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Clinical lab > Aerosol therapy+LET > Flashcards

Aerosol therapy+LET Flashcards

1
Q

What should the flow meter be set to for a SVN?

A

6-8 L/min. A compressor can also be used

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2
Q

How should a patient breath on a jet neb?

A

A patient should breath normally with occasional deep breaths until the device sputters or no more aerosol is produced

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3
Q

How should the nebulizer be positioned during use?

A

vertically

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4
Q

What assessments do you do on a patient prior to aerosol therapy?

A

Primary, general, vitals

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5
Q

You only need to assess you patient prior to and after treatment

A

False. You should assess your patient before, during and after treatment if possible

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6
Q

What are the clinical applications for SVNs?

A

Delivery of bland aerosols for sputum induction
Medication delivery
Bronchodilators
Secretion modifiers
Antimicrobials
Vasodilators
Anti inflammatory agents
Diagnostics

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7
Q

A SVN can only hold 2-4 milliliters of medication

A

False. A jet neb can hold 5-20 mL of medication

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8
Q

How much can LVJN (Large volume jet neb) hold

A

Up to 200 ml
Can be used for medications or bland aerosol delivery

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9
Q

An effective SVN should deliver how much of its fill volume as aerosol in the respirable range? How long does this take?

A

50%
Should be able to do it in less than 10 minutes

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10
Q

How much of the drug is commonly deposited in the respiratory tract when using a vmn?

A

As little as 1%
More commonly 10-20% of the medication should be delivered

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11
Q

Does the SVN nebulize all of the solution?

A

No
remaining medication is dead volume

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12
Q

What piece of equipment greatly increases the delivered dose of an SVN?

A

Reservoir

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13
Q

A reservoir can increase the delivered dose by 5-15%

A

False. A reservoir increases the delivered dose by 5-10%

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14
Q

The collection bag reservoir technique is an ineffective method to deliver increased dosages from an SVN

A

False, the collection bag increases the inhaled dose by 30-59% but is not widely used

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15
Q

What device could you use to deliver more medication at a faster rate than a SVN?

A

A BAN.

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16
Q

A BAN increases the inhaled dose by as

A

50%

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17
Q

Why would a SVN be chosen over a BAN if the BAN is more effective at delivering medication?

A

The BAN increases the WOB when set to be breath actuated. A valve can be adjusted that allows it to be converted to a SVN in the case that the patient is in distress or becoming fatigue. The SVN is also much cheaper than the BAN and hospitals like to save money

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18
Q

Why does the BAN more effectively deliver aerosolized medication?

A

The BAN utilizes a one way valve that only allows aerosol to be produced upon inspiration therefore increasing the inhaled dose and wasting less medicine

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19
Q

alves and expiratory filters are used specifically with which drug?

A

Pentamidine

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19
Q

What is a less commonly know benefit of the BAN?

A

It decreases the risk of potential drug inhalation by caregivers

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20
Q

When and how should SVNs be maintained?

A

should be cleaned and disinfected or rinsed with sterile water and air dried between uses
Disposable and for single patient use only
Should be changed when visibly soiled

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21
Q

SVNs can only be administered with a mouthpiece

A

False, they can be administered with a mask or a mouthpiece however the type of drug should be taken into account as certain drugs can damage the eyes of patients if they use a mask

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21
Q

Advantages of small jet nebulizers include versatility in administration (mouthpiece or a mask, being relatively inexpensive, and being completely safe for patients and providers

A

False. SVN are versatile and inexpensive but are not completely safe depending on the drugs being administered. Pentamidine and atrovent both are capable of having harmful effects on the patient or the provider

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22
Q

What situations would call for a large volume nebulizer?

A

Patients that need to have a large dose administered over a long period of time

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23
Q

Drug toxicity must be monitored when administering LVNs. How would you do this?

A

Yes.
Continually assessing patient vitals, how they are feeling, and monitoring for any abnormalities that might present themselves as a result of drug toxicity

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23
Q

What is the brand name for vibrating mesh nebs?

