A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?

Suctioning is the priority observation in the client's care, as it prevents airway obstruction and respiratory distress caused by blood, mucus, or secretions. The client has a permanent tracheostomy and cannot cough or clear the airway effectively. The nurse should assess the need for suctioning frequently and perform it as needed, using sterile technique and maintaining oxygenation.

a) Patency of the intravenous line is important, but not the priority observation in the client's care. The intravenous line provides fluids, electrolytes, and medications to the client, but it does not affect the airway patency or oxygenation.
c) Integrity of the dressing is important, but not the priority observation in the client's care. The dressing protects the surgical site from infection and bleeding, but it does not affect the airway patency or oxygenation.
d) Level of pain is important, but not the priority observation in the client's care. The pain can be managed with analgesics and nonpharmacological measures, but it does not affect the airway patency or oxygenation.

This statement indicates an understanding of the teaching, as weight loss is one of the most effective ways to decrease the number of nightly apneic episodes in clients who are obese and have obstructive sleep apnea. Obstructive sleep apnea is a condition in which the upper airway collapses or becomes blocked during sleep, causing pauses in breathing and hypoxia. Obesity is a major risk factor for obstructive sleep apnea, as excess fat tissue around the neck and throat can narrow the airway and increase its collapsibility. Losing weight can reduce the pressure on the airway and improve its patency.

b) "I sleep better if I take a sleeping pill at night." This statement indicates a lack of understanding of the teaching, as sleeping pills are not recommended for clients who have obstructive sleep apnea. Sleeping pills can worsen the condition by relaxing the muscles of the throat and tongue, which can further obstruct the airway and decrease the arousal response to hypoxia. The nurse should advise the client to avoid sleeping pills and other sedatives or alcohol before bedtime.
c) "It might help if I tried sleeping only on my back." This statement indicates a lack of understanding of the teaching, as sleeping on the back is not helpful for clients who have obstructive sleep apnea. Sleeping on the back can increase the risk of airway obstruction by allowing gravity to pull the tongue and soft palate backward, which can block the airway and cause snoring and apnea. The nurse should suggest that the client try sleeping on the side or elevate the head of the bed to prevent this.
d) "I should get a humidifier to run at my bedside at night." This statement indicates a lack of understanding of the teaching, as a humidifier is not likely to decrease the number of nightly apneic episodes in clients who have obstructive sleep apnea. A humidifier can moisten the air and ease breathing for clients who have dry or irritated nasal passages, but it does not address the underlying cause of airway obstruction or hypoxia. The nurse should inform the client that a humidifier may not be effective for obstructive sleep apnea and may increase the risk of infection or mold growth if not cleaned properly.