung disease

An accumulation of fluid within the alveoli produces apnea by interfering with pulmonary gas exchange and producing acute respiratory failure. Apnea may arise suddenly, as in near drowning and acute pulmonary edema, or gradually, as in emphysema. Apnea also may be preceded by crackles and labored respirations with accessory muscle use.

Pleural pressure gradient disruption

Conversion of normal negative pleural air pressure to positive pressure by chest wall injuries, such as flail chest, causes lung collapse, producing respiratory distress and, if untreated, apnea. Associated signs include an asymmetrical chest wall and asymmetrical or paradoxical respirations.

Pulmonary capillary perfusion decrease

Apnea can stem from obstructed pulmonary circulation, most commonly due to heart failure or lack of circulatory patency. It occurs suddenly in cardiac arrest, massive pulmonary embolism, and most cases of severe shock. In contrast, it occurs progressively in septic shock and pulmonary hypertension. Related findings include hypotension, tachycardia, and edema.

Other causes

Drugs

CNS depressants may cause hypoventilation and apnea. Benzodiazepines may cause respiratory depression and apnea when given I.V. along with other CNS depressants to elderly or acutely ill patients.

Neuromuscular blockers

These medications, such as curariform drugs and anticholinesterases, may produce sudden apnea because of respiratory muscle paralysis.

Sleep-related apnea

These repetitive apneas occur during sleep from airflow obstruction or brain stem dysfunction.

Nursing considerations

Perform continuous assessment of the patient’s respiratory and cardiac systems until he’s stable. Obtain his vital signs, and perform a full neurologic examination.

Patient teaching

If the cause of the apnea was preventable, review the standards with the patient, if applicable, and his family. Educate the patient about safety measures related to aspiration of medications. Encourage cardiopulmonary resuscitation training for all adolescents and adults.

Pictures

Book Source Details

• Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Orthopnea

Read excerpts from these other book chapters related to Orthopnea:

Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.

More About Causes of Orthopnea

• Back to symptom: Orthopnea: Introduction (review 41 causes)
• Next Book Extract About Orthopnea: Bradypnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• All Book Extracts: All Online Book Extracts for Orthopnea

---

More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

 » Next page: Bradypnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Bradypnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Hyperpnea (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Respirations, stertorous (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Bradypnea (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Hyperpnea (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

homepage | back to top

Common Health Mistakes

Choose ... Alzheimers & Dementia Asthma Child ADHD ADHD in Adults Allergy Hypertension Bipolar Breast Cancer Celiac Disease Crohns Disease Colon Cancer Contraception Diabetes Cancer Depression Erectile Disorder Cholesterol COPD GERD Heartburn/Reflux Metabolic Syndrome Migraine/Headache Multiple Sclerosis Obesity Osteoporosis Overactive Bladder Psoriasis Sexual Disorder Sleep Disorders Smoking The Pill Ulcerative Colitis All Common Mistakes

Symptom
Checker

Choose... Fever Rash Pain Headache Fatigue Cough Other symptoms

Search Specialists by State and City

Choose... GENERAL PRACTICE CARDIAC HEALTH WOMEN'S HEALTH CANCER CARE RADIOLOGY MENTAL HEALTH PATHOLOGY EAR, NOSE, THROAT MEDICINE GENETICS NEUROLOGY DIALYSIS CARE SURGERY ORTHOPEDICS/SPORTS MEDICINE CHILDREN'S HEALTH OTHER SPECIALTIES