4 Apnea Nursing Care Plans

March 13, 2018

Apnea is defined as periodic cessation of breathing for more than 15 seconds in the full-term or more than 20 seconds in the preterm infant. It may be related to sepsis, gastroesophageal reflux, metabolic abnormality, seizure disorder, trauma or the impairment of breathing during sleep, although it is not uncommon to find no apparent causative factor.

Apneas in a preterm infant may be central, obstructive or mixed. In central apnea, there is a loss of chest wall movement due to the depressed respiratory center in the brain, while obstructive apnea is caused by pharyngeal collapse, neck flexion or nasal obstruction. Mixed apneas involve a central apnea that is directly followed by an obstructive apnea.

Apnea occurs during infancy and is usually resolved by one year of age without resulting in the death of the infant. The apparent life-threatening event (ALTE) that is indicative of apnea is not considered a cause of SIDS (sudden infant death syndrome), although the infant with apnea is at slightly higher risk. Both apnea and high-risk SIDS infants may be monitored by an apnea-monitoring device as a preventive measure.

Nursing Care Plans

Nursing care plan for sleep apnea is directed at supporting the infant’s cardiopulmonary status, improvement in gas exchange and breathing pattern, attainment of an optimal level of parental coping, knowledge on the treatment program and home care, and absence of complications.

Here are four (4) nursing care plans (NCP) for sleep apnea:

Ineffective Breathing Pattern

Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation.

May be related to

Impaired regulation

Possibly evidenced by

Apnea during sleep
Changes in respiratory depth
Pallor, cyanosis

Desired Outcomes

Infant/Child will maintain respiratory status to baseline parameters for pattern rate, depth, and ease.

Nursing Interventions	Rationale
Assess the frequency and pattern of breathing; Observe presence of apnea and changes in the heart rate.	Infants with apnea have periods of cessation of breathing over 15-20 seconds accompanied by bradycardia.
Assess skin, nail beds, skin, mucous membranes for pallor or cyanosis.	Reveals presence of hypoxemia causing cyanosis from an uneven distribution of gases and blood in the lungs, and alveolar hypoventilation caused by airway obstruction and absence of chest wall movement.
Place infant on an apnea monitor and pulse oximeter.	Identify changes in the chest movement, heart rate, and oxygen saturation caused by apnea.
Position the infant’s head and neck in neutral position.	If the neck bends too far forward or backward, blockage of breathing can happen.
Avoid prolonged suctioning; Discourage taking rectal temperatures and tube feedings.	Vagal stimulation may cause bradycardia, triggering apneic episodes.
Provide tactile stimulation by applying gentle rub in the soles of feet or chest wall	Indicated for mild and intermittent episodes of apnea to stimulate spontaneous breathing.
Administer methylxanthines (e.g., (theophylline, caffeine) as prescribed.	Used as a smooth muscle relaxant and a cardiac muscle and central nervous system stimulant.
Use of Nasal Continuous positive airway pressure (CPAP).	Indicated when the infant remains to have episodes of apnea despite producing a therapeutic level of methylxanthine.