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Are you looking for a study guide on Aerosol Drug Therapy? If so, then this is the post for you. The practice questions found here cover everything you need to know for Egan’s Chapter 39 (from the 11th Edition) in order to ace your exams.

Are you ready to get started? Then let’s go ahead and dive right in!

Oh, and by the way. If your Respiratory Therapy program is like mine, then you probably use the Egan’s Workbook as well. Don’t get me wrong, it’s a solid workbook that can be helpful at times. The problem is, it takes way too long to look up all the answers, so it tends to be more busywork than anything else.

To help with that, we looked up all the answers for you so that you don’t have to waste any more of your valuable time. So if you do need the Egan’s Workbook Answers, you can check out our Workbook Helper. 🙂

Aerosol Drug Therapy Practice Questions:

1. Can you use a USN to administer undiluted bronchodilator to patients with severe bronchospasm?: Yes.

2. Conversion Solution for drug dosage: 1 ml of a 1% solution= 10mg

3. Dosage equation for drug dosage: dosage = volume x original concentration

4. How are DPIs categorized?: categorized by the design of their dose containers.

5. How are medical aerosols generated in the clinical setting?: with devices that physically disperse matter into small particles and suspend them in gas.

6. How does a Large Volume USN work?: incorporates air blowers to carry mist to the patient for delivery of bland aerosol therapy or sputum induction.

7. How do ultrasonic nebulizers work? (USNs): uses piezoelectric crystal to produce aerosol. The crystal converts electrical energy into high frequency vibrations to produce aerosol. Output is directly affected by amplitude setting

8. How do you prime an MDI?: Shake device and release one or more sprays into the air when MDI is new or hasn’t been used for a while

9. How is Aerosol Output measured?: By collecting the aerosol that leaves a nebulizer and collects on special filters.

10. How often do you assess a patient on continuous nebulization?: every 30 minutes for the first 2 hours then hourly. (For adverse drug responses)

11. Percent solution for drug dosage: Volume (ml)= Dosage desired (mg) / % original concentration

12. Ratio Solution for drug dosage: 1:100= 1% percent solution

13. What affects MDI performance and drug delivery?: Low temperature decreases output of CFC MDI’s. Debris build up on nozzle or actuator orifice reduces emitted dose.

14. What are 3 examples of aerosol devices?: 1. Atomizers, 2. Nebulizers, 3. Inhalers

15. What are 3 factors that determine particle size?: 1. Substance being nebulized, 2. Method used, 3. Environmental conditions

16. What are beneficial characteristics of an MDI?: 1. portable, 2. compact, 3. easy to use

17. What are heterodispersed aerosols?: aerosols with particles of different sizes

18. What are key mechanisms of aerosol deposition?: 1. inertial impaction, 2. Gravimetric sedimentation, 3. Brownian diffusion

19.What are medication delivery issues for infants and children?: Smaller airway diameter, faster breathing rate, Nose breathing filters out large particles, lower minute volumes, and spontaneous patient cooperation

20. What are Monodispersed aerosols?: aerosols with particles of similar sizes.

21. What are small volume USNs used for?: delivery of aerosolized medications (i.e. bronchodilators, antibiotics and anti-inflammatory agents.)

22. What are sub-hazards to aerosol drug therapy?: 1. infection, 2. airway reactivity, 3. pulmonary and systemic effects of bland aerosols, 4. drug concentration changes during nebulization, 5. eye irritation

23. What are therapeutic Aerosol depositions influenced by?: 1. Inspiratory flow rate, 2. Flow pattern, 3. Respiratory Rate, 4. Inhaled volume, 5. I:E ratio, 6. Breath-holding

24. What are two methods to measure medical aerosol particle distribution?: 1. Cascade impaction, 2. Laser diffraction

25. What contributes to aging of aerosols?: 1. Composition of aerosol, 2. Initial size of particles, 3. time in suspension, 4. Ambient condition

26. What does Assay measure?: Quantity of drug

27. What does Geometric standard deviation (GSD) describe?: Variability of particle sizes

28. What does Gravimetric analysis measure?: Aerosol weight

29. What happens to a solution placed in a USN?: Temperature of the solution increases

30. What is a dry powder inhaler (DPI): breath actuated dosing system by which a patient creates the aerosol by drawing air through a dose of finely milled drug powder. Dispersion of powder into respirable particles depends on creation of turbulent flow in inhaler. (THERE IS NO PROPELLANT)

31. What is Aerosol emitted dose?: the mass (amount) of drug leaving the mouthpiece as an aerosol

32. What is aerosol output?: The mass (amount) of fluid or drug contained in aerosol

33. What is aerosol output rate?: The mass (amount) of aerosol generated per unit of time. Varies depending on different nebulizers and inhalers used.

34. What is Aging when pertaining to aerosols?: process by which the aerosol suspension changes over time.

35. What is a Metered-dose inhaler? (MDI): A pressurized canister containing the prescribed drug in a volatile propellant combined with surfactant and a dispersing agent

36. What is an aerosol?: A suspension of solid or liquid particles in gas

37. What is a positive response indicated from Continuous nebulization?: increase in peak flow of >10% with a goal of at least 50%

38. What is a technical downfall of MDIs?: 80% of the aerosol hits the back of the throat depositing the medication in the oropharynx

39. What is a USN capable of?: higher aerosols outputs and higher aerosol densities than conventional jet nebulizers

40. What is Brownian diffusion?: The primary deposition mechanism for very SMALL particles and will deposit DEEP within the lung.

41. What is gravimetric sedimentation?: When aerosol particles settle out of suspension and are deposited due to the pull of gravity. Breath-holding after inhalation increases sedimentation and distribution in the lungs. the greater the mass of a particle the faster it settles

42. What is inertial impaction?: when aerosol in motion collides with and are deposited onto a surface. The greater the mass and velocity of a moving droplet, the greater the inertia and tendency of that droplet to continue moving along its set path.

43. What is Intrapulmonary percussive ventilation IPPV: Provides high-frequency oscilation of airway while administering aerosol particles

44.What is non-invasive ventilation?: Bi-Pap and C-Pap (pressurized assisted ventilation)

45. What is the blow-by technique?: used if patient cannot tolerate mask treatment, aerosol is directed from aerosol from nebulizer towards the patients nose and mouth from a distance of several inches from the face.

46. What is the fundamental principle of aerosol deposition?: Only a fraction of emitted aerosol will be inhaled and only a fraction of what is inhaled will make it to the lungs.

47. What is the most commonly prescribed method of aerosol therapy?: MDI

48. What is the primary hazard of aerosol drug therapy?: adverse reaction to medication

49. What is the relationship between GSD and the range of particle sizes?: The greater the GSD, the wider the range of particle sizes and therefore a more heterodispersed aerosol.

50. What’s the difference between spacers and holding chambers: Spacer: valve-less just adds distance from point of discharge to the mouth. Holding chamber: has valves for holding medication.

51. Where should the aerosol generator be placed with IPPV?: in circuit close to patient’s airway

52. Why would you prime an MDI?: To mix the drug and propellant and to ensure adequate dose is provided

53. Why would you use continuous nebulization?: for treatment of refractory bronchospasm. nebulized albuterol is dosed at 5-20mg/hour

 

1. Two most common laboratory methods used to measure medical aerosol particle size distribution are:: cascade impaction; laser diffraction

2. Three Categories of DPIs: 1. Unit-Dose DPI, 2. Multiple unit-dose DPI, 3. Multiple Dose Drug Reservoir DPI

3. The AARC recommends that when monitoring trends,: the same unit be used for a given patient and that the patient’s range be reestablished if a different flowmeter is used

4. Additional techniques can be used for mechanically ventilated patients because: (1) a change in the differences between peak and plateau pressures (the most reliable indicator of a change in airway resistance during continuous mechanical ventilation) can be measured, (2) automatic positive end expiratory pressure levels may decrease in response to bronchodilators (see Chapter 41), and (3) breath-to-breath variations make measurements more reliable when the patient is not actively breathing with the ventilator.70

5. Aerocount Autohaler: flow triggered pMDI designed to eliminate the need for hand-breath coordination by automatically triggering in response to the patient’s inspiratory effort.24 To use the Autohaler, the patient cocks a lever on the top of the unit, which sets in motion a downward spring force. Using the closed-mouth technique, the patient draws through the mouthpiece. When the patient’s flow rate exceeds 30 L/min, a vane releases the spring, which forces the canister down and triggers the pMDI. In the United States, the Autohaler is available only with pirbuterol, a bronchodilator similar to albuterol.

