Respiratory Therapy, Chapter 6 (Exam #4)
Define Humidity.
are individual molecules in a vapor or gaseous state. It's can not transmit bacteria.
Define absolute humidity.
The actual content or weight of water present in a given volume of gas content.
- It is recorded as g/m3 or mg/L
What happens to the AH (absolute humidity) when the temperature increases?
The AH goes up as well.
What does AH equal?
AH= 44 mg/L
What is water vapor pressure?
47 mmHg
Define Relative Humidity.
It is the ratio of content to capacity.
What is the formula for RH?
Measured Humidity Content / water capacity X 100
What causes condensation? What must be used to prevent aspiration in patients?
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.
Define Body Humidity.
It is the maximum amount of water that can be held at body temperature.
What formula can you use to solve for Body humidity?
Content MG/L / water capacity X 100
Define Humidity deficit
The difference between the actual water content and body humidity
What is the formula for HD?
Body Humidity - Ambient (what the device is giving) = HD
Where is isothermic saturation boundary?
It is 5 cm below carina
What symptoms does an intubated patient with no humidity experience?
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
What are 4 results of long standing Humidity Deficit?
1. Airway Drying
2. Retention of secretions
3. Airway plugging
4. Increased chance of infection
What are some clinical signs and symptoms of inadequate humidification?
1. Atelectasis
2. Dry, non productive cough
3. Thick dehydrated secretions
4. Increased RAW
5. Increase chance of infection
6. Substernal Pain
What is the overall goal of Humidity Therapy?
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)
What is meant by invasive mechanical ventilation? List some examples of two airways that provide this?
Intubation.
ETT, or tracheostomy.
What is noninvasive ventilation.?
Ventilation without entering the body.
What is another name for noninvasive ventilation?
CPAP or BPAP
What is meant by the term active humidification?
Active humidification increase heat and moisture of inspired gas, like a Wicks Humidifier,
What is meant by the term passive humidification?
Passive Humidification takes patients exhaled gas and utilizes it
What is the recommendation for humidification for patients on invasive mechanical ventilation?
Humidification is recommended for all patients on invasive mechanical ventilation
What type of humidification is recommended for noninvasive mechanical ventilation?
Active humidification is recommended because it improves adherence and patient comfort.
What level and type of humidification is recommended for invasive mechanical ventilation.
Recommendation is 33-44 mgH20/L of water at 34-41 degree celcius at the WYE piece and 100% room humidity.
What do they recommend if you are using passive humidification on invasive mechanical ventilation?
An HME which must provide a minimum of 30 mgH20/L
What type of humidification is NOT recommended for noninvasive ventilation?
An HME because it collects dead space.
If your patient is receiving a lung protective strategy, what type of humidification is not recommended?
Heat and moisture exchanges.
Should HME's be used as preventative strategy for vap?
NO.
Name one type of low flow active humidifier?
bubble humidifier.
Name two types of high flow active humidifiers?
- Wicks type humidifier
- Passover humidifier (fisher paykal)
Name on type of high flow passive humidifier?
HME
What does a bubble humidiifer deliver at flows < 5 L/M?
It delivers flows of 10-20 mg/L and 20% RH at BTPS
What is the purpose of a diffuser?
To create more bubbles = more surface area
What are 4 factors that increase the effectiveness of a humidifier?
1. The surface area
2. The temperature
3. The time of contact
4. The thermal mass
At what psi will the pop off alarm activate at? (W/ a bubble humidifier?
2 psi
A bubble humidifier can only be attached to _______ bore tubing.
small
When is active High Flow Humidity devices used?
They are used when supplying all the inspiratory gas to intubated or trached patients.
What is the recommended min humidity for these devices?
33 mg H20/L
Active High Flow Humidity devices can only be attached to _______ bore tubing.
large.
What is shown?
A fisher & paykel passover humidifier that may or may not contain a heated wire circuit. It provides 100% RH at various temperatures.
There are three common types of passover humidifiers, describe the first, simple reservoir models.
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.
Describe Wick Units.
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.
Describe membrane devices:
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.
What is an open humidity system?
a system that physically needs to be opened and filled with sterile water.
What are some problems that can occur with this type of system?
- Greater risk of contamination
- Higher risk of leaks
- May change the reservoir temperature
- interrupts mechanical breaths from machine
Describe a Manual system and its disadvantages.
