Question Answer
what is bland aerosol? liquid particels suspended in gas
what can be deliverd through aerosol therapy? sterile watre, hypotonic saline, isotonic saline, hypertonic saline
which device is used for bland aerosol treatments? aerosol mask, face tent, traceostomy mask, T- tube, oxygen hood, oxygen tent
what are the indication for aerosol use? upper airway edema, croup, epiglottis, post extubation edema, bypassed upper airway, need for sputum
what are the types of bland aerosol? cool, heated, MMAD, Hypo and Hypertonic saline
what are the types of aerosol generators? Large volume Jet Nebulizer, SVN and inhalers, USN
what are the contraindications of bland aerosols? bronchocontriction, history of airway hyperresponsiveness
what are the hazards of bland aerosols? wheezing or bronchospasm, infections, overhydration, edema of the airway wall


Question Answer
What are the factors that affect aerosol drug therapy? Aerosol output Particle Size Deposition Aging Breathing Pattern Physical characteristics of the airway
Particle Size Depends on substance nebulized, methods used to generate aerosol and environmental conditions.
What is the optimal particle size? 1 to 5 microns
Deposition How it lands. The size deetermines how it deposits. It’s affected by inertia, sedimentation, and bownian movement.
What is inertia? Particles collide and burst resulting in rainout and less medication to site of action. Turbulent flow can cause this.
What is sedimentation? The larger the particle the more effect gravity will have. This can cause rainout.
What is brownian movement? As you breathe in airflow slows down. Particles slow down and hit eachother causing rain out.
What is aging? How long it is supsended before it gets to target site.
Aging depends on? Composition of aerosol, initial size of particles, time in suspension, ambient condition which it is exposed.
What is optimal breathing pattern? Slow laminar flow with gentle, deep breaths.
Different medications… need different particle sizes
What are the types of nebulizers used for aerosol drug therapy? Small volume jet nebulizer Metered Dose inhalers (MDI) Dry Powder Inhaler (DPI)
How is the small volume jet nebulizer powered? Pneumatically, flow 6-8 L/Min
The efficiency of small volume jet nebulizer depends on what? flow, gas source, ambient conditions, characteristics of the drug and breathing pattern
What can be used with the small volume jet nebulizer? mask or mouthpiece
Can it be used with a ventilator circuit? yes
How should the small volume jet nebulizer be positioned? Upright
Does it contain a baffle? Yes
Facts about the small volume jet nebulizer. Can be continuous or intermittent (may be breath actuated) May contain a filter
Why would a small volume jet nebulizer contain a filter? In the case of PCP pneumonia when administering pentaminide. You only want the patient to have the drug and you don’t want it in the air.
Metered dose inhalers are also known as MDI’s They are the most commonly prescribed method.
The efficiency depends on? Patient technique 60% of people will use them incorrectly.
How is the MDI powered? It is either hand or breath actuated. When breath actuated, patient must be able to generate enough flow rate.
Can the MDI be used in a ventilator circuit? Yes
The propellent makes up what percent of the cannister? 80%, only 1% is actual drug. The propellent used is HFA, CFC is no longer used
What apparatus is used with the MDI? Spacers They reduce the need for hand/breath coordination
What is an easy acronym to instruct patients that are having difficulty? (SMB) Shake, Mash, Breathe
Dry Powder inhalers contain? Powdered drugs
How are dry powder inhalers powered? They are breath actuated metered dose inhalers
What must patient be able to do in order to use the DPI? They must be able to generate adequate flow rate and efficiency will depend on patient technique
DPI’s are different from MDI’s in that they….; contain no propellent
DPI’s cannot be used with a ventilatory circuit
What are other drug devices used for aerosol drug therapy? Large volume jet nebulizers Small volume ultrasonic nebulizers Small Particle Aerosol Generatore (SPAG) Nasal Spray pumps
What is the SPAG used for? only used for administration of Ribavirin (treatment of RSV in small children)
To choose a device you should consider Available drug formulation Patient’s characteristics Desired site of deposition Patient’s Preference
To determine efffectiveness of chosen device you should assess patient technique Assess patient compliance with use Assess patient response to therapy
What factors are associated with reduced aerosol deposition in the lung? Patient technique Obstruction
What are the hazards of aerosol drug therapy? side effects of the drug airway reactivity (bronchospasm) Infection risk Drug reconcentration Irritation of tissues in the mouth

