Respiratory Therapy, Chapter 6 (Exam #4) Flashcards

are individual molecules in a vapor or gaseous state. It's can not transmit bacteria.

The actual content or weight of water present in a given volume of gas content.

- It is recorded as g/m3 or mg/L

The AH goes up as well.

AH= 44 mg/L

47 mmHg

It is the ratio of content to capacity.

Measured Humidity Content / water capacity X 100

Condensation occurs when temperature decreases and gas can't hold as much moisture anymore. The moisture falls out of suspension. Because water tends to pool at the lowest point in the tubing, a water trap is required to prevent patients from aspirating this water.

It is the maximum amount of water that can be held at body temperature.

Content MG/L / water capacity X 100

The difference between the actual water content and body humidity

Body Humidity - Ambient (what the device is giving) = HD

It is 5 cm below carina

They experience dried out lungs and inspissated secretions. The reason why is because The lungs provide the humidity and moisture to the airways instead. At the carina, the temp: 30 , RH: 95% aand AH: 30.4 mg/L

1. Airway Drying

2. Retention of secretions

3. Airway plugging

4. Increased chance of infection

1. Atelectasis

2. Dry, non productive cough

3. Thick dehydrated secretions

4. Increased RAW

5. Increase chance of infection

6. Substernal Pain

To minimize of eliminate the humidity deficit while the patient is breathing a dry, medical gas. (basically in order to provide 100% humidity at body tempt)

Intubation.

ETT, or tracheostomy.

Ventilation without entering the body.

CPAP or BPAP

Active humidification increase heat and moisture of inspired gas, like a Wicks Humidifier,

Passive Humidification takes patients exhaled gas and utilizes it

Humidification is recommended for all patients on invasive mechanical ventilation

Active humidification is recommended because it improves adherence and patient comfort.

Recommendation is 33-44 mgH20/L of water at 34-41 degree celcius at the WYE piece and 100% room humidity.

An HME which must provide a minimum of 30 mgH20/L

An HME because it collects dead space.

Heat and moisture exchanges.

NO.

bubble humidifier.

1. Wicks type humidifier
2. Passover humidifier (fisher paykal)

HME

It delivers flows of 10-20 mg/L and 20% RH at BTPS

To create more bubbles = more surface area

1. The surface area

2. The temperature

3. The time of contact

4. The thermal mass

2 psi

small

They are used when supplying all the inspiratory gas to intubated or trached patients.

33 mg H20/L

large.

A fisher & paykel passover humidifier that may or may not contain a heated wire circuit. It provides 100% RH at various temperatures.

Simple reservoirs direct gas over the surface of a volume of water. These are used to provide heated humidified gases during mechanical ventilation.

Fisher and Paykel heated humidifier is an example.

On a wick humidifier, gas passes over or through water saturated material.No bubbling or aerosol is produced, As dry air enters the chamber, it flows around the wick, quickly picking up heat and moisture, leaving the chamber fully saturated with water vapor.

Hudson RCI ConchaTherm IV is an example.

The water is separated from the gas steam by a hydrophobic membrane. Water vapor molecules can pass, but liquid water and pathogens can not. Bubbling and aerosol dont happen.

Vapotherm 2000i is an example.

a system that physically needs to be opened and filled with sterile water.

• Greater risk of contamination
• Higher risk of leaks
• May change the reservoir temperature
• interrupts mechanical breaths from machine

A manual system refill simple large reservoir systems with sterile or distilled water. However, manually refilling can:

1. Change the reservoir temperature
2. Interrupt mechanical ventilation
3. Increase the risk of cross contamination

A small inlet port in the wall of the humidifier chamber attached to a gravity feed-fed water bag allows refilling w/o interrupting ventilation.

These system still require constant checking and manual replenishment. If not checked regularly, the reservoir in these systems can go dry, placing the patient at risk.

Heated Wire Circuit.

It functions in decreasing rainout/condensation with a humidifier. If this technology is not used, a water trap should be.

Gas will not be fully saturated and a humidity deficit will occur.

1. Decrease or obstruct gas flow to patient
2. Change FIO2 delivered to patient
3. Condensation may be aspirated by patient.

Vapor Transfer Cartridge

Disposable water path & delivery tube

Molecular water passes into gas stream without direct contact between the two. It utilizes shortened nasal cannula or may be used with other devices such as a transtracheal catheter or CPAP.)

