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.
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
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
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
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
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
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
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