Question Answer
water is gaseous for {vapor} “cant see it” humidity
the process of adding humidity 2 air or medical gas humidification
any device that creates water vapor adding gaseous water to dry gas humidifier
liquid or solid particles suspended in a gas aerosol
any device that produces aerosol particles nebulizer
___&___ are responsible for heat & moisture exchange normally Nose & upper airway
nose heats & humidifies inhalation
nose collects moisture exhalation
inspired gas achieves BTPS as it moves into the lungs inhalation {37*C}
body temperature; ambient pressure; saturated w/water vapo BTPS
5cm~below the Carina. this point is called the ISOTHERMIC SATURATION BOUNDARY ISB BTPS is achieved ___
below this ISB temp & relative humidity remain ____ constant
actual content or wt of H2O(mg) that is present in a given volume of gas(L) written mg/L content is often substituted 4 this word absolute humidity
amount of water content that a gas is capable of holding at a given temp; as a gas is heated its capable of carrying more water vaopr humidity capacity AKA potential humidity
device used to directly measure relative humidity hygrometer
when absolute humidity =’s potential humidity then gas is ____ & RH is 100% fully saturated
temp 20*C water vapor 17.3mg/L
temp 25*C water vapor 23mg/L
temp 30 water vapor 30.4mg/L
temp 37*C water vapor 43.9
temp 40*C water vapor 51.1
absolute humidity/potential humidity X100=??? % RH
Question Answer
what is absolute Humidity? the actual content or weight of water present in a given volume of gas.
what is ISO? International Standards Organization
What does ISO recommend with absolute Humidity? AH of 33mmgH2O/L
How should AH be titrated? dependant on individual needs of patient
what is 98.6 F in celcius? 37 degrees
what does cooling the gas do to AH? decrease AH
what is relative humidity? the ratio of how much water a gas sample is actually holding
what is BTPS? body, temperature at the pressure to which the patient is exposed and 100% saturated with water vapor
what is Isothermic saturation Boundary? at or below carina, the point where inspired gases are fully saturated and warmed to body temp.
what best describes Vapor pressure? pressure of vapor in lings exert 47mmHg
what best describes humidity deficit? the amount of water vapor needed to achive full saturation at body temperature.
what does humidity therapy involve? adding water vapor and sometimes heat to the inspired gas
what is the primary goal of humidification? maintain normal conditions in lower airways thinning of bronchial secretions sputum inductions
what are the goals of humidity? reduce airway swelling, removal of thick secretions, prevent airway response to cold air
what are the hazards of humidity? bronchospasm ( cool mist), infection, over hydration
what are the three varibles that affect qulity of a humdifer’s prefomance? Temperature, surface area, contact time
what are the low flow humidifiers? bubble, jet
what are the high flow humidifiers? heated bubble, passover, wick, vapor phase, capillary force, membrane type, HME
what are the contraindications of HME? patients with thick or bloody secretions, body temp lees than 32 degrees, high spontaneous mv, HME must be taken out for aerosolied medication
what are the two types of asthmatics? Intrinsic= non seasonal and Extrinsic= inhaled airborne antigen aka atopic asthma
Question Answer
Where is the Isothermic saturation boundary (ISB)located? Approximately 5cm below the carina (egans pg 776)
What does the term Inspissated refer to? Thickening of secretions due to dehydration (egans pg 776)
With prolonged breathing of improperly conditioned gases through the tracheal airway can result in what condition? Hypothermia (a reduced body temperature) (egans pg 777)
What are humidifiers used for? To add molecular water to gases (Egans pg 777)
Temperature is an important factor affecting humidity due to the fact that the greater the temperature of the gas the more H2O vapor it will hold. (true or false) True (egans pg 778)
In order for evaporation to occur what are the ideal conditions that need to be present? There needs to be a large surface area to enable evaporation to take place (egans pg 778)
What are the three most common humidifiers used in Respiratory care? 1)Bubble humidifiers 2)Passover humidifiers 3)Heat and moisture exchangers (HME’s)(egans pg 779) (egans pg 779)
In the Passover humidifier what is the purpose of the Hydrophobic membrane? The membrane-type separates the water from the gas stream (egans pg 780)
What is a HME? And what are the three most common used? HME is a heat and moisure exchange device. 1)Simple condenser humidifiers 2)Hygroscopic condenser humidifiers 3)Hydrophobic condenser humidifiers (egans pg 780)
What organization sets the standards for the HME’s? International Organization for Standarization (ISO) (egans pg 781)
Heated humidifiers operating continuously in breathing circuits can evaporate more than ___ L H2O per day. 1L of H2O per day (egans pg 784)
Simple large reservoir systems are manually refilled with sterile or distilled water. Why would this be a problem? Because the system must be opened for refilling where cross contamination can occur. (egans pg 784)
What type of probe does the Servo-controlled heating system use at or near the patients airway? Thermistor probe (egans pg 783)
Not all active heated humidifiers perform the same under all conditions. (True or False) True (Egans pg 787)
To maintain airway temperatures by humidification the temperature has to range between ___ and __ C 35 and 37 C (egans pg 787)
What are the three most common problems with humidification systems? 1)Dealing with condensation 2)Avoiding cross contamination 3)Ensuring proper conditioning of the inspired gas (egan pg 787)
Name some factors that would influence the amount of condensation in a humidified system? 1)Temperature difference across system (humid. to airway) 2)Ambient temperature 3)Gas flow 4)Set airway temperature 5)Length,diameter, and thermal mass of breathing circuit (egans pg 787)
What is the definition of a Nebulizer? Device that produces an aerosol suspension of liquid particles in a gaseous medium using baffling to control particle size. (egans pg 1324)
Name two devices that are used to deliver bland aerosols? 1)Large-Volume nebulizers 2)Ultrasonic nebulizers (egans pg 790)
Bland aerosols can cause bronchospasms in some patients. (True or false) True (egans pg 795

