Apnea Nursing Care Plans

An apneic infant on your unit means a monitor that will alarm at 3 a.m., parents who are terrified to sleep, and a discharge plan that lives or dies on how well you teach them. Your job is to keep the airway open, catch the bradycardia that rides along with the pauses, and send the family home able to run the monitor and do CPR without you in the room.

What is Apnea?

Apnea is 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 impaired breathing during sleep, though often no causative factor turns up.

Apnea in a preterm infant may be central, obstructive, or mixed. Central apnea is a loss of chest wall movement from a depressed respiratory center in the brain. Obstructive apnea comes from pharyngeal collapse, neck flexion, or nasal obstruction. Mixed apnea is a central apnea followed directly by an obstructive one.

Apnea occurs during infancy and usually resolves by 1 year of age without killing the infant. The apparent life-threatening event (ALTE) that signals apnea is not considered a cause of SIDS (sudden infant death syndrome), though an infant with apnea carries a slightly higher risk. Both apneic and high-risk SIDS infants may be watched with an apnea-monitoring device as a preventive measure.

Nursing Care Plans and Management

Care is aimed at supporting the infant's cardiopulmonary status, improving gas exchange and breathing pattern, getting the parents to a workable level of coping, building their knowledge of the treatment program and home care, and preventing complications.

Nursing Problem Priorities

• Maintain a patent airway.
• Monitor and assess respiratory function.
• Deliver the right interventions, including CPAP or mechanical ventilation when needed.
• Educate and support the caregivers on apnea management and prevention.
• Work with the team to treat the underlying cause and optimize overall care.

Nursing Assessment

Assess for these subjective and objective findings:

• Loud or excessive snoring during sleep
• Pauses in breathing or choking and gasping episodes during sleep
• Excessive daytime sleepiness or fatigue
• Morning headaches
• Difficulty concentrating or memory problems
• Irritability or mood changes
• Restless sleep or frequent tossing and turning
• Decreased libido or sexual dysfunction
• Dry mouth or sore throat on waking
• Frequent awakenings during the night

Nursing Goals

• The infant or child maintains respiratory status at baseline for rate, depth, and ease.
• The infant or child shows improved gas exchange, with arterial blood gases in the normal range for age.
• Family members express their feelings and needs to each other.
• Family members identify three healthy coping mechanisms.
• The parents state they are ready to handle the infant during apneic episodes.
• The parents apply and operate the apnea monitor correctly.
• The parents perform infant CPR competently.

Nursing Interventions and Actions

1. Improving and Maintaining Respiratory Status

Watch the rate, depth, and pattern of breathing, and note any apnea or change in heart rate. Infants with apnea stop breathing for over 15 to 20 seconds, often with bradycardia.

Check the skin, nail beds, and mucous membranes for pallor or cyanosis. Cyanosis points to hypoxemia from uneven distribution of gas and blood in the lungs and from alveolar hypoventilation caused by airway obstruction and absent chest wall movement.

Place the infant on an apnea monitor and pulse oximeter. This catches changes in chest movement, heart rate, and oxygen saturation during an event.

Assess skin color and perfusion. Apnea drives tissue hypoxia, which shows up as poor perfusion and color change.

Watch for irritability, somnolence, or a drop in level of consciousness. These signal hypoxia as blood oxygen falls and brain oxygenation suffers.

Monitor ABG levels and oxygen saturation. Track pO2 and pCO2 for the changes that come with an abnormal ventilatory drive.

Review chest X-ray studies. These reveal respiratory infection affecting gas exchange.

Position the head and neck in neutral. Flexing or extending the neck too far blocks the airway.

Avoid prolonged suctioning, and skip rectal temperatures and tube feedings when you can. Vagal stimulation triggers bradycardia and apneic episodes.

Give tactile stimulation with a gentle rub on the soles of the feet or the chest wall. This is enough to restart spontaneous breathing in mild, intermittent apnea.