6. AeroEclipse: A unique, spring-loaded, one-way valve design draws the jet to the capillary tube during inspiration and causes nebulization to cease when the patient’s inspiratory flow decreases below the threshold or the patient exhales into the device. Expiratory pressure on the valve at the initiation of exhalation moves the nebulizer baffle away from its position directly above the jet orifice, reduces the pressure, and stops aerosolization

7. Aerosol: A suspension of a solid or liquid particles in gas

8. Aerosol administration by a VM nebulizer has been estimated to deliver greater than: 10% deposition in adults and infants without the addition of gas into the ventilator circuit. The low residual drug volume and small particle size are associated with higher efficiency. Similar to the USN, the VM nebulizer does not add gas flow into the ventilator circuit, so ventilator parameters and alarms do not need to be adjusted before, during, or after nebulization. In contrast to jet SVNs and USNs, the medication reservoir of the VM nebulizer is above the circuit and separated from the ventilator tubing by the mesh, reducing the risk of retrograde contamination of medication in the reservoir from the ventilator circuit. Because of the nature of the mesh, the reservoir can be opened and medication can be added to the nebulizer without creating a perceptible leak during ventilation.

9. Aerosol generators include: pMDIs (w/ or w/o spacers & holding chambers), DPIs, Small and Large Volume (jet) nebulizers, Hand-Bulb atomizers, Ultrasonic Nebulizers, Vibrating Mesh Nebulizers

10. Aerosol Output: the mass of fluid or drug contained in the aerosol product by a nebulizer. The mass of aerosol generated per unit of time.

11. Aerosol particle size depends on:: the substance for nebulization, method used to generate the aerosol, and The environmental conditions surrounding the particle.

12. Aerosols occur in nature as:: pollens, Spores, Dust, Smoke, Fog, and Mist

13. Aersol particle can change size as a result of: evaporation or hygroscopic water absorption.

14. After CBT is started, the patient is carefully assessed every: 30 minutes for the first 2 hours and thereafter every hour. A positive response is indicated by an increase in PEFR of at least 10% after the first hour of therapy. The goal is at least 50% of the predicted value. For small children, improved oxygenation (oxygen saturation by pulse oximeter [SpO2] >92% on room air) with evidence of decreased work of breathing indicates a favorable response. Once the patient “opens up,” intermittent SVN administration is resumed, or a pMDI dose-response assessment is conducted.

15. Aging: The process by which an aerosol suspension changes over time.

16. The aim of medical aerosol therapy is to:: Deliver a therapeutic dose of the selected agent (drug) to the desired site of action.

17. All patients with acute airway obstruction should be monitored for oxygenation status with: pulse oximetry. This value can be used in conjunction with observational assessment to titrate the level of inspired O2 given to the patient (see Chapter 35). Arterial blood gases are not essential for determining patient response to bronchodilator therapy but may be needed for patients in severe distress to assess for hypercapnic respiratory failure

18. Another special-purpose large volume nebulizer: a small particle aerosol generator (SPAG). The SPAG was manufactured by ICN Pharmaceuticals specifically for administration of ribavirin (Virazole) to infants with respiratory syncytial virus infection. Incorporates a drying chamber with its own flow control to produce a stable aerosol.

19. Another type of off-label use involves drugs that: have not been approved for inhalation, ranging from heparin to certain antibiotics. Although physicians may order such drugs via inhalation, the risk to the patient and institution is greater when the administration of such drugs via inhalation has not been thoroughly studied. All forms of off-label use should be avoided when approved and viable alternatives exist. Likewise, off-label
administration should always be backed by appropriate departmental or institutional policies and procedures.

20. appropriate airway clearance techniques should accompany any aerosol therapy designed to help mobilize secretions.

21. Baffle: is a surface on which large particles impact and fall out of suspension, whereas smaller particles remain in suspension, reducing the size of particles remaining in the aerosol.

22. Basic Concepts for spacer devices include:: 1. Small volume adapters, 2. Open Tube Designs, 3. Bag reservoirs, 4. Valved holding chambers.

23. Before initial use and after storage, every pMDI should be: primed by shaking and actuating the device to atmosphere one to four times. without the priming, the initial dose actuated from a new pMDI cansiter contains less active substance than subsequent actuations. waste a single does when it has not been used for 4-6 hours

24. Booths or stations should be used for: sputum induction and aerosolized medication treatments given in any area where more than one patient is treated. The area should be designed to provide adequate airflow to draw aerosol and droplet nuclei from the patient into an appropriate filtration system or an exhaust system directly to the outside. Booths and stations should be adequately cleaned between patients

25.Breath-Actuated Nebulizers: -aerosol device that is responsive to the patient’s inspiratory effort and reduces or eliminates aerosol generation during exhalation. generate aerosol only during inspiration. eliminates waste of aerosol during exhalation and increases the delivered dose threefold or more over continuous and breath-enhanced nebulizers.

26. Breath-Actuated Pressurized Metered Dose Inhaler: a variation of a pMDI that incorporates a trigger that is activated during inhalation. This trigger reduces the need for the patient or caregiver to coordinate MDI actuation with inhalaiton.

27. Breath-Enhanced Nebulizers: nebulizers that entrain room air in direct relationship to the inspiratory flow of the patient, they generate aerosol continuously, using a system of vents and one-way valves to minimize aerosol waste

28. Breath holding after inhalation of an aerosol increases…..: The residence time for the particles in the lung and enhances distribution across the lungs and sedimentation

29. Brownian Diffusion: The primary mechanism for deposition of small particles (< 3um), mainly in the respiratory region where bulk gas flow ceases

30. Careful, ongoing patient assessment is: is key to an effective bronchodilator therapy protocol. To guide practitioners in implementing effective bedside assessment, the AARC has published Clinical Practice Guideline: Assessing Response to Bronchodilator Therapy at Point of Care.

31. Cascade impactors: are designed to collect aerosols of different sizes ranges on a series of stages or plates

32. The CDC recommends that nebulizers: be cleaned and disinfected, or rinsed with sterile water, and air-dried between uses.

33. Characteristics of Drug Fomulation: Viscosity, Surface tension, Homogeneity

34. Chlorofluorocarbons (CFCs): gaseous chemical compounds that were originally used to power metered dose inmhalers but currently phased out of use

35. Cleaning of holding chambers and spacers: should be cleaned regularly, typically monthly, as recommended by the manufacturer. Use of dilute liquid dishwashing soap, with or without rinsing, and allowing to air dry are recommended.

36. Clinical efficacy varies according to: both patient technique and device design. For these reasons, the best approach to aerosol drug therapy is to use an assessment-based protocol that emphasizes individually tailored therapy modified according to patient response.

37. Cold air and high-density aerosols can cause:: Reactive bronchospasm and increased airway resistance.

38. Cold Freon Effect: -occurs when the cold aerosol plume reaches the back of the mouth and the patient stops inhaling. Can be reduced by using a spacer or holding chamber.

39. Components of pMDI, including function of the metering valve: …

40. Concerns in the use of disposable nebulizers with compressors at home involve: possible degradation of performance of the plastic device over multiple uses

41. Continuous Drug Delivery: when nebulization occurs over extended periods. this is the greatest effect.

42. Continuous pneumatic nebulizers produce the greatest amount of: secondhand aerosol, with most (60%) of the aerosol produced passing directly into the environment. The Respirgard II (Vital Signs, Totowa, NJ) nebulizer was developed for administration of pentamidine, adding one-way valves and an expiratory filter to contain aerosol that is exhaled and not inhaled. Breath-actuated nebulizers, DPIs, and pMDIs tend to generate less secondhand aerosol.

43. Continuous Small Colume Nebulizers with Collection Bags: – hold the aerosol generated during exhalation and allow the small particles to remain in suspension for inhalation with the next breath, while larger particles rain out, attributed to a 30% to 50% increase in inhaled dose

44. conventional spirometry: remains the standard for determining bronchodilator response.

45. Deposition: where the aerosol particle connects or lands to the body

46.Depth & Penetration & deposition of a particle in the respiratory tract vary…: with size and tidal volume. With this knowledge it may be possible to target aerosol deposition to specific areas of the lung by using the proper particle size and breathing pattern.

47.Determinant of Deposition (where a particle of any specific size is deposited): particle size, inspiratory flow rate, flow pattern, respiratory rate, inhaled volume, ratio of inspiraton time to expiratory time, and breath holding.

48. Determine Dose Left in Pressurized MDI with dose counters: 1.Determine how many puffs of drug the pMDI has when full. 2.Learn to read the counter display because each dose counter has a different way of displaying doses left in the canister. 3.Check the counter display to track the pMDI actuations remaining in the canister. 4.Reorder the pMDI when there are a few days of drug remaining. 5.Dispose of the pMDI properly, after the last dose is dispensed.