A

Aerogen

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24
Q

The mesh vibrates at 130 kHz due to the rapid fluctuation of air through the solution

A

False. The mesh or piezoceramic plate vibrates at 130 kHz due to electricity flowing through it

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25
Q

How does a vibrating mesh nebulizer create an aerosol?

A

The vibrating plate (vibrates at 130 kHz) pumps liquid through 1000 apertures or holes breaking the the liquid into fine droplets of 3-4 micrometers

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26
Q

The droplet size distribution for a VMN is 1-4 micrometers

A

False. The VMN creates droplets with a range of 3-4 micrometers

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27
Q

The mesh or plate vibrates at 130 Hz

A

False, the plate vibrates at 130 kHz

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28
Q

What is the drug volume that the VMN can administer?

A

0.1-4 ml

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29
Q

What are the advantages of VMNs?

A

Rapid rate of drug delivery
Low retained dead volume
Portability
Little effect on gas density
Uniform aerosol production
Can deliver undiluted brochodilators for severe brinchospasm
Does not add extra gas flow to ventilator

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30
Q

Why are VMNs particularly useful for patients on ventilators?

A

VMNs do not have a significant effect on gas density
VMNs do not add extra gas flow to the ventilator

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31
Q

What are some of the major drawbacks of VMNs?

A

Expensive
Difficult to repair

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32
Q

Describe how an ultra sonic nebulizer is different from a vibrating mesh nebulizer

A

A VMN creates a mist by pumping liquid through a vibrating mesh with 1000 apertures creating an aerosol with droplets in the 3-4 micrometer range
An ultrasonic nebulizer operates on the piezoelectric principle where a crystal transducer converts and electrical current into high frequency acoustic vibrations which form waves and generate a geyser of droplets that become aerosol particles

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33
Q

In ultrasonic nebulizers, the particle size is directly related to the frequency, but it is not user adjustable

A

False. The frequency and particle size are inversely related with higher frequencies producing smaller droplets and vice versa. The frequency is however not adjustable by the user

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34
Q

What is the main clinical application for USNs?

A

Large volume USNs are used for Bland aerosol therapy meant to induce sputum
Small volume USNs are used for medication delivery

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35
Q

USNs are self actuated and do not require patient effort

A

False. The patients inspiratory flow draws the aerosol from the neb into the lungs

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36
Q

Where should medication be placed in an USN?

A

In couplant compartment or directly into manifold compartment on top of the crystal transducer

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37
Q

What advantages do USNs and VMNs share?

A

Reduced treatment time
Ability to deliver undiluted bronchodilators for severe bronchospasm
Both do not add extra gas flow to ventilators
Portability

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38
Q

Why might you choose a VMN over a USN?

A

The particle size, aerosol density and output of a USN can be significantly effected by the humidity of the carrier gas
Temperature may increase by up to 10 degrees celsius
USNs are not consistently reliable

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39
Q

What are the contents of the pressurized containers on MDIs?

A

Medications
Other
Propellants
Surfactant
Preservatives
Flavoring agents
Dispersing agents

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40
Q

What is the propellant used in MDIs?

A

Hydro fluoroalkanes

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41
Q

Why is HFA used as a propellant in MDIs?

A

Has a warmer spray and less impact force at the back of the throat
Engineered to generate 1-2 micrometer particles to more effectively reach the lower respiratory tract

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42
Q

Storage conditions do not affect MDI performance

A

True

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43
Q

How much of the medication is deposited in the lunges when using a pMDI?

A

10-25%

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44
Q

What is the volume emitted by pMDIs?

A

15-20 ml

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45
Q

Debris build up on the nozzle does not affect device performance

A

False, debris build up reduced the emitted dose. The nozzle should regularly be inspected and cleaned if necessary

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46
Q

Spacers are not effective for optimizing drug delivery due to their inherent electrostatic charge which prevents medicine from exiting the chamber’

A

False, while the electrostatic charge can cause some medication to stick to the inside of the chamber, the problem can be solved by simply washing and air driving the container

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47
Q

The volume of the chamber should be more than 150 ml

A

False, the chamber should be more than 100 ml

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48
Q

What do spacers do to optimize medication delivery?