What are 2 types of therapeutic aids to ventilation?
1. Humidity and Aerosol therapy and 2. Chest tubes and drainage systems.
What is Humidity therapy?
Non particle-size water that is distriuted uniformly in the air.
What happens to normal humidity when environment differs?
Enviornments differ in their normal humidity (20%, 50%, 70% etc.) but the body always needs 100% humidity.

What is Humidity deficit?
It is the amount of water (humidity) the body needs to makeup from ambient air in order to achieve 100%. It is expressed as mmgH20/L of gas. The body needs 44 mg H20/L of gas.
When does devices intended to help humidity deficit work better?
1. Temperature is increased. 2. Surface area of the water is increased. 3. Pressure in the system is decreased.

What is the problem with humidity devices?
It can be a source of contamination.

What is areosol therapy/ the aerosol particles?
aerosol particles are larger particles, can often been seen visually. May be made of water, liquid medication, or dry powder-type medication.

What does an aerosol therapy cause to the patient?
Aerosols are not natural to the airways and may cause irritation, bronchospasm.

What are the optimal particle sizes in aerosol therapy?
Large airways -particles >5 microns.Middle&small airways is 3-5 microns. Alveoli-particle s >0.5 microns & < 3 microns.

What happens when there is a particle deposition in an aerosol therpay?
The higher the flow rate, the higher up the resp. tract the deposition will occur.The Inspiratory hold will increase particle deposition

What are the general goals of aerosol therpay?
goals: delivered medications- Bronchodilators, Mucolytics (secretions thining agents), Provides mucosa hydration & delivered antibiotic medications.