49. Determine Dose Left in Pressurized MDI without dose counters: 1.Read the label to determine how many puffs of drug the pMDI has when full. 2.Calculate how long the pMDI will last by dividing the total number of puffs in the pMDI by the total puffs used per day. If the pMDI is used more often than planned, it will run out sooner. 3.Identify the date that the medication will run out, and mark it on the canister or on a calendar. 4.For drugs that are prescribed to be taken as needed, track the number of puffs of drug administered on a daily log sheet and subtract them from the remaining puffs to determine the amount of medication left in the pMDI. 5.Keep the daily log sheet in a convenient place, such as taped to the bathroom mirror. 6. Refill the pMDI prescription when there are a few days of use remaining in the pMDI. 7.Dispose of the pMDI properly when the last dose is dispensed.

50.Determining Doses Left in the Dry Powder Inhaler is important to know for the patient.

51. Direct pMDI actuation by simple elbow adapters typically results in the least: pulmonary deposition, with most of the aerosol impacting in either the ventilator circuit or the tracheal airway. Higher aerosol delivery percentages occur only when an actuator or spacer is placed in-line in the ventilator circuit. These spacers allow an aerosol “plume” to develop before the bulk of the particles impact on the surface of the circuit or endotracheal tube. The result is a more stable aerosol mass that can penetrate beyond the artificial airway and be deposited mainly in the lung. This situation leads to a better clinical response at lower doses

52. Dose Counters: – a serious limitation of pMDIs is the lack of a “counter” to indicate the number of doses remaining in the canister.

53. DPIs SHOULD NOT BE USED FOR: the management of acute bronchospasm.

54. Droplet size and nebulization time are inversely proportional to gas flow through the jet.: higher the flow of gas to the nebulizer, the smaller the particle size generated, and the shorter is the time required for nebulization of the full dose.

55. Drug Concentration: what increases solute concentrations during nebulization: evaporation, heating, baffling, and recycling of drug solutions

56. Drugs for nebulization that escape from the nebulizer into the atmosphere or are exhaled by the patient can be inhaled by: anyone in the vicinity of the treatment. The risk imposed by this environmental exposure is clear and is associated with a range of drugs and patients with infectious disease. Pentamidine and ribavirin were associated with health risks to health care providers even when used in conjunction with filters on exhalation ports of nebulizers, containment and scavenger systems, and high-efficiency particulate air (HEPA) filter hoods and ventilation systems (Figure 36-36).

57. Dry Powder Inhaler (DPI): typically a breath-actuated dosing system. patient creates the aerosol by drawing air though a dose of finely milled drug powder with sufficient force to disperse and suspend the powder in the air. dispersion of the powder into respirable particles depends on the creation of turbulent flow in the inhaler. Turbulent flow is a function of the ability of the patient to inhale the powder with a sufficiently high inspiratory flow rate

58. Emitted Dose: The mass of drug leaving the mouthpiece of a nebulizer or inhaler as aerosol

59. Every drug approved for inhalation to date has been designed for and tested in: populations of ambulatory patients with moderate disease. As patients with lung disease become acutely and critically ill, the approved label doses, frequency of administration, and devices may not be practical or effective, especially for treatment of patients requiring ventilatory support. In such cases, clinicians may explore and consider nonstandard methods (doses, frequency, and devices) for administration of approved inhaled drugs to patients in the acute care environment, known as off-label use

60. exhalation into the device before inspiration can result in: – loss of drug delivery to the lung

61. Eye irritation is caused by:: aerosol asministered via face mask which causes the drug to be deposited in the eyes.

62. Personal protective equipment is recommended when: caring for any patient with a disease that can be spread by the airborne route.84 The greatest risk is communication of tuberculosis or chickenpox.

63. pMDI: used to administer bronchodilators, anticholinergics, & steroids. Are easy to use but commonly misused.

64. pMDI is: a pressurized canister that contains the prescribed drug in a volatile propellant combined with a surfactant and dispersing agent.

65. pMDI steroid aerosol impaction occurs deep in the hypopharynx, which cannot be easily rinsed with gargling for this reason…: steroid pMDIs should not be used alone but always in combination with a spacer or valved holding chamber.

66. Poor patient response to bronchodilator therapy often occurs because: an inadequate amount of drug reaches the airway. To determine the “best” dose for patients with moderate obstruction, the respiratory therapist (RT) should conduct a dose-response titration.

67. A potential problem with continuous bronchodilator therapy (CBT): is increase in drug concentration. Patients receiving CBT need close monitoring for signs of drug toxicity (e.g., tachycardia and tremor).

68. Practitioner demonstration followed by repeated patient return demonstration is a: must and should be done frequently, such as with each office or clinic visit.

69. precise amount of drug delivered to the patient’s airways can be measured in terms of:: -patient’s clinical response to aerosol drug therapy including the desired therapeutic effects and any unwanted adverse effects.

70. Preliminary assessment should balance: the need versus the risk of aerosol therapy

71. The primary hazard of aerosol drug therapy is: an adverse reaction to the medication being administered. Other hazards include infection, airway reactivity, systemic effects of bland aerosols, and drug reconcentration

72. Priming: Shaking the device and releasing one or more sprays into the air when the pMDI is new or has not been used for a while. done to mix the drug and the propellant required to provide an adequate dose.

73. The Problem of Drug precipitation can jam breathing valves or occlude the ventilator circuit cn be overcome by:: (1) placing a one-way valve between the SPAG and the circuit and
(2) filtering out the excess aerosol particles before they reach the exhalation valve, changing filters frequently to avoid increasing expiratory resistance.

74. procedures to help reduce contamination and infection associated with respiratory care equipment: nebulizers should be sterilized between patients, nebulizers should frequently be replaced with disinfected or sterile units or rinsed with sterile water (not tap water) and air dried every 24 hours.

75. Propellant: something that propels or provides thrust, as the propellant in a metered dose inhaler

76. Pulmonary and Systemic Effects Excess water can cause:: overhydration

77. Range of particle size for common aerosols in the environment and the influence of inertial impactions, sedimentation, and diffusion.:

78. Regardless of the device used, the clinician must be aware of: the limitations of aerosol drug therapy. First, depending on the device and patient, 10% or less of drug emitted from an aerosol device may be deposited in the lungs (Figure 36-30). As indicated in Box 36-7, additional reductions in lung deposition can occur in many clinical situations that sometimes necessitate the use of higher dosages.

79. A reservoir on the expiratory limb of the nebulizer: conserves drug aerosol

80. Residual Drug Volume: or dead volume, is the medication that remains in the SVN after the device stops generating aerosol and “runs dry.” The residual volume of a 3-ml dose can range from 0.5 to more than 2.2 ml, which can be more than two-thirds of the total dose. Residual volume also depends on the position of the SVN.

81. The Respimat soft mist inhaler (Boehringer, Ingelheim am Rhein, Germany) is a: small hand-held inhaler that uses mechanical energy to create an aerosol from liquid solutions to produce a low-velocity spray (10 mm/sec) that delivers a unit dose of drug in a single actuation. To operate the device, patients twist the body of the device to load an internal spring, place the mouthpiece of the Respimat between the lips, and press a button to release the drug through a uniblock to create spray, which is released over 1.1 to 1.4 seconds, depending on the formulation configuration. The Respimat device requires hand-breath coordination on the part of the patient, as does a pMDI, but because of the longer spray time, it seems more likely to get a greater percent of emitted dose despite coordination issues. Because of the small particle size and low-velocity spray, pulmonary deposition of 40% is independent of inspiratory flows with oral deposition (40%) half the oral dose used with most pMDIs and DPIs (80%). The Respimat is currently available with several drugs in Europe and is slated for introduction with tiotropium in the United States.

82. Respirable Mass: proportion of aerosolized drug of the proper particle size to reach the lower respiratory tract

83. Restlessness, diaphoresis, and tachycardia also may indicate: severity of airway obstruction but must not be confused with bronchodilator overdose

84. Risk for Caregivers and Bystanders: risk the above hazards as a result of exposure to secondhand aerosol drugs.

85. Scintigraphy: photograph showing the distribution and intensity of radioactivity in various tissues and organs after administration of a radiopharmaceutical.

86. Sedimentation: Occurs when aerosol particles settle out of suspension & are deposited owing to gravity. The greater mass of the particle the faster it settles.

87. A simple albuterol dose-response titration involves: giving an initial 4 puffs (90 mcg/puff) at 1-minute intervals through a pMDI with a holding chamber. After 5 minutes, if airway obstruction is not relieved, the RT gives 1 puff per minute until symptoms are relieved, heart rate increases to more than 20 beats/min, tremors increase, or 12 puffs are delivered. The best dose is the dose that provides maximum relief of symptoms and the highest PEFR without side effects.