A

Give patients more time to inhale and make the process simpler
They reduce the need for coordination when pressing the actuator and breathing in the medicine

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49
Q

T/F: Spacers decrease the amount of time it takes to deliver the medication’

A

False, spacers increase the amount of time it takes to deliver the medication which allows the lungs to absorb the medication more smoothly and slowly

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50
Q

T/FUsing a spacer decreases the concentration of medication delivered into the lungs

A

False, because the patient is able to breath more slowly and evenly, and because the spacer prevents oropharyngeal impaction, more medicine is delivered to the lungs

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51
Q

When should an MDI be primed? Shaken?

A

New MDIs must always be primed and if they have not been used in 2 weeks,
MDIs should be shaken before every use

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52
Q

Why do you have to wait 15 seconds between MDI actuations?

A

When the propellants are release, the device cools, changing the aerosol output and the amount of medicine delivered

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53
Q

A horn like sound from the chamber indicates that the patient inhaled correctly

A

False. A hornlike sound indicates that the patient inhaled too quickly

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54
Q

The patient should immediately exhale after inhaling medication

A

False. The patient should take a paced deep breath and hold it for as long as possible, preferably for 10 seconds

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55
Q

Open mouth technique is an acceptable practice when administering MDIs

A

False
Less medication is delivered
Medications such as ipratropium bromide can accidentally be sprayed in eyes causing eye damage
If patient is using ICS, they increase their risk of contracting an oral yeast infection (thrush)

56
Q

A patient with poor coordination and arthritis would have trouble using an MDI

A

True. Even with a spacer, using an MDI would be difficult for a patient with these conditions and they should be given an SVN

57
Q

What is the appropriate response to a patient having an adverse reaction to a treatment?

A

Stop therapy
Contact provider
Reassess vitals
Document

58
Q

DPIs require that the patient breathe in slowly and deeply

A

False
The patient should take a fast steady and deep breath in order to get medication into the lungs

59
Q

What is dispersion dependent upon with DPIs?

A

The patients ability to create a turbulent flow in the inhaler

60
Q

Patients inspiratory capacity must be greater than 50 liters per minute in order to effectively use a DPI

A

False, patients inspiration must be between 30 and 120 liters per minute

61
Q

Aeroliser and handihaler are examples of what? Why can this particular design be confusing to patients?

A

Unit does DPIs
Medication is store in individual capsules that the device must puncture in order to release the medicine
People accidentally orally ingest the medicine with this one a lot

62
Q

Diskhaler is an example of what?

A

Multiple unit dose DPI
Diskhaler contains a case of 4 to 8 individual blister packets of medication on a disk inserted in the inhaler

63
Q

What must you instruct your patient to do after they have used an ICS?

A

Rinse and spit
The steroid will decrease the inflammation response in their mouth and they could develop thrush as a result

64
Q

Twisthaler, Flexhaler and Diskus are examples of what?

A

Multiple dose drug reservoir DPIs
Devices are preloaded with a quantity of the the pure drug sufficient for up to 120 doses

65
Q

Spiriva is administered using which device?

A

Handihaler

66
Q

What steps should you take to ensure the patient is getting the medicine from a handihaler

A

Listen for an audible click when the capsule is pierced
Have them repeat the process of inhaling through the device rapidly if there is medication still in the chamber
Check the chamber and the capsule after administering medication to ensure all of the medication was inhaled

67
Q

What should a patient make sure not to do when using a DPI

A

Breath into the chamber. The humidity will make the medication clump and it wont be dispersed during inhalation appropriately

68
Q

Disadvantages of DPIs include

A

Longer load time for each use than an MDI (barely)
Multiple different models that all operate slightly differently and confuse patients and providers
DPIs require periodic cleaning to ensure there isnt a powder build up similar to MDIs
High ambient humidity can cause the medication to clump
Patients can also accidentally exhale into the device and clump the medication
Patients must be able to meet the inspiratory flow requirements to actuate and disperse the medication

69
Q

What are some advantages of DPIs over MDIs?

