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
What are the factors that affect aerosol drug therapy?Aerosol output Particle Size Deposition Aging Breathing Pattern Physical characteristics of the airway
Particle SizeDepends on substance nebulized, methods used to generate aerosol and environmental conditions.
What is the optimal particle size?1 to 5 microns
DepositionHow 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 each other causing rain out.
What is aging?How long it is suspended 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 pentamidine. You only want the patient to have the drug and you don’t want it in the air.
Metered dose inhalers are also known asMDI’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, the patient must be able to generate enough flow rate.
Can the MDI be used in a ventilator circuit?Yes
The propellant makes up what percent of the canister?80%, only 1% is actual drug. The propellant 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 the 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 propellant
DPI’s cannot be used witha ventilatory circuit
What are other drug devices used for aerosol drug therapy?Large volume jet nebulizers Small volume ultrasonic nebulizers Small Particle Aerosol Generator (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 considerAvailable drug formulation Patient’s characteristics Desired site of deposition Patient’s Preference
To determine effectiveness of chosen device you shouldassess 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
water is gaseous for {vapor} “cant see it”humidity
the process of adding humidity 2 air or medical gashumidification
any device that creates water vapor adding gaseous water to dry gashumidifier
liquid or solid particles suspended in a gasaerosol
any device that produces aerosol particlesnebulizer
___&___ are responsible for heat & moisture exchange normallyNose & upper airway
nose heats & humidifiesinhalation
nose collects moistureexhalation
inspired gas achieves BTPS as it moves into the lungsinhalation {37*C}
body temperature; ambient pressure; saturated w/water vapoBTPS
5cm~below the Carina. this point is called the ISOTHERMIC SATURATION BOUNDARY ISBBTPS 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 wordabsolute 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 vaoprhumidity capacity AKA potential humidity
device used to directly measure relative humidityhygrometer
when absolute humidity =’s potential humidity then gas is ____ & RH is 100%fully saturated
temp 20*Cwater vapor 17.3mg/L
temp 25*Cwater vapor 23mg/L
temp 30water vapor 30.4mg/L
temp 37*Cwater vapor 43.9
temp 40*Cwater vapor 51.1
absolute humidity/potential humidity X100=???% RH
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 celsius?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 lines exert 47mmHg
what best describes humidity deficit?the amount of water vapor needed to achieve 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 variables that affect quality of a humidifier’s performance?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 less than 32 degrees, high spontaneous mv, HME must be taken out for aerosolized medication
what are the two types of asthmatics?Intrinsic= nonseasonal and Extrinsic= inhaled airborne antigen aka atopic asthma
Where is the Isothermic saturation boundary (ISB)located?Approximately 5cm below the carina
What does the term Inspissated refer to?Thickening of secretions due to dehydration
With prolonged breathing of improperly conditioned gases through the tracheal airway can result in what condition?Hypothermia (a reduced body temperature)
What are humidifiers used for?To add molecular water to gases
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
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
What are the three most common humidifiers used in Respiratory care?1)Bubble humidifiers 2)Passover humidifiers 3)Heat and moisture exchangers
In the Passover humidifier what is the purpose of the Hydrophobic membrane?The membrane-type separates the water from the gas stream
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
What organization sets the standards for the HME’s?International Organization for Standarization (ISO)
Heated humidifiers operating continuously in breathing circuits can evaporate more than ___ L H2O per day.1L of H2O per day
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.
What type of probe does the Servo-controlled heating system use at or near the patients airway?Thermistor probe
Not all active heated humidifiers perform the same under all conditions. (True or False)True
To maintain airway temperatures by humidification the temperature has to range between ___ and __ C35 and 37 C
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
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
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.
Name two devices that are used to deliver bland aerosols?1)Large-Volume nebulizers 2)Ultrasonic nebulizers
Bland aerosols can cause bronchospasms in some patients. (True or false)True