88. The site of deposition in the respiratory tract varies with the size of the particle. Use of nebulizers that produce particles in a specific size range improves the targeting of aerosols for deposition to a desired site in the respiratory tract, as follows:

89. Small volume nebulizers (SVNs): most commonly used for medical aerosol therapy hold 5 to 20 ml of medication.

90. Small volume USNs have been promoted for administration of a wide variety of formulations ranging from: bronchodilators to antiinflammatory agents and antibiotics

91. Sole dependence on tests of expiratory airflow for assessing patient response to therapy is: unwise because not all patients can perform these maneuvers. Other components of patient assessment useful in evaluating bronchodilator therapy include patient interviewing and observation, measurement of vital signs, auscultation, blood gas analysis, and oximetry.

92. Spacer: A spacer is a simple valveless extension device that adds distance between the pMDI outlet and the patient’s mouth. This distance allows the aerosol plume to expand and the propellants to evaporate before the medication reaches the oropharynx.

93. Spacers and Valved holding Chambers: -are pMDI accessory devices designed to reduce both oropharyngeal deposition and the need for hand-breath coordination. All spacers add distance between the pMDI and the mouth, reducing the initial forward velocity of the pMDI droplets. Reduces foul taste.

94. SPAG: duces medical gas source from the normal 50 pounds per square inch gauge (psig) line pressure to 26 psig with an adjustable regulator. The regulator is connected to two flowmeters that separately control flow to the nebulizer and drying chamber. The nebulizer is located within the glass medication reservoir, the fluid surface and wall of which serve as primary baffles. As it leaves the medication reservoir, the aerosol enters a long, cylindrical drying chamber. Here the second (separate) flow of dry gas is entrained, reducing particle size by evaporation, creating a monodisperse aerosol with an MMAD of 1.2 to 1.4 µm. Nebulizer flow should be maintained at approximately 7 L/min with total flow from both flowmeters not less than 15 L/min. The latest model operates consistently even with back pressure and can be used with masks, hoods, tents, or ventilator circuits.

95. Spontaneous breathing in all patients, including pediatric and neonatal patients, results in: greater deposition of aerosol from an SVN than occurs with positive pressure breaths (e.g., intermittent positive pressure ventilation). This mode of ventilation reduces aerosol deposition more than 30% compared with the effect of spontaneously inhaled aerosols

96. Tail-off effect: refers to variability in the amount of drug dispensed toward the end of the life of the canister.

97. Technique for using a SVN: -Slow inspiratory flow optimizes SVN aerosol deposition. deep breathing and breath holding during SVN therapy do little to enhance deposition over normal tidal breathing. As long as the patient is mouth breathing, there is little difference in clinical response between therapy given by mouthpiece and therapy given by mask

98. temperature: Decreased temperature (<10° C) has been shown to decrease the output of CFC pMDIs.

99. three categories of nebulizers include: (1) pneumatic jet nebulizers, (2) USNs, and (3) VM nebulizers.

100. Through preliminary patient instuction: can last 10-30 min, should include: demonstration, Practice, Confirmation of patient performance

101. Timing of Actuation Intervals: Manufacturers recommended 30 sec to 1 min between actuations. Very rapid acutation of multiple puffs per breath reduces inhaled drug per puff

102. To avoid opportunistic oral yeast infection:: rinse the mouth after steriod use.

103. Two specific problems are associated with SPAG use to deliver ribavirin.: 1. Caregiver exposure to the drug aerosol. 2.Drug precipitation can jam breathing valves or occlude the ventilator circuit.

104. Two types of VM nebulizers, active and passive, are available commercially.: Active VM nebulizers use a dome-shaped aperture plate, containing more than 1000 funnel-shaped apertures. This dome is attached to a plate that is also attached to a piezoceramic element that surrounds the aperture plate. Electricity applied to the piezoceramic element causes the aperture plate to be vibrated at a frequency of approximately 130 kHz (or one-tenth that of a USN), moving the aperture plate up and down by 1 µm or 2 µm, creating an electronic micropump. The plate actively pumps the liquid through the apertures, where it is broken into fine droplets. The exit velocity of the aerosol is low (<4 m/sec), and the particle size can range from 2 to 3 µm (MMAD), varying with the exit diameter of the apertures.

105. a typical SVN is powered by: a high-pressure stream of gas directed through a restricted orifice (the jet). The gas stream leaving the jet passes by the opening of a capillary tube immersed in solution. Because it produces low lateral pressure at the outlet, the high jet velocity draws the liquid up the capillary tube and into the gas stream, where it is sheared into filaments of liquid that break up into droplets. This primary spray produces a heterodisperse aerosol with droplets ranging from 0.1 to 500 µm.

106. Unit-Dose DPIs: dispense individual doses of drug from punctured gelatin capsules.

107. The USN uses a piezoelectric crystal to: generate an aerosol. The crystal transducer converts an electrical signal into high-frequency (1.2- to 2.4-MHz) acoustic vibrations. These vibrations are focused in the liquid above the transducer, where they disrupt the surface and create oscillation waves (Figure 36-25). If the frequency of the signal is high enough and its amplitude strong enough, the oscillation waves form a standing wave that generates a geyser of droplets that break free as fine aerosol particles.

108. Valved holding chambers: protect the patient from poor hand-breath coordination, with exhaled gas venting to the atmosphere, allowing aerosol to remain in the chamber available to be inhaled with the next breath. allow infants, small children, and adults who cannot control their breathing pattern to be treated effectively with pMDIs.

109. A variety of booths and specially designed stations are available for delivery of pentamidine or ribavirin: The Emerson containment booth (Figure 36-37) is an example of a system that completely isolates the patient during aerosol administration. The AeroStar Aerosol Protection Cart (Respiratory Safety Systems, San Diego, CA) is a portable patient isolation station for administration of hazardous aerosolized medication. It has been used during sputum induction and for pentamidine treatment. The patient compartment is collapsible with a swing-out counter and three polycarbonate walls. Captured aerosols are removed with a HEPA filter. A prefilter is used to retain larger dust particles and to prevent early loading of the more expensive HEPA filter.

110.Volume Mean Diameter (VMD): the median diameter of an aerosol particle measured in units of volume.

111. well-designed baffling systems decrease both: the MMAD (size) and the GSD (range of sizes) of the generated aerosol.

112. When ribavirin or pentamidine is given, the treatment is provided in a: a private room. The room should be equipped for negative pressure ventilation with adequate air exchanges (at least six per hour) to clear the room of residual aerosols before the next treatment. HEPA filters should be used to filter room or tent exhaust, or the aerosol should be scavenged to the outside.

113. When used in conjunction with high-frequency oscillatory ventilation, administration of albuterol sulfate via a VM nebulizer placed between the ventilator circuit and the patient airway has been reported to: deliver greater than 10% of dose to both infants and adults.79,80 A pMDI with adapter placed immediately proximal to the endotracheal tube achieved similar results in adult patients ventilated via high-frequency oscillatory ventilation.81

114. Where aerosol particles are deposited in the respiratory tract depends on their: size, shape, and motion and on the physical characteristics of the airways. Key mechanisms causing aerosol deposition include inertial impaction, sedimentation, and brownian diffusion.

115. Whether aerosol particles that are inhaled into the lungs are deposited into the respiratory tract depends on:: size, shape, and motionof the particles and on the physical characteristics of the airways and breathing pattern.

116. With continuous or bias flow through the ventilator circuit, the delivery is reduced: as flow increases, whereas placement of a VM nebulizer near the ventilator increases delivery

117. with ipratropium use: the closed-mouth technique to avoid spraying in the eyes.

118. without a dose counter: there is no viable method to determine remaining drug in a pMDI other manually keeping a log of every dose taken.