Provides 95-100% RH

Provides up to 55 Mg H20/ L

Tempt range of 33-43 degrees celcius

ConchaTherm humidification system

• Neonate-adults
• 1-40 L/M
• Adjustable airway temperature
• Doesn't differentiate between adults and pedi patients, Can select whether you want it to be used invasive or noninvasive.

Hudson RCI comfort flo humidification system.

HME are classified as passive humidifiers. They capture exhaled heat and moisture and use it to heat and humidify the next inspiration,

They are used for short term spontaneously breathing mechanically ventilated patients with endotracheal and tracheostomy tubes.

Best used for:

• Short term ventilation
• Patients with limited secretions
• Patients with normal body tempts

That the exhaled gas contains 100% RH at 37 degrees Celsius .

They must be used on mechanically ventilated patients.

10-31 mgH20/L at 30 degrees C

needs to be at least 70% efficient.

it increases the resistance and causes the patients WOB to increase.

Because they add 30-90 mL of dead-space, often exceeding the Vt of a 5 kg infant. uncuffed ETTs in small infants allow a potion of exhaled gas to leak around the tube, bypassing the HME and reducing its ability to capture exhaled heat and moisture and utilize it.

You remove the HME because the medicine will become clogged in the device.

A gibeck humid-flo HME. Which has an average humidity output over 72 hours. (30.7 mgH2O/L)

An active device: King System HME booster which has a hydrophobic membrane which is semi permeable to water. It supposed to last 3 days by adding water into the system. However, it adds more dead space and weight which makes the device susceptible to

Water is fed to the heater through a gravity feed solution bag.

36-39 mgH20/L

34-36 mgH20/L

1. Not to be used on Pt with thick and bloody secretions

2. Pt with Vt < 70%

3. Pt's with low Vt cant use HME because they contribute to additional dead space.

4. Pt's with body temps > 32 degrees C

5. Pt's with VE > or equal to 10 L/M

6. Noninvasive ventilation with large air leaks

Mandatory to be used with endotracheal and tracheostomy tube patients.

1. Potential for electric shock
2. Hypothermia
3. Thermal injury to the airway
4. Under hydration or impaction of mucus secretion
5. Increase WOB and RAW due to mucus plugging
6. Potential burns for caregivers

1. Humidifier setting
2. Gas temperature
3. Inspired gas temperature
4. Alarm settings
5. Monitor airway obstructions

Solid or liquid particles suspended in a gas.

You can measure and count particles.

The mist produced.

This means that the patient is not getting adequate aerosol treatment. You should turn up the liter flow in this case.

Aerosols/

0.9%

<0.9%

>0.9%. It's used to induce sputum samples by making the airways extra moist,

1. To humidify dry medical gases

2. Sputum induction

3. Decrease airway edema

1. Cross contamination

2. Over hydration

3. Airway irritation = Bronchospasm

4. Inadequate mist production

5. Swelling of secretions or airway obstruction due to swollen mucus

Bland aerosol therapy is quiet, unlike LVN which are loud.

Mass Median Aerodynamic Diameter

It divides so that half are larger and half are smaller

microns.

<1 micron particles.

increase.

1. Gravity/ sedimentation

2. Inertial impaction

3. Aging

4. Diffusion

central airways.

1-5 microns.

Flows >30 L/M ( like when a patient takes a fast breath in, all it does is cause the particles to hit the back of the throat and settle there, defeating the purpose. The patient has to take a slow breath in so the particles can reach the desired destination.)

This usually happens with >5 microns.

Aging causes particles to grow and shrink and fall out of suspension over time. Small particles grow and shrink faster than large particles.

It causes particles to deposit in respiratory region, adjacent to alveoli because they have low mass.

They have to have small particles so that they can reach the alveoly.

Bronchodilators need 3-5 micron particle size so that they reach the small airways and not into the alveolus.

A slow breath in, hold the breath to allow it to settle in the airways for 4-10 seconds

A mouthpiece.

Only delivers Humidity Therapy.

Can deliver Both.

Both.

Both.

Aerosol Therapy only. (specially for medicated aerosols.)

An Atomizer. It's missing a baffle.

A large volume nebulizer with a baffle.

1. The fluid surface

2. Sides of the container

3. Device in the gas stream

They work on the bernoulli principle to produce aerosol. Gas exits a restriction due to the lateral pressure being less than the atmospheric fluid drawn up through the capillary tube. Fluid is then shattered into small particles.

iF A BAFFLE IS IN PLACE YOU GET DECREASED AND MORE UNIFORMED PARTICLE SIZES.

Bland aerosol Therapy.

They are used to get a sputum sample. In order to do so you would need large particles to rain out in the upper airways.