A manual system refill simple large reservoir systems with sterile or distilled water. However, manually refilling can:
- Change the reservoir temperature
- Interrupt mechanical ventilation
- Increase the risk of cross contamination
Describe a Gravity (continuous) feed system and its advantages.
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.
What must you still do with these systems?
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.
What is shown and what is it's function.
Heated Wire Circuit.
It functions in decreasing rainout/condensation with a humidifier. If this technology is not used, a water trap should be.
What happens if the Heated Wire Circuit is warmer than the humidifier outlet?
Gas will not be fully saturated and a humidity deficit will occur.
What are 3 reasons why not using a water trap may be a problem?
- Decrease or obstruct gas flow to patient
- Change FIO2 delivered to patient
- Condensation may be aspirated by patient.
What is shown?
Vapor Transfer Cartridge
What is shown?
Disposable water path & delivery tube
Describe Vapotherm Precision Flow.
How much RH does it provide?
Mg of water?
Tempt range?
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
What is shown?
List its functions.
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.
What is shown?
Hudson RCI comfort flo humidification system.
What is shown?
Describe.
HME are classified as passive humidifiers. They capture exhaled heat and moisture and use it to heat and humidify the next inspiration,
Which patients are HME's used for?
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
What is the theory behind HME?
That the exhaled gas contains 100% RH at 37 degrees Celsius .
What are the ISO standards for these devices?
They must be used on mechanically ventilated patients.
In general, what amount of humidity does this device provide?
10-31 mgH20/L at 30 degrees C
needs to be at least 70% efficient.
What happens to the devices resistance when it is wet? (HME)
it increases the resistance and causes the patients WOB to increase.
Why are HME not recommended for infants?
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.
What do you do if a ventilator patient has an HME in place and needs a nebulizer or MDI treatment?
You remove the HME because the medicine will become clogged in the device.
What is shown?
A gibeck humid-flo HME. Which has an average humidity output over 72 hours. (30.7 mgH2O/L)
What is shown?
Describe the benefits?
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
How is water incorporated in the system?
Water is fed to the heater through a gravity feed solution bag.
How much does the Vt deliver with 500 ml?
36-39 mgH20/L
How much does the Vt deliver with 1000 ml?
34-36 mgH20/L
What are some contraindications for HME use?
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
What are the indications? (of HME)
Mandatory to be used with endotracheal and tracheostomy tube patients.
What are the hazards? (of HME)
- Potential for electric shock
- Hypothermia
- Thermal injury to the airway
- Under hydration or impaction of mucus secretion
- Increase WOB and RAW due to mucus plugging
- Potential burns for caregivers
What do you need to monitor with an HME?
- Humidifier setting
- Gas temperature
- Inspired gas temperature
- Alarm settings
- Monitor airway obstructions
What is the definition of an aerosol?
Solid or liquid particles suspended in a gas.
What can be measured with aerosols?
You can measure and count particles.
What can you see with aerosols?
The mist produced.
What should you do if you see that a mist is not being produced during inhalation and what does this mean?
This means that the patient is not getting adequate aerosol treatment. You should turn up the liter flow in this case.
What can transmit bacteria?
Aerosols/
What percentage is normal saline?
0.9%
What percentage is hypotonic?
<0.9%
What percentage is hypertonic and what is it used for?
>0.9%. It's used to induce sputum samples by making the airways extra moist,
What are three uses of bland aerosol therapy?
1. To humidify dry medical gases
2. Sputum induction
3. Decrease airway edema
What are 5 hazards of bland aerosol therapy?
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
What is the special consideration for pedi patients?
Bland aerosol therapy is quiet, unlike LVN which are loud.
What is the definition of MMAD
Mass Median Aerodynamic Diameter
What does MMAD do?
It divides so that half are larger and half are smaller
Particles are measured in ________.
microns.
What size particles are exhaled?
<1 micron particles.
Decrease the particle size and you _______where it deposits in the lungs.
increase.
What 4 things effect Aerosol deposition?
1. Gravity/ sedimentation
2. Inertial impaction
3. Aging
4. Diffusion
Larger, less stable particles deposit in the ___________. These particles are ____________.
central airways.
1-5 microns.
Inertial impaction happens with high inspiratory flows greater than what?
What size particles does this usually happen with?
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.
What does aging cause particles to do?
Aging causes particles to grow and shrink and fall out of suspension over time. Small particles grow and shrink faster than large particles.
What does diffusion causes particles <3 microns to do?
It causes particles to deposit in respiratory region, adjacent to alveoli because they have low mass.
What size particles does Antibiotics need to have?
