A nurse observes a preterm infant who has no airflow but continues to exhibit chest and abdominal movements. This presentation is characteristic of which type of apnea?

Appeared in: RAK Nursing Officer - 2019

Explanation

Obstructive apnea is defined by the absence of airflow despite persistent respiratory effort.
The question describes exactly this scenario: 'no airflow' (absence of airflow) but 'continues to exhibit chest and abdominal movements' (persistent respiratory effort).
This indicates that the infant is trying to breathe, but an obstruction in the upper airway, such as pharyngeal collapse, is blocking the flow of air.
This is a critical distinction from central apnea, where the drive to breathe itself is absent.

Why Other Options Were Wrong

Option A: In central apnea, there is no respiratory effort. The brain fails to send signals to the breathing muscles, so both airflow and chest/abdominal movements would be absent.
Option B: Mixed apnea is a combination of central and obstructive patterns. The presentation described is purely obstructive, without a central component (i.e., a period of no effort).
Option D: Secondary apnea is a term related to neonatal resuscitation. It describes apnea that follows a period of primary apnea and gasping during asphyxia and requires intervention like positive pressure ventilation.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Classification of apnea in neonates to guide bedside assessment, documentation, and the next nursing action.
Accurate identification of the type of apnea is crucial for appropriate nursing intervention. Obstructive apnea may be managed with positioning changes (e.g., slight neck extension, prone positioning) to open the airway.
All preterm infants, especially those less than 34 weeks gestation, require continuous cardiorespiratory monitoring to detect apnea and associated bradycardia or desaturation promptly.
Nursing interventions for apnea include tactile stimulation, positioning, and if unresolved, escalating to respiratory support like CPAP, which helps splint the airway open.

How to Approach the Question

First, identify the two key clinical signs described in the question: airflow and respiratory effort.
Note the status of each sign: Airflow is 'no airflow' (absent), while respiratory effort is 'continues to exhibit chest and abdominal movements' (present).
Recall the definitions of the three main types of apnea based on these two signs.
Central Apnea = No Airflow + No Effort.
Obstructive Apnea = No Airflow + Present Effort.
Mixed Apnea = A combination of both patterns.

Concept Tested & Keywords

Concept Tested: Classification of apnea in neonates
Stem keywords: preterm infant, no airflow, chest and abdominal movements, apnea
Lead-in keywords: characteristic of
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QSP8sZiVCEcC7a4QTz7FuP

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1084-1086

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 6991-6993

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