They can deliver flows 26-35 mh H2O/L, and can entrain room air with specific FiO2's. If you want to change the FiO2 you need to change the collar. remember, liter flow DOES NOT effect FiO2.

Water creates backpressure and doesn't allow the device to entrain room air. more fluid = higher FiO2, decreasing the total flow. A water trap should be used.

A water trap to prevent aspiration.

total flow decreases, FiO2 increases

Total flow decreases, aerosol density increases(meaning more density produced.)

High Flow

For FiO2's >50%

You would set it at the same FiO2 for both. (as well as the same liter flow for both)

30 L/M. Remember, each flow meter is set at the same liter flow, so you multiply 15 x 2.

two

40-110 L/M

38

primary, add gas

Room air, Oxygen

Oxygen, Room air

They use a humidifier and a blender to deliver high flows at a specific oxygen concentration.

It is much quieter and supplies heated air if hypothermia is an issue.

To deliver a therapeutic dose of medication to the desired site of action..

Medicated aerosol

1. Delivers where it needs to work

2. Decreases systemic side effects.

3. Rapid absorption and onset of action.

1. Reaction to medicine

2. Infection

3. Bronchospasm

4.Drug concentration changes

5. Eye irritation

6. Exposure to secondhand aerosol

Respiguard Aerosol.

50, 1-5

only 10%. A SVN is very inefficient, it nebulizes when the patient is inhalation and exhaling, causes medication to be lost.

airway depostion.

Bronchodilators and steroid.

parenchymal deposition.

Antibiotics.

4-5 ML

Amount of volume that can't be nebulized.

8 L/M

You would soak the parks in a 1:3 ratio of water and white vinegar for at least 30 mins.A final rinse should be used with plain tap water. Parts should be disinfected 1-2x per week.

Place 18 inches from the patients airway and 6 inches from the patients WYE.

It should only nebulize on inspiration and use the same oxygen concentration as patient.

Breath Actuated Nebulizer. (BAN) which only nebulizers on inspiration which eliminates the waste of medicine, increases delivered doses (3x greater than other nebs) and decreases treatment time and number of treatments needed.

Con: It cost more.

In an emergency setting, for short term use since its expensive. It needs to be used with a mouthpiece.

They generate Aerosol continuously. Increasing delivered dose over simple medication nebs and decreases aerosol waste.

A Pari Jet Sprint Nebulizer.

1. Air from the compressor breaks down liquid medication into smaller breathable particles which form a mist.

2. As patient inhales, the valve at the top opens, letting air in and speeding up mist generation.

3. As patient exhales, the top valve closes, slowing down mist production. the mouth flap opens, letting the patients breath out.

Device would be used in a home setting.

A NebuTech HDN

It can be used with a mouth piece or mask. It uses 8 L of flow.

top, side

A PediNeb

• It uses no compressed air
• Generates negligible heat
• Works with drugs in solution or suspension
• Adds no additional flow into a ventilator circuit
• Creates a fine particle, low velocity aerosol with precisely sized particles
• Leaves virtually no residual

AeronebGo

It's average particle size is 3.1 microns MMAD

It's medication cup capacity maximum is 6 ml

used as a bronchodilator therapy.

An Aeroneb Pro X

Can be used with a ventilator or with a mouth piece for spontaneously breathing patients

In an emergency room to stop an asthma episode and prevent future treatment.

Also can be used for continuous bronchodilator therapy, can be hooked up right before the patients humidifier.

MicroAir

Uses 2 AA batteries and provides 40 treatments.

Patients who are unable to use MDI's, DPI's, and who are out and about.

1. Place patient in environmental chamber with HEDA filter

2. Use exhalation filter (like respiguard)

3. Place in a negative pressure room (or wear Hepa masks)

4. Use BAN nebulizers

In an environmental chamber with hepa filters in order to trap small sized particles.

They are used for pentamadine delivery and use one way valves to make particles smaller and protect the practitioner, This filter provides the protection,

Cadema : Protect the patient as well, it has a one way valve on inspiratory side and one way valve on expiratory side.

A circulair neb, which uses a bag to collect extra medication mist, which means the patient gets more meds on the next breath.

It is indicated for the mobilization of secretions, lung expansion therapy and the treatment and prevention of pulmonary atelectasis.

Delivers medicated aerosol while oscillating the airways with continuous pulses of positive pressure.

Provides medicated aerosol combined with continuous positive pressure to assist in holding open and expanding the airways.