They have to have small particles so that they can reach the alveoly.
What size particles do bronchodilators need to have?
Bronchodilators need 3-5 micron particle size so that they reach the small airways and not into the alveolus.
What is the best breathing pattern to increase aerosol penetration?
A slow breath in, hold the breath to allow it to settle in the airways for 4-10 seconds
What device should you use for medicated aerosol?
A mouthpiece.
State whether they are used to deliver Humidity Therapy, Aerosol Therapy or both.
Aerosol Mask.
Only delivers Humidity Therapy.
State whether they are used to deliver Humidity Therapy, Aerosol Therapy or both.
Face tent.
Can deliver Both.
State whether they are used to deliver Humidity Therapy, Aerosol Therapy or both.
Tracheostomy Collar
Both.
State whether they are used to deliver Humidity Therapy, Aerosol Therapy or both.
Briggs Adapter (T piece)
Both.
State whether they are used to deliver Humidity Therapy, Aerosol Therapy or both.
Mouthpiece.
Aerosol Therapy only. (specially for medicated aerosols.)
What is shown?
What doesn't this device have?
An Atomizer. It's missing a baffle.
What is shown?
A large volume nebulizer with a baffle.
What 3 things can act as a baffle?
1. The fluid surface
2. Sides of the container
3. Device in the gas stream
By what principle do LVN (jet nebulizers) work?
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.
What happens if a baffle is in place in a LVN?
iF A BAFFLE IS IN PLACE YOU GET DECREASED AND MORE UNIFORMED PARTICLE SIZES.
What are LVN most used for?
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.
What can LVN deliver?
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.
What happens if water is in the corrugated tubing?
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.
What do bland Aerosols require?
A water trap to prevent aspiration.
What happens to total flow and FiO2 if water is in the tubing?
total flow decreases, FiO2 increases
What happens to total flow and aerosol density as you increase FiO2?
Total flow decreases, aerosol density increases(meaning more density produced.)
With a __________ device you must deliver all the inspiratory needs of a patient or the patient will inhale room air and the FiO2 will decrease.
High Flow
When must you use a double flow set up?
For FiO2's >50%
What FiO2 should you set each nebulizer at on a double flow set up?
You would set it at the same FiO2 for both. (as well as the same liter flow for both)
What is the total flow of a 100% double flow set up running at 15 LPM?
30 L/M. Remember, each flow meter is set at the same liter flow, so you multiply 15 x 2.
High Flow Nebulizers requires ______ gas flow sources.
two
High flow nebulizers offers flows from?
40-110 L/M
High flow nebulizers have _____ mm fitting so device can attach to sterile water bottles.
38
High flow nebulizers use _______ gas to drive the nebulizer and _________to nebulizer o increase flow to > 40 LPM.
primary, add gas
For 21-50% oxygen, you connect to ________ and inject _________/
Room air, Oxygen
For 50-100% oxygen, you connect to ________ and inject ______________.
Oxygen, Room air
Describe what High flow set ups use?
They use a humidifier and a blender to deliver high flows at a specific oxygen concentration.
What is the advantage of high flow set ups?
It is much quieter and supplies heated air if hypothermia is an issue.
What is the goal of medicated Aerosol Therapy?
To deliver a therapeutic dose of medication to the desired site of action..
What is the most common use of aerosol therapy?
Medicated aerosol
What are three advantages of Medicated Aerosol?
1. Delivers where it needs to work
2. Decreases systemic side effects.
3. Rapid absorption and onset of action.
What are 6 hazards of medicated aerosols?
1. Reaction to medicine
2. Infection
3. Bronchospasm
4.Drug concentration changes
5. Eye irritation
6. Exposure to secondhand aerosol
What type of aerosol has a filter to protect RT's from secondhand inhalation?
Respiguard Aerosol.
Small Volume Nebulizers have a ______mL reservoir tube that helps increase aerosol deposition. The average MMAD is __________microns.
50, 1-5
How much medication actually gets delivered to the patient?
only 10%. A SVN is very inefficient, it nebulizes when the patient is inhalation and exhaling, causes medication to be lost.
2-5 microns for ______________________.
airway depostion.
2-5 microns are best for what?
Bronchodilators and steroid.
1-2 microns for ______________.
parenchymal deposition.
1-2 microns are best for what?
Antibiotics.
How full should a SVN be?
4-5 ML
What is dead space volume?
Amount of volume that can't be nebulized.
What liter flow should you use for SVN?