119. Workplace exposure to aerosol may be detectable in: the plasma of bystanders & health care providers.

QuestionAnswer
What are some of the advantages of MDI?Ref page 806 1.Inexpensive 2.Light,compact,resistant to moisture 3.Quick delivery of drugs 4.Precise and consistent doses 5.Available with most anti asthmatic drugs
What are some of the disadvantages of MDI?Ref page 807 1.Difficulty in coordination of activation& inspiration 2.Time consuming to teach 3.Cold freon effect i.e. inability to continue to breathe when propellant is released into mouth
What is meant by priming the MDI?Ref page 807 Activating a wasted dose to fill the metering chamber; used for new inhalers and those that have not been used for >4 to 6 hours. The old dose may have evaporated
What patients can not use DPI?Ref page: 815 Children under 5 and patients unable to generate a high air flow. They also may not work as well in high humidity environments
When should an MDI be activated for a ventilator patient?Ref page 837: Coordinate firing the MDI with the beginning of the ventilator inspiration
When using an MDI,how much time should you allow between actuations?Ref page 813 Allow 30 to 60 seconds.
How does an atomizer differ from an SVN?Ref page 816: Atomizers don’t have baffles. They are usually powered by a hand-squeezed bulb. Because the particles are larger, the drug deposits in the upper airway. You might deliver a local anesthetic through an atomizer prior to bronchoscopy
True or False:DPI Require high inspiration flow>60/l/minRef page 813 True
What are some of the Advantages of a spacer?Ref page 810-811 1.no need to activate coordination with inspiration 2. Increases drug deposition in the lungs [130%]. 3. Reduces drug deposition in the mouth. 4.used in children with face mask 5.decreases the incidence of oral thrush
What are some of the characteristics of Jet Nebulizer?Ref page 823 1.Cools during operation 2.Small aerosol particle size 3.Less expensive
In what part of the lung would like to deposit beta-adrenergic bronchodilator drugs?REF PAGE 803 In the lower airways
What is “blow- by” technique used with infants?Ref page 820: Blow-by is directing the mist by the baby’s mouth and nose without direct application to the face via a mask. It is not very effective.
SVN dosages should be adjusted when delivered to an intubated patient by what amount?Ref page 836: Give 2 to 5 times the normal dose
What is the optimal flow rate and amount of solution to put in an SVN?Ref page 817: 6 to 8 L/min
What are of the characteristics of Ultra sound nebulizers?Ref page 824 1.Heats up during operation 2.Larger aerosol particle 3.More expensive 4.Less noise
What class of inhaled drugs requires that you always use a spacer or chamber?Ref page 811 Corticosteroids to reduce oropharyngeal deposition
What is the aerosol output an ultra sound nebulizer is capable of delivering?Ref page 824 0.2 to 1.0 ml/min
What are some of the hazards of aerosol therapy?Ref page 805-806 1.Bronchospasm 2.Over hydration 3.Overheating of inspired gases 4.Delivery of contaminated aerosol 5.Tubing condensation draining into the airway
Why is particle size so important in aerosol therapy?Ref page 803 The ability of aerosols to travel through the air, enter the airways, and deposit in the lung is largely based on particle size.