A

Easier to coordinate since their is no actuation
No hand breath coordination
A single piece of equipment, no canister and chamber to keep track of
DPIs do not use propellants

70
Q

Why would you want to use an atomizer to deliver topical anesthetics or decongestants?

A

Atomizers produce large particles and particle size determines where the particles will be deposited in the respiratory tract. Large particles are deposited in the nasopharnx, the oropharynx or the hypopharnx whereas smaller particles are deposited deeper in the respiratory system

70
Q

In healthy people, sighing, spontaneous deep breathing and coughing is a mechanism for what?

A

Lung expansion

70
Q

How are atomizers different from nebulizers?

A

They do not have a baffle
Baffles decrease particle size, atomizers produce large particles

71
Q

Partial or complete collapse of the lung tissue is called

A

Atelectasis

71
Q

LET can also be called

A

Hyperinflation therapy
Lung expansion maneuvers

72
Q

The goal of lung expansion therapy is to

A

Reinflate collapsed areas of the lung
Improve gas exchange

73
Q

Describe factors frequently associated with atelectasis

A

Obesity
Neuromuscular disorders
Heavy sedation
Surgery near diaphragm
Bed rest
Poor cough
History of lung disease
Restrictive chest wall abnormalities (obesity counts)

74
Q

Pursed lip breathing involves inhaling through your mouth with pursed lips

A

False. In order to properly perform pursed lip breathing, the patient should be instructed to breath in through their nose and out slowly through pursed lips as if they were attempting to whistle
The patient should attempt to take twice as long to exhale as to inhale

74
Q

List clinical signs of atelectasis

A

History of recent major surgery
Tachypnea
Fine late inspiratory crackles
Diminished breath sounds
Tachycardia
Increased density or signs of volume loss on chest radiographs

75
Q

When performing pursed lip breathing, the patients position is not significant

A

False. The patient should be seated upright or laying down with shoulders relaxed

76
Q

What kind of breathing should pursed lip breathing be performed with simultaneously

A

Diaphragmatic breathing

77
Q

When diaphragmatic breathing, the patient should attempt to breath with their chest and abdomen

A

False. The patient should place one hand on their chest and the other on their stomach and focus on breathing such that the hand on the stomach is pushed out as they inhale while the hand on their chest remains stationary

78
Q

IS is completely benign and has no risks associated with its use

A

False. Unconscious patients and patients with reduced cognitive abilities should not use IS
Patients with untreated an Pneumothorax should not use IS

79
Q

The goal of segmental breathing is to

A

Place a quick stretch on the intercostal muscles of the patient at the end of expiration in order to facilitate their contraction

80
Q

Management of atelectasis can be performed using

A

Incentive spirometry

80
Q

Pressure should be applied to the patient in what way during segmental breathing

A

Downward and inward just prior to inspiration

81
Q

Incentive spirometry is:

A

A low level resistance breathing exercise
Incorporates maximal sustained inspiration
A goal oriented device that allows patients to see progress
Can be either flow or volume oriented

82
Q

IS is most useful for

A

Post operative reversal of atelectasis

82
Q

IS does not directly measure flow or volume

A

False. IS can very precisely measure flow and volume with proper use and calculations
Flow oriented devices are separate from volume oriented devices

83
Q

When using an IS, it is important that patients

A

Inhale slowly and deeply
Do not block the mouthpiece with their tongue
Keep the flow gauge in the proper range

84
Q

After inhaling through the IS, patients can exhale normally

A

False. After inhaling, patients should attempt to hold their breath for at least 3 seconds or longer and then exhale slowly through pursed lips

85
Q

How often should a patient use the IS?

A

10-12 times every hour that they are awake and capable, or as often as directed

86
Q

How does a PEP generate positive pressure?

A

PEP is applied to airway as patient exhales through adjustable orifice device that provides a set amount of resistance
Resistance is set and adjusted by the therapist

87
Q

How much back pressure can PEP generate?