8 L/M
Describe how you would disinfect a SVN at Home?
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.
How far from the patient should you place a SVN?
Place 18 inches from the patients airway and 6 inches from the patients WYE.
How should SVN be used on mechanical ventilation?
It should only nebulize on inspiration and use the same oxygen concentration as patient.
What is shown?
Describe it.
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.
When would a BAN be most likely used?
In an emergency setting, for short term use since its expensive. It needs to be used with a mouthpiece.
Describe BENs (Breath Enhanced Nebulizers.)
They generate Aerosol continuously. Increasing delivered dose over simple medication nebs and decreases aerosol waste.
What is shown?
Describe how it works?
Where would this device be used in?
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.
What is shown?
A NebuTech HDN
Describe A NebuTech HDN
It can be used with a mouth piece or mask. It uses 8 L of flow.
If using a mask with the NebuTech HDN, you move the green valve from _______ to ________ port.
top, side
What is shown?
A PediNeb
What are the advantages of Vibrating Mesh Technology?
- 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
What is shown?
What is the average particle size that it produces? It's med cup capacity?
AeronebGo
It's average particle size is 3.1 microns MMAD
It's medication cup capacity maximum is 6 ml
What is an aeronebgo mainly used for?
used as a bronchodilator therapy.
What is shown?
What is used for
An Aeroneb Pro X
Can be used with a ventilator or with a mouth piece for spontaneously breathing patients
Where can an Aeroneb Pro X be used?
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.
What is shown?
How many treatments can it provide?
MicroAir
Uses 2 AA batteries and provides 40 treatments.
What patients benefit from a MicroAir?
Patients who are unable to use MDI's, DPI's, and who are out and about.
What are 4 engineering controls that may be utilized to reduce exhaled aerosols?
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
Where would you put a patient with tuberculosis?
In an environmental chamber with hepa filters in order to trap small sized particles.
Describe Respirguards filters
They are used for pentamadine delivery and use one way valves to make particles smaller and protect the practitioner, This filter provides the protection,
What is shown? Describe it
Cadema : Protect the patient as well, it has a one way valve on inspiratory side and one way valve on expiratory side.
What is shown.
A circulair neb, which uses a bag to collect extra medication mist, which means the patient gets more meds on the next breath.
What is the MetaNeb system indicated for?
It is indicated for the mobilization of secretions, lung expansion therapy and the treatment and prevention of pulmonary atelectasis.
Describe the mode CHFO. (Continuous High Frequency Oscillation)
Delivers medicated aerosol while oscillating the airways with continuous pulses of positive pressure.
Describe the mode CPEP (Continuous positive expiratory pressure)
Provides medicated aerosol combined with continuous positive pressure to assist in holding open and expanding the airways.
Describe the I-Neb.
What happens when the drug is finished?
What is it used to treat?
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.
What are 3 methods of continuous nebulization?
1. Frequent refilling
2. Use of a nebulizer and infusion pump
3. Use of a large volume nebulizer like a Heart neb.
What is shown?
What is the MMAD for this device and why .
Heart nebulizer
MMAD: 2.2-3.5 microns , reason is because the goal is to get to the upper airways.
What is shown?
An Ultrasonic nebulizer
What is he purpose of the piezoelectric transducer?
To change electric currents into sound waves that create a geyser that breaks up medication into smaller particles.
Why is the couplant chamber filled with tap water?
1. To absorb mechanical heat
2. Act as a medium for sound waves
Can you change the amplitude on an USN?
If so, what does it control?
What is the fluid output range?
Yes!
It controls the output of the aerosol.
The fluid output is 1-7 ml/min
Can you change the frequency? What does it control? What is the particle size ranges and its mean.
No.
It controls the particle size.
particles range from 1-10 microns with a mean of 3 microns.
Who regulates USN?
The FCC (Federal communication commission)
What is an MDI?
How do you take one?
A metered dose inhaler is a pressurized canister with a drug in a propellant with other ingredients and a mouthpiece.
Describe the proper use of taking an MDI.
- 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.
How much percent actualy enters the lower airway? where does the rest deposit?
About 10% enters the lower airways, the rest deposit in the back of the throat.
What should you do after not using an MDI for a couple of days?
You must prime the device following the manufacturers instructions!
What is the purpose of a spacer?
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.
What is the purpose of a holding chamber?
iT ALLOWS EXHALED AEROSOL TO REMAIN IN A CHAMBER AND REMAIN AVAILABLE TO BE INHALED WITH THE NEXT BREATH.
