Question

Case Study

Jim Wyatt is a 42-year-old Caucasian male, 5’11 and 200 pounds, with a body mass index (BMI) of 27.9 (considered overweight according to BMI tables). He reports being tired “all the time”. Other health problems include hypertension that is poorly controlled with three prescription medications and a HgbA1C level that has been rising, the most recent measure at 6.2. On a typical day he awakens at 6:30 a.m., often with a significant headache and feeling like he has not gotten a good night’s sleep. He adds that on most mornings he has a dry mouth as well. He is worried that his work performance is suffering and he has trouble staying awake at meetings. He had one minor traffic accident recently when his car went off the road after he fell asleep at the wheel. He often will nap when he gets home from work and falls asleep watching television after dinner. He attempts to go to bed around 9:30 or 10 each night in hope of getting enough sleep so he will not be so tired the next day. He has stopped going out to social events in the evening due to the difficulty he has staying awake. On a recent camping trip his companions teased him about his loud snoring. He explains that his father “was the same way.” On physical exam the nurse notes he is having difficulty staying awake while he is talking and he has a neck circumference of 17 ½ inches. On examination of his oropharynx the nurse cannot visualize the uvula or tonsils.

Case Analysis

Mr. Wyatt has many common symptoms of obstructive sleep apnea (OSA). Physically, the neck circumference greater than 17 in is highly correlated with OSA. He also reveals a positive family history indicative of OSA. No matter how much he sleeps, he never feels rested. This situation has been getting worse as evidenced by his laboratory values showing possible metabolic problems and also what may be treatment resistant hypertension. His quality of life is suffering as is his work performance. Naps and sleeping longer at night do not help because the apnea continues. No matter how much time he spends thinking he is “sleeping,” he is not getting the restorative sleep that he needs to be healthy, productive, and energetic. He has many of the characteristics of someone with significant OSA. It is important to remember, however, that people who do not fit the typical physical pattern may also have OSA. They are likely to have many of the signs, however, such as snoring and feeling tired regardless of the amount of sleep they get.

Please answer the following questions regarding the Case Study.

Question 1:

Identify and discuss important assessments needed for Mr. Wyatt?

Question 2:

What diagnostic testing is recommended for Mr. Wyatt?

Question 3:

What are three nursing interventions that should be used with Mr. Wyatt?

Answer 1

1.The important assessment needed for this patient are

• Monitoring his blood pressure regularly because an elevated blood pressure can lead to OSA
• Assessing the patient for his lifestyle regarding smoking ,alcohol or any drug use because tgus can interrupt the quality of sleep and life
• Use STOP -Bang method to assess the exact cause

2.The diagnostic testing which can be used are

• Polysomnography helps to monitor the patient continuously throughout the sleep and identify where the problem is
• A complete diabetic panel ,thyroid profile to eile our any endocrine problems
• Sleep apnea testing in home is another method

3.The nursing intervention required for this patient are

• Educating the patient to maintain normal weight by lifestyle modification by exercise and diet
• The nurse can apply CPAP so that the patient can sleep well in the night time to have a quality day time
• Maintaining blood pressure under control by administration of medication as per order