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Question
the nurse observes the sleep pattern of a client with a bmi >30 and cardiac disease. the nurse notes occasional periods of apnea. which action should the nurse take first? assess the clients vital signs and pulse oximetry. review the clients health record for factors contributing to sleep disturbances. administer bronchodilators. ask a colleague to come and observe the sleep pattern.
When a client with a BMI >30 (indicating obesity, a risk factor for sleep - related breathing disorders) and cardiac disease has occasional apnea, the first step is to assess vital signs and pulse oximetry. Vital signs (such as heart rate, blood pressure, respiratory rate) and pulse oximetry (to measure oxygen saturation) can quickly indicate if the apnea is causing immediate physiological distress (e.g., hypoxemia, changes in heart rate due to lack of oxygen). Reviewing the health record (while important for long - term management) is not the first action. Administering bronchodilators is premature without knowing the client's current oxygenation and respiratory status. Asking a colleague to observe is not as urgent as assessing the client's immediate physiological state.
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Assess the client's vital signs and pulse oximetry.