QuestionAnswer
List the 3 clinical objectives for oxygen therapy Egan’s p.8681.Correct documented/suspected acute hypoxemia 2.Decrease the symptoms of hypoxiemia 3.Decrease the work of the heart related to hypoxemia
List 2 indications for the use of oxygen therapy Egan’s p. 8691. PaO2<60 2.SaO2/SpO2<90%on room air 3.Severe Trauma 4.Acute MI 5.Postanesthesia
Symptoms of mild/moderate hypoxemia involving the respiratory system Egan’s p.8701. Tachypnea 2. Dyspnea/SOB 3.Pale skin color
Oxygen toxicitiy primarily affects which branch of the nervous system Egan’s p.870The Central Nervous System (CNS)
Low Flow Oxygen Delivery Devices include: Egan’s 8731. nasal cannula 2. nasal catheter 3. transtracheal catheter 3. simple face mask 4. partial rebreathing mask
What is the proper flow range for an adult using a nasal cannula? Egan’s p. 8740.25-8 liters per minute
What is the flow range for a simple mask?5-10 liters per minute
Why is the minimum setting of a Nonrebreathing mask 10 liters? Egan’s p.874To prevent the reservoir bag from collapse on inspiration
Variables that raise the FiO2 received from a Low-Flow O2 system include: Egan’s p.877increased O2 output, Mouth-closed breathing, low inspiratory flow, slow respiratory rate
Variables that lower the FiO2 received from a Low-Flow O2 system include: Egan’s p. 877Low O2 output, Mouth-open breathing, Rapid respiratory rate
What is the tank conversion factor for an e cylinder filled with oxygen? Egan’s p.851conversion factor is 0.28
What is the formula used to determine the length of time a cylinder of oxygen with 2000psi will last at 4 liters per minute? Egan’s p.851the answer is 2000 X 0.28 = 560 divide the answer by the liter flow 560/4 = 140 minutes or 2 hours 20 minutes
What color is an oxygen tank in the United States? Egan’s p.848Green
What are the pin locations on an oxygen tank using the pin-index safety system? Egan’s p.857The pin index hole positions are 2 and 5
What effect does supplemental oxygen have on the heart of a hypoxemic patient? Egan’s p.868Supplemental oxygen reduces the need for an increase in cardiac output to meet tissue demand
What effect does too much supplemental oxygen have on a patient with COPD? Egan’s p.871Too much oxygen for a COPD patient can cause a depression in ventilation by “knocking out” their hypoxic drive
What causes Retinopathy of Prematurity? Egan’s p.871retinopathy of Prematurity is caused when low-birth-weight and/or premature infants receive too much supplemental oxygen
What risk is posed by providing supplemental oxygen at an FiO2 greater than 50%? Egan’s p.872FiO2s greater than 50% can lead to Nitrogen wash out resulting in Absorption atelectasis
Define High-Flow oxygen system? Egan’s p.880A high flow oxygen system is defined as a system that meets or exceeds the amount of oxygen required by the patient
Names 2 types of oxygen enclosures Egan’s p.888oxygen tent and oxygen hood
QuestionAnswer
particles of water or liquid suspended in a gasaerosol
the size of the particles determine how far they can be inhaled into the airwayparticle size
used to deliver aerosolized medications to the patients airwaynebulizer
what has smaller particle sizes then the standard SVNMDI
useful to tx nasal and oral areas>10
most particles go to central airways5 to 10 microns
overall lower respiratory tract (large airways to periphery). Most bronchoactive agents work here2-5 microns
increased delivery to lung parenchyma, incl. terminal airways and alveoli.0.8-3.0 microns
density, viscosity and surface tension are characteristics of whatsolution
pneumatic and ultrasonic are examples of whatnebulizers
jet neb is most common, uses Bernoulli principle, requires a source of gas flowpneumatic
electricity creates sound waves that convert liquid inot dropletsultrasonic
when the forward velocity of a gas increasesbernoulli principle
lateral pressure decreasesbernoulli principle
the forward pressure increasesbernoulli principle
by creating a restriction in the flow of gas, the veolcity and forward pressure increase and the lateral pressure decreasesbernoulli principle
decreases in lateral wall pressure to shatter fluid particles at the point where the gas flow exists constrictionpneumatic nebulizers
lateral pressure around gas stream decreases below atmospheric, fluid is drawn up capillary tube and reaches the gas stream, dead volume not nebulizedpneumatic neb
used to shatter fluid particles to decrease the sizebaffle
can include a fluid surface, sides of the aerosol generatot or a structure placed in front of the gas streambaffle
gas flow interacts with solution prior to leaving exit portinternal mixing design
the gas solution interact after both leaves the nozzleinternal mixing design
neb built inmain stream neb
t- piece and corregated tubing as resevoir in common set up of whatnebulizer
decrease amount of aerosol lost during expiration phaseenhanced neb performance
collect aerosol during exhalationreservoir bags
increase neb. output during inspiratory phasebreath-enhanced neb. ( vented)
caputures aerosol during expiratory phasereservoir bags
captured aerosol is inhaled during inspiratory phasereservoir bags
prevents exhaled gas from entering the bagcirculair
some exhaled gas enters the bagaero tee
one way valve to prevent exhaled gas from filling the resevoir bagcirculair
inspiratory / expiratory resisitorcirculair
aerosol produced during exhalation for delivery on subsequent inhalationaero tee
provides 50% more aerosol to the patient than a standard neb. tee with a 6in. resevoir tubeaero tee
no effect on particle size generated by nebaero tee
cost effective, simple to use, requires no adjustementsaero tee
enhances neb. outputbreath inhanced neb. (vented)
pari nebbreath enhanced neb (vented)
mainstream design with valvesbreath enhanced neb (vented)
patient breaths through the neb during INSPIRATIONbreath enhanced neb (vented)
inlet vent closes on exhalationpari neb
aerosol exits via one-way valve on mouthpiecepari neb
increases inhaled dose up to 50%pari neb
no increase in treatment timepari neb
synchronizes aerosol generation with inspirationbreath – actuated neb
increases amount of drug available up to fourfoldbreath – actuated neb
amount of drug inhaled about the same each breathbreath – acuated neb
used for certain medicines were none can be wastedaero-eclipse breath acuated neb
turns off when exhalingaero-eclipse breath acuated neb
high output extended aerosol resp. therapyHEART neb.
large volume nebHEART neb
aerosol production for 4 hoursHEART neb
runs at a flow of 10-15 l/minHEART neb
piezolectric transducedultrasonic neb USN
vibrates at high frequencyUltrasonic Neb
converts electricity to sound wavesUltrasonic Neb
creates waves in liquid above transducerulatrasonic neb
disrupting liquids surfaceulatrsonic neb
forms a geyser of dropletsultrasonic neb
an electrical charge is applied intermittently (at high frequency vibrations) to a substance that has a piezoelectric quailtyprinciples of ulatrasonic neb
the ability to change shape when a charge is applied to itprinciples of ultrasonic neb
curved focusing, flat, and shielded are examples ofpiezolectric transducers
lower output than curved, does not require specific water level, output 0-3 ml/minflat transducer
breaks up aerosol to greater degree, requires controlled water level, output 0-6 ml/mincurved focusing transducer
3 compontents power unit, piezolectric transducer, fan or patient inspritationUSN
medicine placed directly into transducerUSN
medicine placed in neb chamber with water used as a couplant to transfer sound wavesUSN
determined by amplitude of the signal, strength of the sound waveoutput
can be adjusted by useroutput
alters number of particles producedoutput
can produce densities as high as 500 mg/l (10 times more then needed for normal body conditions)output
determined by frequency of elctrical energyparticle size
cannot be adjusted by userparticles size
differnt nebs may operate on different frequenciesparticle size
usually used for bland aerosol therapylarge vol USN
sputum inductionLarge vol neb
has air blower to carry mist to patientlarge vol neb
temperature of a solution may increase( as much as 15 degrees C over 15 minutes)(drug concentration also rises)large vol neb
filled with water ( helps absorb mechanical heat produced)coupling chamber
acts to transfer medium for sound waves to the neb chambercoupling chamber
solution may be placed in medication cup or directly onto the transducersmall volume neb
battery power sourcesmall vol neb
patient inspiration carries aerosolsmall vol neb
may clear aerosol during exhalation (better to divert exhalation, min waste of meds, more drug available on inspiration)small vol neb
convienient for travellumiscope USN
high operating speedlumiscope USN
electrical outlet, car cig. lighter, rechargeable battery are 3 power sources forlumiscope USN
treatment delivered with in 6 minmabismist USN
less then 1 poundmabismist USN
90% particles with in 1-5 micron in diametermabismist USN
weighs 8 oz.omron portable USN
98% medication deliveryOmron portable USN
4 AA batteries or ACOmron portable USN
particles 1-7 micronsOmron portable USN
4 times a dayQID
3 times a dayTID
2 times a dayBID
every other dayQOD
every dayQDq
every 4 hoursQ4H
every 2 hoursQ2H
what drug must a patient spit / rinse mouth aftercorstasteriod
can create candida slbicans thrushcorstasteriod
5-10& salinehypertonic saline
QuestionAnswer
What is Humidity Therapy?The addition of molecular water vapor to a gas delivered to the airway.
What are results of a dry airway?Increased mucus production. Thickened Secretions. Decreased Cilia funtion Increased airway irritability
What patient population are most susceptible to a dry airway?Patients with bypassed airways
What are the normal functions of the upper airway?Filter Heat Humidity
Where does inspired air achieve BTPS conditions?At the Carina
Which part of the upper airway heats and humidifies on inspiration?The nose, it’s more efficient than the mouth.
What happens to inspired gas on expiration?It cools and transfers heat to the cool trachea. It condenses and returns to the airway.
What is relative humidity?The ratio comparing absolute humidity to its saturated capacity at a given temperature.
How is relative humidity expressed?As a percentage
Absolute humiditity is?The actual water vapor present
What is saturated capacity?The maximum amount of vapor a gas can hold.
What is the saturated capacity of body temperature?43.8 mg/L
How do you calculate relative humidity?Absolute humidity divided by saturated capacity X 100
What is the humidity deficit?the amount of water vapor that the body must add to inspired gas to achieve 100% relative humidity at body temperature.
How do you calculate the humidity deficit?capacity at body temperature- absolute humidity
What is body humidity?The ratio comparing absolute humidity to the saturated capacity at body temperature?
How do you calculate body humidity?absolute humidity/saturated capacity X body temp
What is the goal of humidity therapy?To maintain normal physilogic conditions in the airway.
What are indications for humidity therapy.Humidity dry medical gases Overcome the humidity deficit when upper airway is bypassed. Managing hypothermia treat bronchospasm caused by cold air.
What is humidifier?A device that adds molecular water vapor to a gas
Facts about humidifiers.Should provide at least 60% relative humidity at BTPS. Some humidifiers can be heated. Intubated patients need 30 mg/L of water vapor
What are the 3 variables that govern humidifier function?Temperature surface area time of contact