What are the complications and hazards of Aerosol therapy?
1. Fluid overload (monitor input/output) 2. Bronchospasm 3. Contamination 4. Ultrasonic Nebulizers should not be used to for medications 5. Dizziness may result if a pt. over-ventilates -Have pt. slow down &Use normal breathing pattern

How do we monitor an aerosol output?
1.If no output – check medications, fluid level, device for proper function – Commonly need to increase the flow 2. If aerosol doesn’t disappear during an inhalation, instruct pt. to breath thru mouth – Not thru Nose

What are the indiccations for a chest-tube insertion?
Pneumothorax -Air &Hemothorax -Fluid &Air in pleural space causing lung collapse.If > 20% of lung need a chest tube(CT) based on X-ray &BS.Pleural Effusion -Excess Fluid causes Lung Spaceloss treat by inserting needle in space to relievepressure;insert CT

What is a chest tube insertion procedure?
1.Pneumothorax -Tube placed in upper chest, 2nd interspace, midclavicular line. 2.Hemothorax/Pleural effusion tube placed b/w 4th &5th interspace, midaxillary line.

What conditions must exists when removing/discontinuing a chest tube?
Tube must be clamped for 24hrs. In that 24hrs they must not be :1. Any sign of Resp. distress 2. Any evidence of Pnuemothorax/Hemothorax as indicated by X-ray. 3. If these exists, unclamped the chest tube &Resume chest drainage.

What is a chest tube removal procedure?
1. Pull the Tube during a Valsalva Manuever after complete exhalation 2. The side should be covered with petroleum based Jelly &Sterile gauze. 3. Pulse X-ray should be taken

What are the type of chest drainage system?
They consist of a single/Series of glass bottles/ Jugs. It is helpful for Visualization purpose, to consider the older type of system in order to increase/understanding on how these systems functions.

What are the functions of a chest drainage system?
1. Collection of fluids. 2. Control suction 3. Allow 1-way movement of gases &Fluids(out of lung, not back in). This is called a Water seal.

What are the types of chest drainage systems?
The 3 bottle systems (1-bottle, 2-bottle, 3-bottle).

What is the 3 bottle system?
From pt. a tube E enters a collection bottle. Fluid drops to bottom &gas is pulled in other tube. TubeD enters water seal bottle gases are drawn thru a tube. i.e Submerged under H2O(Gentle bubbling is seen). TubeC enters suction control bottle no bubbling

What is the disposable system ?
Used in 3 bottle system. 1.Suction Control 2.Water Seal 3.Collection bottle. When Collection chamber is full replace whole unit. 1-2cm H2O should be placed in Water seal bottle. 15-20cm H2O should be placed in suction control bottle

What are the potential problems while there is a low return volume in a mech. Vent found during monitioring a chest drainage system?
low return volume in a mech. Vent – It means lost volume thru the lung & the Chest Tube. 1. Adjust VT to maintain desired ABG values. 2.Hole in the Lung may need surgical repair.

What are the potential problems when there is no bubbling in the suction control bottle found during monitioring a chest drainage system?
Increase vaccum pressure @ the Wall source until bubbling occurs.

What are the potential problems when excessive bubbling in the suction control bottle found during monitioring a chest drainage system?
Decrease until only gentle bubbling is present.

What are the potential problems when excessive/continous bubbling found during monitioring a chest drainage system?
1. Indicates a leak b/w pt.&water-seal bottle. 2. If all connections are secure-begin unclamping tube E where the tube exists the pt. If bubbling stops then leak is inside the pt.& surgery is needed.
If bubbling continues what is to be done?
If bubbling continues move clamp b/w pt & collection tube. If bubbling stops-replace tube.If bubbling continues move clamp to tubing b/w collection & water-seal bottle. If bubbling stops-replace tubing. Bubbling should stop if not, replace external system

What are the potential problems when nothing developing in the collection bottle – lung is not re-inflating found during monitioring a chest drainage system?
1. Ensure there is suction coming from the wall. 2. Ensure bottle system is below insertion site of chest tube. *sometimes systems use gravity alone. There is no vaccum. These systems work fine. Vaccum only assist evacuation.

What are the potential problems No bubbling in the water-seal bottle found during monitioring a chest drainage system?
Suction is not enough -not enough water in the suction control bottle.

What are the potential problemscollection bottle is developing fluid quickly @ >100 ml/hr found during monitioring a chest drainage system?
1. Pt. may be hemorrhaging. 2. Evaluate: Hb, Bp, vitals and all data associated w/blood loss.
What should be done if a glass bottle breaks during monitioring a chest drainage system?
If glass bottle breaks then submerge chest tube into water from any container.