What is the difference between a spacer and a holding chamber?
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.
How should you teach a patient on hw to use an MDI?
Basically teach the patient verbally, then physically, question the patient, have them perform it as well, work on fixing their mistakes then follow up.
What is shown?
Describe the device.
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.
What is shown?
Describe the device.
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.
Describe DPI.
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.
What inspiratory flow must you be able to generate?
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.)
Describe the directions for taking a DPI
- Assemble apparatus
- Load dose
- exhale slowly away from the mouthpiece to prevent clogging
- seal lips around mouthpiece
- inhale deep and forcefully >60 LPM
Who can't use a DPI?
- 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.
What is shown?
Twist and click to load dose.
Patient may not feel or taste the med
Do not shake after loading
What is shown?
A diskus DPI
*remember patient has to hold their breath for 10 seconds.
What is shown?
Foradil Aerolizer
What is shown?
What is shown?
Breo Ellipta
*single step activation, you just move the cap
What is shown?
A Turdoza Pressair
- Has a dose indicator
- Green light = ready to inhale
-Take a breath in click sound
What is shown?
Spiriva Handihaler
- With this you need to insert a capsule
- to ensure you get the full dose, you breath in deeply 2x !!
What is shown?
Exubera powder for insulin delivery.
What are 5 considerations when choosing an aerosol delivery system?
1. Available drug formulation
2. Site of deposition needed
3. The patients disease characteristics
4. Patients ability to use the device
5. Patient preference !
Lab Questions.
Why does the type of solution in the couplant make a difference in the amount of mist being produced?
The minerals in the water help transmit sound waves.
Lab Questions.
What effect did increasing the amplitude of the USN have on the aerosol output being produced?
It increased the output
Lab Questions.
What effect did increased the amplitude of the USN have on the density of aerosol being produced?
The density increase
Lab Questions.
What affects aerosol particle size of the USN?
The frequency
Lab Questions.
List 2 medications that are delivered in MDI form?
Four in DPI?
MDI
1.Respimat inhaler
2. Combivent respimat
DPI
1. Foradil Aerolyzer
2. Pulmicort Flexhaler
3. Breo Ellipta
4. Spiriva handihaler
Lab Questions.
Provide at least two differences between the filtered nebulizer and a SVN?
1. WYE
2. One way valves
Lab Questions.
What 2 advantages are there to using the Heart nebulizer?
1. Continuously gives medicine
2. Can attach to an oxygen blender
Lab Questions.
What 2 advantages are there to a circular nebulizer?
1. Gives Pt a higher volume of medication
2. Conserves medication in the bag
Lab Questions.
What 2 advantages are there to using an AeronebPro nebulizer?
1. Run w/o a gas source
2. Doesn't add additional flow
Lab Questions.
What would be an advantage to using the AeronebPro neb with a patient on mechanical ventilation?
IT doesn't add additional flow !
Lab Questions.
What are 2 differences between the pari nebulizer and the SVN?
1. Has one way valves
2. only works on inpiration
spiLab Questions.
A 60 year old, obtunded, male who requires treatment with 0.5 ml Proventil and 3.0 ml of NSS:
Aerosol device __________
Interface ____________
Small Volume Nebulizer
Aerosol Mask
Lab Questions.
An AIDS patient who requires Pentamidine:
Aerosol device ____________
Interface ______________
Respiguard nebulizer w/ series of one way valves and a filter
Mouthpiece
Lab Questions.
A 35 yr old female in the recovery room following abdominal surgery and requires a bronchodilator.
Aerosol device _____________
Interface ______________-
Small Volume Neb
Aerosol mask
Lab Questions.
A 55 yr old make with a size 8.0 tracheostomy tube only requiring humidity.
Aerosol device _____________
Interface ______________
Large volume nebulizer
trach mask or trach collar
Lab Questions.
30 yr old patient with possible pneumonia, a sputum sample is required
Aerosol Device ________
Interface _____________
USN (ultra sonic nebulizer)
Aerosol Mask
Lab Questions.
An 18 year old asthmatic who is sensitive to the propellant in the MDI
Aerosol Device _______________
Interface _______________
Small Volume nebulizer
Mouth piece
Lab Questions.
Status asthmaticus patient is admitted to the intensive care. The patient is not responding to q1-2h treatments. The physician request that you administer high dose bronchodilator therapy.
Aerosol Device _____________
Interface ________________
Heart Nebulizer
Aerosol Mask