TemperatureThe greater the temperature the greater the water output
Surface areaThe greater the surface area, the greater the evaporation, the greater the vapor output
Time of contactThe greater the contact time, the greater the evaporation, the greater the water vapor output
What are the types of humidifier systems?Room Bubble Passover Heat Moisture Exchanger (HME)
Bubble HumidifierPneumatically powered (powered by gas) Not heated Inneficient Absolute humidity approximately 15-20 mg/L
What is the bubble humidifier used with?Simple oxygen delivery devices. (i.e. cannula)
What safety feature does the bubble humidifier have?A pop off safety valve for pressure relief (Audible, pops off at 2 PSIG)
How is a passover humidifier powered?It can be pneumatically and electrically powered.
What are the three tips of passover humidifiers?Simple resivoir passover Wick Membrane
What are some facts about the passover humidifier?It is heated very efficient (30+ mg/L) Used with mechanical ventilators
Simple resivoir passover humidifierDirects gas over surface of water and picks up vapor. (CPAP/Heated or non heated) It can maintain saturated gas at high flow rates. It’s functional at high flow rates due to low resistance to airflow.
Wick passover humidifierIt’s heated an very efficient Passes over heater/saturated wick. It does not bubble.
Membrane passover humidifierSeparates water from the gas stream by means of a hydrophobic membrane. It is heated and only allows water vapor to come through but blocks liquid water.
What do active humidifiers use?Electric heat
What do passive humidifiers use?The body heats it with exhaled gas.
What is an example of a passive humidifier?Heat moisture exchanger (HME) AKA artificial nose
How is the HME powered?Passive/patient powered
How does the HME work?It captures exhaled heat and water vapor and uses it to heat and humidify the next breath.
What is the efficiency rating?Approximately 70%
How is the Heat Moisture exchanger used?With artificial airways/mechanical ventilators
What are the contraindications to an HME?Presence of copious, thick, or bloody secretions; leak around ETT;hypothermia; and a high minute ventilation
How often must HME’s be changed?Every 24 hours or prn
What are the hazards of an HME?Underhydration, Secretion buildup in HME, Increased WOB, mucous plugging, increased deadspace, and hypothermia
What is a special consideration of the Heat Moisture Exchanger?It must be removed for administration or aerosol drugs.
What are indications for heating systems?Bypassed airway, hypothermia, airway sensitive to cold air
What are contraindications to heating systems?Airway inflammation
What are some types of heating elements?Hot plates, wrap around heaters, yolk or collar heating elements, immersion heaters
What are some hazards to heating systems?Overheating the airway or humidifier system.
What should always be monitored with the heating systems?The water level and the temperature
What are two hazards of humidity therapy?Condensation Infection Risk/Cross contamination
CondensationDisrupts or occludes the gas flow. It can be aspirated. Is an infection risk.
Infection risk/cross contaminationmonitor handling of devices use disposible equipment use automatic feed reservoirs Avoid contamination with the floor and trash can. Change circuit as required/needed
What are some ways to ensure adequate gas conditions?Use hygrometer to monitor humidity levels. Monitor temperature. Monitor water levels.
What are aerosols?Particles suspended in a gas.
What are some examples of aerosols?Liquid, smoke, dust, fog, pollen
Bland aerosol therapy isa form of humidity therapy where solutions are aerosolized. (saline, sterile H20)
What is a device that creates an aerosol?A nebulizer
What are indications for bland aerosol therapy?bypassed airway treatment of upper airway inflammation sputum induction
What are the two types of nebulizers?large volume jet nebulizer ultrasonic nebulizer
How is the large volume jet nebulizer powered?Pneumatically
Some facts about the jet volume nebulizerIt can be heated and is very efficient It usually runs continuously
What is a large volume jet nebulizer used with?Aerosol mask, face tent, trach collar, Briggs adaptor, oxygen tents and oxygen hoods
What must you use to power this?An adequate flow rate.
What does the large volume jet nebulizer contain?A baffle to break up H20 particles and an Fi02 control
How is the ultrasonic nebulizer powered?With electricity
What are some facts about the ultrasonic nebulizer?It is not heated It should only be used intermittently It is used with the same devices as large volume jet nebulizer. It can also be used as a room humidifier
What are some risks to the ultrasonic nebulizer?overhydration and bronchospasm
How does the ultrasonic nebulizer work?It uses a piezoelectric crystal to convert electrical energy into sound waves.
How is particle size controlled?It is controlled by frequency for uniform particle size but the output is controlled by the therapist.
The ultrasonic nebulizer only provides?Room air
What are some hazards of bland aerosol therapy?Infection risk/cross contamination Environmental issues (TB) Swelling secretions (overhydration) Bronchospasm Overhydration Noise Condensation Overheating when using a heater
What is the goal of aerosol drug therapy?To deliver a therapeutic dose of a selected agent to the desired site of action
What are the benefits of aerosol drug therapy?Targets the site of action High therapeutic index (very effective/fewer systemic side effects)
List some categories of aerosol drugs.Bronchodilators Steroids Mucolytics Antibiotics
QuestionAnswer
Which of the following best defines an aerosol?D. Suspension of liquid or solid particles in a gas
What devices generate therapeutic aerosols?A. I & II- Atomizers & Nebulizers
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol?C. Output
Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol?B. Emitted Dose
Which of the following is a common method to measure aerosol particle size?C. Cascade Impaction
What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?C. mean mass aerodynamic diameter(MMAD)
what is the retention of aerosol particles resulting from contact with respiratory tradct mucosa called?D. Deposition
What is the primary mechanism for deposition of large, high mass particles(greater than 5 um) inthe respiratory tract?A. Inertial Impaction
What will increase aerosol deopisiton by inertial impaction?A. II & III-Variable or irregular passages & turbulent gas flow
Where do most aerosol particles in the 5-10 um range deposit?D. Upper airways
Where do most aerol particles in the 1-5 um range deposit?C. Central airways
What term describes the primary mechanism for deposition of small particles?C. Brownian diffusion
Which of the following aerosols would have the highest rate of deposition by diffusion?MMAD of 0.1 um
Where do most aerosol particles that are less than 3 um deposit?A. Alveoli
What is teh process by which aerosol suspension changes over time?C. Aging
What is the primary hazard of aerosol drug therapy?A. untoward drug reactions
To minimize risk of infection associated with aerosol drug therapy, whjat should you do?D. I, II, III-Sterilize nebs b/w pts, Frequently replace in use units, rinse nebs with sterile water
To monitor a pt for possibility of reactive bronchospasm during aerosol drug therapy what should u do?D. I,II,III,IV-Measure pre & post peak flow and/or %forced expiratory volume in 1 second, Auscultatefor adventitious breath sounds, Observe pt’s response & Communicate with pt during therapy
After heated water aerosol tx thru jet nebs you notice a dramatic increase in the magnitude of coarse crackles heard on auscultation. Recommendations?C. Add coughing and postural drainage to the therapy
What is the preferred method for delivering bronchodilators to spntaneously breathing and intubated, ventialted pts?C. MDI(Metered Dose Inhaler)
Immediately aftert firing, the aerosol produced by most MDI’s are about how large?D. 35 um
Most of the spray generated by the majority of MDI’s consist of what?B. Propellant
When fired inside the mouth what % of the drug dose delivered by a simple MDI deposits in the oropahrynx?D. About 80%
Before inspiration and actuation of a MDI, the pt should exhale to which of the following?C. Functional residual capacity
To ensure delivery of proper drug dosage with an MDI, which of the following must be done first?C. II&III- Canister should be warmed to hand or body temp, & canister should be vigorously shaken.
What groups of pts are most likely to have difficulty using a simple MDI inhaler for aerosol drug therapy?D. I,II,III- Pts in acute distress, infants & young children, elderly persons
What is a potential limitation of flow triggered MDI devices?C. High flows necessary for actuation
For which pts would you recommend against using a flow triggered MDI as the sole bronchodilator delivery system?A. Pt likely to develop acute severe bronchospasm
The key difference b/w and MDI holding chamber and a spacer is that the holding chamber incorporates what?B. One way inspiratory valve
What device would you select to deliver an aerolized bronchodilatoir to a young child?B. MDI, holding chamber, and mask
Proper use of a dry powder inhaler(DPI) requires that the pt be able to do what?A. Generate inspiratory flows of 60 l/min or higher
What device depends the pt’s inspiratory effort to dispense the dose?C. Dry Powder Inhaler(DPI)
For what pt groups is the DPI for bronchodilator administration NOT recommended?A. I&II- Infants and children under 5, pt’s with an acute bronchospastic episode
Exhalation into what device can result in loss of drug delivery?C. Dry powder inhaler
SVN ouput drops after lowering pt’s bed while giving a treatment but there is 3ml of solution still left in reservoir. Correct Problem?C. Reposition pt so that the SVN is more upright.
What happens as the pressure for flow delivered thru a SVN gets higher?D. I,II,III-Tx time becomes shorter, Patricle size becomes smaller, Aerosol output becomes greater.
Normally, when using a 50-psi flowmeter to drive a SVN, you set the flow at what?C. 6-8 L/min
To minimize a pt’s infection risk b/w drug tx’s with a SVN what would you do?A. Rinse the SVN with sterile water; air dry
Physician has ordered an anitviral agent ribavirin(Virazole) to be administered by aerosol to an infant with bronchiolitis. Use which device?B. SPAG-Small particle aerosol generator
When using a SPAG to administer Virazole to an infant which air flow settings would you use?A. NEB-8L/min Drying Chamber-8L/min
What serious problems are associated with the delivery of Virazole using the SPAG?B. I&III-Caregiver exposure to drug aerosol, drug precipitation in ventilator circuits
Virazole aerosol precipitation causing malfunction of vent circuits can be overcome by what?A. I&II-Placing a one way valve b/w SPAG and circuit, Placing HEPA filter proximal to exhgalation valve
Advantages of SVUN (Small volume ultrasonic Nebs) for drug delivery include all of the following except:D. Decreased Cost
For maintenance administration of bronchodilators to adult pt w/adequate inspiratory flow, which aersol devices would u recommend?D. III&IV- DPI, pMDI and holding chamber
What aerosol drug delivery system would you recommend against using with a toddler or small child?A. I&II- MDI & SVN
On average, what % of an aerosol drug delivery device’s output actually deposits in the lungs?B. 10%-20%
Possible complications associated w. the selection of an aerosol drug delivery device include all except:B. Overhydration or fluid imbalances