Administer methylxanthines (theophylline, caffeine) as prescribed. They act as a smooth muscle relaxant and a stimulant to cardiac muscle and the central nervous system.

Deliver continuous nasal airflow or CPAP by nasal mask or face mask. CPAP is used for preterm apnea thought to come from airway collapse.

Prepare the infant for mechanical ventilation when indicated. This is the step once drug therapy and CPAP have failed.

2. Promoting Effective Family Coping

Assess the family's anxiety and any erratic behavior (anger, tension, disorganization) and how they read the crisis. This tells you what is driving their ability to cope with the apnea and the monitoring.

Ask how they have coped before and whether it worked. If old methods are not changing the behavior in front of you, they need new skills.

Help the family identify and use three techniques to solve problems and regain control. This gives them a handle on the situation.

Take a history of apnea, SIDS, and life-threatening events in the family. These are risk factors that direct further assessment.

Screen for apneic episodes, bradycardia, cyanosis, gastroesophageal reflux, upper respiratory infection, and poor feeding with choking. This flags the episodes and risk factors that warrant evaluation.

Assess whether the parents can take part in monitoring and learn CPR. Fear, guilt, and dread of losing the child all get in the way of the learning their infant's survival depends on.

Encourage them to talk about their feelings, and give accurate information about infant apnea. This lowers anxiety and builds understanding.

Tell parents that overprotective behavior can stunt the infant's growth and development. They need to see the downside, not just the danger.

Reinforce the coping behaviors that work, and name them out loud. Recognition drives the adaptation to apnea care.

Stress keeping the rest of the family healthy and socially connected. Chronic anxiety, fatigue, and isolation from constant monitoring wear down the family's capacity to care for the infant.

Encourage parents to voice unmet needs and set realistic expectations for themselves. This heads off the isolation and social deprivation that hit caregiving parents, especially mothers.

Keep the environment calm and positive, and commend good parenting. Lower stress means better learning of the care routines.

Encourage touch and play between parents and infant. This strengthens bonding and reinforces positive parenting.

3. Teaching Home Monitoring and CPR

Set up the monitor with the parents and have them return-demonstrate the whole sequence: attach the electrodes to the belt, apply the belt to the chest, turn the monitor on, set it, and test the alarms, then remove and care for it after use. Home apnea monitors are prescribed for apneic and near-miss infants. Use is controversial, but the monitor tracks cardiac and respiratory activity and alarms when rates fall outside the prescribed settings.

Walk through when and how to respond to alarms and to changes in breathing and heart rate. Catching a prolonged pause early is what prevents hypoxia and death.

Cover the safety basics: unplug the power cord when it is not connected to the monitor, remove the leads from the infant when off the monitor, and put safety covers on outlets so siblings cannot poke objects in. This prevents electrical accidents at home.

Give parents written or picture instructions for monitoring and resuscitation. They need a reference once you are gone.

Demonstrate infant CPR on a model and have both parents and another family member return-demonstrate it. Teach them to assess the infant, recognize the need for CPR, and perform correct rescue breaths and chest compressions. Supply written and pictorial instructions for review. CPR is what resuscitates an infant who has stopped breathing and turned cyanotic.

Teach a support person or relative to care for the infant on the monitor, CPR included. Sharing the load keeps the parents from carrying continuous monitoring alone.

Give honest praise as the parents master the monitor and CPR. Positive reinforcement builds the confidence new parents need in this situation.

Tell parents to place healthy infants on their backs to sleep and to keep pillows and soft mattresses out of the crib. The American Academy of Pediatrics recommends back sleeping to cut SIDS risk. Infants placed on their sides may roll prone.

Explain the difference between apnea and SIDS. Parents often blur the two, and that confusion fuels their fear for the child.

Refer the family to a home care agency and to family, friends, and support services. A wider net lowers anxiety and keeps the parents socially active.