The I-Neb is a breath activated adapted neb. It monitors the first 3 breaths and the drug is aerosolized for 50% of inspiration.

When the drug is finished the device alarms

It's used to deliver iloprost to treat primary pulmonary hypertension.

1. Frequent refilling

2. Use of a nebulizer and infusion pump

3. Use of a large volume nebulizer like a Heart neb.

Heart nebulizer

MMAD: 2.2-3.5 microns , reason is because the goal is to get to the upper airways.

An Ultrasonic nebulizer

To change electric currents into sound waves that create a geyser that breaks up medication into smaller particles.

1. To absorb mechanical heat

2. Act as a medium for sound waves

Yes!

It controls the output of the aerosol.

The fluid output is 1-7 ml/min

No.

It controls the particle size.

particles range from 1-10 microns with a mean of 3 microns.

The FCC (Federal communication commission)

A metered dose inhaler is a pressurized canister with a drug in a propellant with other ingredients and a mouthpiece.

• Shake the device
• It's important to coordinate hand and breath in, you want to breath in slowly.
• Hold your breath for up to 10 seconds. This allows for better deposition.
• Wait 30-60 seconds between pumps, then recap.

About 10% enters the lower airways, the rest deposit in the back of the throat.

You must prime the device following the manufacturers instructions!

It prevents the medication from hitting the back of your throat (inertial impaction.) it adds distance between the MDI and the patients mouth to slow down the flow, improves patient synchronization and minimizes oropharyngeal impaction.

iT ALLOWS EXHALED AEROSOL TO REMAIN IN A CHAMBER AND REMAIN AVAILABLE TO BE INHALED WITH THE NEXT BREATH.

A spacer doesn't have valves, it needs to be coordinated.

A Holding chamber has valves, you don't have to coordinate pushing the button and breathing. you can also take more than one breath.

Basically teach the patient verbally, then physically, question the patient, have them perform it as well, work on fixing their mistakes then follow up.

Respimat inhaler

Has 45% deposition which means more meds in!

The drug is released as patient takes a slow deep breath, no coordination is needed, all you do is start breathing and it'll activate automatically.

A combivent respimat inhaler.

While taking a slow deep breath in, PRESS the dose release button and continue to breathe in slowly for as long as you can. It has a meter which tells you how much medicine you have left.

Dry powdered inhalers do not use CFC or pressurized gas source. The delivery drug is in a powdered form which use lactose or glucose carriers. They are breath activated, meaning your breath creates the aerosol.

You must be able to generate a fast breath in ! >40-60 LPM

Your breath in generates the movement and particle size (1-3 microns.)

• Assemble apparatus
• Load dose
• exhale slowly away from the mouthpiece to prevent clogging
• seal lips around mouthpiece
• inhale deep and forcefully >60 LPM

• Small children or compromised patients who can't generate enough flow to use the device.
• Can't use with a Ventilator
• Can't use with a spacer.

Twist and click to load dose.

Patient may not feel or taste the med

Do not shake after loading

A diskus DPI

*remember patient has to hold their breath for 10 seconds.

Foradil Aerolizer

Breo Ellipta

*single step activation, you just move the cap

A Turdoza Pressair

- Has a dose indicator

- Green light = ready to inhale

-Take a breath in click sound

Spiriva Handihaler

- With this you need to insert a capsule

- to ensure you get the full dose, you breath in deeply 2x !!

Exubera powder for insulin delivery.

1. Available drug formulation

2. Site of deposition needed

3. The patients disease characteristics

4. Patients ability to use the device

5. Patient preference !

The minerals in the water help transmit sound waves.

It increased the output

The density increase

The frequency

MDI

1.Respimat inhaler

2. Combivent respimat

DPI

1. Foradil Aerolyzer

2. Pulmicort Flexhaler

3. Breo Ellipta

4. Spiriva handihaler

1. WYE

2. One way valves

1. Continuously gives medicine

2. Can attach to an oxygen blender

1. Gives Pt a higher volume of medication

2. Conserves medication in the bag

1. Run w/o a gas source

2. Doesn't add additional flow

IT doesn't add additional flow !

1. Has one way valves

2. only works on inpiration

Small Volume Nebulizer

Aerosol Mask

Respiguard nebulizer w/ series of one way valves and a filter

Mouthpiece

Small Volume Neb

Aerosol mask

Large volume nebulizer

trach mask or trach collar

USN (ultra sonic nebulizer)

Aerosol Mask

Small Volume nebulizer

Mouth piece

Heart Nebulizer

Aerosol Mask