What would you recommend as initial therapy for pt admitted to ER w/ acute airway obstruction?A. I&II- Asess dose response of MDI albuterol (up to 12 puffs), & Provide up to 3 SVN tx’s w/albuterol q 20 minutes.
Appropriate documentation when conducting point of care assessment of a pt’s response to bronchodilator therapy includes all except:D. blood levels of the bronchodilator agent
What is false about the use of PEFR in assessing pts response to bronchodilator therapy?B. PEFR is the standard for determining bronchodilator response
When assessing a pt’s response to bronchodilator therapy u notice a decrease in wheezing accompanied by an overall decrease in breath sounds. Whats most likely?A. Increasing airway obstruction
When assessing a pt’s response to bronchodilator therapy u notice a decrease in wheezing accompanied by an overall increase in breath sounds. Whats most likely?C. Decrease in airway obstruction
What is teh proper dose response assessment of an MDI bronchodilator?B. Give 4 puffs 1-2 minutes apart; repeat up to 12 puffs w/continued improvement. Best dose provides max subjective relief and highest PEFR w/o side effects.
Ina dose response seessment of pt’s response to MDI bronchodilator, you would stop increasing the dose when?A. I,II,&III-When PEFR improves <10%to15%, When tachycardia occurs, when tremors are evident
Asthma pt in severe resp distress presents to ER and is started on albuterol by SVN. Approaches recommended to assess therapy to pt.?D. I,II,III,IV-Perform ABG analysis, Monitor SpO2, Asses breath sound & vitals before & after each tx., Measure PEFR or forced expiratory volume(FEV1) in 1 second before & after tx.
An asthmatic in severe ditress is admitted to ER. After full asessment and obatining a pre-tx baseline, you start pt on albuterol with a SVN. When should you stop documentation & tx?A. The pt’s symptoms are relieved pr PEFR/FEV1 in 1 second exceeds 70% of personal best.
What factor is most crucial in developing an effective program of aerosol drug self administration in an adult pt requiring maintenance bronchodilator therapy?D. good patient education
Best way to confirm that an asthmatic OP can prpoerly self manage a newly prescribed aerosol drug therapy?B. Have pt provide a repeat or return demo.
Physician ordes continuous bronchodilator therapy with 1:200 albuterol for asthma pt at dosage of 20mg/hr. How much 1:200 albuterol will be needed for 1st hr of tx?C. 4 ml
Indications of an adverse drug response during continuous bronchodilator therapy include all except:A. decreased consciousness
When using a chamber style adapter with an MDI to deliver a bronchodilator to a pt receiving mech ventilation, with what would you coordinate MDI firing?A. beginning of inspiration
QuestionAnswer
Which of the following is false about absorption atelectasis?A) It can occur only when breathing supplemental O2.
To ensure the prescribed FIO2 for a patient receiving 65% O2, you apply a closed reservoir delivery system with a one-way expiratory valve. What other component must be included in this system to ensure a fail-safe operation?C) Emergency inlet valve
At an FIO2 of 1, what is the approximate half-life of blood carboxyhemoglobin?B) 80 minutes
Which of the following would indicate adequate oxygenation for adult patients with chronic lung disease and an accompanying acute-on-chronic hypoxemia? I. SaO2 of 90% or higher II. PaO2 of 50 mm Hg to 60 mm Hg III. SaO2 of 85% to 90%B) II and III II. PaO2 of 50 mm Hg to 60 mm Hg III. SaO2 of 85% to 90%
Which of the following is false about multiplace hyperbaric oxygenation chambars? Feedback: Refer to page 893A) The chamber normally is filled with 100% O2.
To prevent an adverse rebound effect when withdrawing NO therapy, what should you do?I. Reduce the NO to the lowest effective dose (ideally, less than 5 ppm). II. Hyperoxygenate the patient just before discontinuing NO. III. Ensure that the patient is hemodynamically stable. D) I, II, and III
An O2 delivery device takes separate pressurized air and O2 sources as input, then mixes these gases through a precision valve. What does this describe?A) O2 blending system
A patient receiving 35% O2 through an air-entrainment mask set at 6 L/min input flow becomes tachypneic. Simultaneously, you notice that the SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate in this situation?B) Increase the device’s input flow to 10 L/min.
Which of the following would indicate a need for O2 therapy for a newborn infant? I. SaO2 less than 88% II. Capillary PO2 less than 40 mm Hg III. PaO2 less than 60 mm HgB) I and II I. SaO2 less than 88% II. Capillary PO2 less than 40 mm Hg
Features of an ideal delivery system for NO for use with mechanical ventilation include all of the following exceptB) premixes NO and O2 in a holding reservoir.
You must deliver the highest possible FIO2 to a 67-year-old man with pulmonary edema breathing at a rate of 35/min. Which of the following O2 delivery systems would be most appropriate?A) Nonrebreathing mask at 12 to 15 L/min
What is the maximum FIO2 expected to be delivered by most air-entrainment masks?C) 50%
You start a chronic obstructive pulmonary disease (COPD) patient on a nasal O2 cannula at 2 L/min. What is the maximum time that should pass before assessing this patient’s PaO2 or SaO2?A) 2 hours
Which of the following signs and symptoms are associated with the presence of hypoxemia?C) I, II, and III I. Tachypnea II. Tachycardia III. Cyanosis
Retinopathy of prematurity may result in which of the following?D) Blindness
All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy except:B) septic shock.
Which of the following factors determine the actual O2 provided by an air-entrainment system?C) I, II, and III I. O2 input flow to the jet II. air-to-O2 ratio of the device III. resistance downstream from the jet
An infant requires both a precise high FIO2 and maintenance of a neutral thermal environment. Which of the following systems can best achieve these goals?A) I and II I. Oxy-Hood or warmed O2 blending system without incubator. II. Heated incubator with automatic O2 controlling system.
A physician orders a 70% He:30% O2 mixture to reduce the work of breathing in a patient having an acute asthmatic attack. Which of the following delivery systems would be appropriate in this case?D) Nonrebreathing mask at 10 L/min
You set up an Oxy-Hood with an FIO2 of 0.5 for a newborn infant. What is the maximum time that should pass before assessing this patient’s PaO2 or SaO2?A) 1 hour
At what level of carboxyhemoglobin saturation is hyperbaric oxygen (HBO) therapy indicated for an adult patient?D) Greater than 25%
Which of the following is FALSE about air-entrainment systems?A) Their FIO2 values are directly proportional to their total flow.
23. Physiologic effects of inhaled nitric oxide (NO) include all of the following except:A) recruitment of collapsed alveoli.
Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except:D) systemic vasodilation.
A physician orders 40% O2 through an air-entrainment nebulizer for a patient with a minute volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the prescribed FIO2?B) 10 L/min
What are some key patient considerations in selecting O2 therapy equipment?D) I, II, III, and IV I. Type of airway (natural or artificial) II. Severity and cause of the hypoxemia III. Age group (infant, child, adult) IV. Stability of the minute ventilation
Compared to air, the density of an 80% He and 20% O2 mixture is about which of the following?C) One-third as much
Benefits of properly applied O2 therapy in patients with chronic hypoxemia include all of the following except:D) improved pulmonary diffusing capacity.
Clogging of an isolette incubator air inlet filter will result in which of the following?C) Increased O2 concentrations
To confirm proper operation of an O2 blending system, what should you do? I. Test low-pressure alarms and bypass systems. II. Analyze FIO2 at 0.21, 1.00, and prescribed level. III. Confirm air and O2 inlet pressures.D) I, II, and III I. Test low-pressure alarms and bypass systems. II. Analyze FIO2 at 0.21, 1.00, and prescribed level. III. Confirm air and O2 inlet pressures
QuestionAnswer
What is the most common type of oxygen delivery system? KHA nasal cannula
Which two masks have the advantage of allowing the patient to breath room air should the oxygen delivery system fail? KHSimple and partial rebreather masks
What type of device will give a guaranteed FiO2 no matter what the patient’s venilatory pattern is? KHHigh flow device
What kind of mask requires the liter flow to be at least 5 LPM to ensure that CO2 is being flushed out? KHSimple mask
What type of O2 device delivers FiO2 from 28 -100%? KHAir-entrainment nebulizer
What are advantages of a high flow device? KHThey are precise and stable and the patient’s rr and Vt have no effect on FIO2%
What is defined as a device that does NOT meet all the inspiratory flow demands of the patient? KHLow flow device
What device delivers up to 100% O2, if bag does not completely collapse during inhalation? KHNon-rebreathing mask
If bag on a non-rebreathing mask collapses more than 2/3 the capacity what can you do to correct the problem? KHTurn up the flow.
What is similar to a simple mask designed to fit over neck area than mouth and nose? KHTracheostomy Mask
Who is a croup tent never to be used on? KHNewborns
What is a clear plastic shell that encompasses the head to provide O2 therapy to children <1 year of age? KHOxygen hood
What is another name for an air-entranment mask? KHVenturi mask or venti mask
What are disadvantages of a nasal cannula? KHDrying of mucosa and nares, increased chance of nosebleeds, soreness and breakdown of tissue around ears.
What does affect the delivered FiO2 in a venturi mask? KHA blocked entrainment port
True or False Your are supposed to use a humidifier with a venturi mask. KHFalse
QuestionAnswer
2 Indications of Aerosol Therapy1-Induce Sputum 2-Administer Meds
4 Hazards of Aerosol Therapy1-Bronchospasm 2-Hypothermia 3-Overhydration 4-Tracheal Lavage
Device that turns Electrical energy into Mechanical energyUltra Sonic Nebulizer
Determines FrequencyParticle Size
Determines AmplitudeRCP
Purpose of Vortan Heart NebulizerTo provide continuous administration of aerosolized medication.
Purpose of HHN/SVNTo deliver medication.
2 Indications of Humidity Therapy1-Humidify Dry Theraputic Gases 2-Provide 100% body humidity of inspired gases for a pt with ETT or Trache Tube
1 Contraindication of humidity therapyAn HME is contraindicated with a pt with thick, copious, or bloody secretions.
Calculate Total Flow100-FIO2/FIO2-RA=____ratio then add ratio and x liter flow=____(l/m?)
Calculate Humidity Deficit44-mg/l=____mg/l then mg/l/44=____x100=____%
How to instruct pt to take an SVNModerate slow deep breaths with 2-3sec. hold on end inspiration
SVN l/m flow range6-8 l/m
Most important factor affecting that effects the humidity of a gasTemperature

Final Thoughts

And that wraps up our study guide on Aerosol Drug Therapy. These practice questions should do a great job of teaching you everything you need to know in Egan’s Chapter 39. But as I always say, repetition is key and it never hurts to go back and read the entire chapter and that’s something I always recommend for most students.

Either way, definitely make sure to keep going through these practice questions again and again until the information sticks. Thank you so much for reading and as always, breathe easy my friend.

🔒 And don’t forget, if you need help with your Egan’s Workbook, we looked up the answers for you so that you don’t have to. Check out our Workbook Helper to learn more.