A

Up to 20 cm of water

88
Q

PEP created can

A

Stent an airway open
Improve airway patency

89
Q

A patient should take a very deep breath when performing PEP

A

False. If the patient were able to take a sufficiently deep breath, PEP would not be necessary
The patient should take a larger tidal breath than normal but not TLC

90
Q

The patient should exhale rapidly to generate as much back pressure as possible when performing PEP

A

False. The patient should be instructed to breath out slowly and attempt to keep the indicator in the proper range in order to generate the proper amount of back pressure

91
Q

What should the patient be instructed to do after performing PEP

A

Huff cough

92
Q

How many PEP cycles should a patient do?

A

10-20 followed by huff coughing several times
This should be repeated 3-6 times until secretions are cleared or treatment period has elapsed.

93
Q

Why might PEP be a better LET for post op patients?

A

Easier to perform than IS and not as painful

94
Q

What are the advantages of PEP

A

Places up to 20 cm of water in the patients chest with exhalation
Less painful or demanding of patients with recent thoracic or abdominal surgery

95
Q

CPAP only applies PEP during the expiratory phase

A

False. CPAP pressure is maintained during both inspiratory and expiratory phases

96
Q

How does CPAP work?

A

CPAP elevates intrathoracic pressure and alveolar pressure which in turn increases function residual capacity and improves oxygenation

97
Q

What is FRC?

A

The volume of air remaining in the lungs after a normal passive exhalation

98
Q

CPAP must be delivered continuously in order to be effective

A

False. While it is most effective when delivered for longer periods of time, it can be delivered continuously or intermittently

99
Q

CPAP cannot be delivered invasively

A

False. CPAP can be delivered noninvasively and invasively

100
Q

CPAP increases the WOB

A

False. CPAP decreases the WOB by stenting open airways and reducing air trapping

101
Q

CPAP is useful for mucus clearance

A

True. CPAP facilitates cephalad mobilization of retained secretions

102
Q

Intermittent Positive Pressure Breathing (IPPB) cannot be delivered invasively

A

False. IPPB can be delivered through and invasive or non invasive ventilator

103
Q

IPPB is actuated automatically with no patient input

A

False. The IPPB delivers a controlled airflow into the lungs at a predetermined pressure when triggered by spontaneous breathing activities

104
Q

IPPB can only be delivered pneumatically

A

False. IPPB can be delivered pneumatically and electrically

105
Q

Patients should be prone when using IPPB

A

False. Patients should be sitting semi fowler

106
Q

IPPB is strictly for inpatient use and cannot be used on patients with cognitive limitations

A

False. IPPB can be used in inpatient, outpatient and in-home settings
IPPB can be used on patients with cognitive limitations

106
Q

EzPAP is a hybrid of what two devices?

A

IPPB and PEP

107
Q

EzPAP generates pressure solely upon exhalation and can be used to deliver aerosol medication

A

False, EzPAP generates positive pressure during inspiration and generates positive expiratory pressure during expiration
EzPAP can be used to deliver aerosol medication

108
Q

Back pressure can also enhance what anatomical safeguard?

A

EzPAP can enhance collateral ventilation with back pressure

109
Q

With EzPAP, the greater the expiratory flow, the greater the back pressure.

A

True

110
Q

With EzPAP, greater inspiratory flower increases the pressure delivered to the airways

A

False. The inhaling with more force will limit the amount of pressure the EzPAP can generate on the airways

111
Q

The patient should breath slowly and deeply through the mouthpiece or mask when using EzPAP

A

False. The patient should breath normally when using EzPAP

112
Q

The flow should be set to 10-15 L/m with EzPAP

A

False, the flow should be set to 5-15 L/m

113
Q

Some patients prefer EzPAP to IS because:

A

It helps them with pressure on inhalation and exhalation
Can be more comfortable than the incentive spirometer for some patients

114
Q

Pneumonectomy, lobectomy and esophagectomy are what in regards to LET?

A

Absolute contraindications for Positive pressure LET

115
Q

What should RTs always be mindful of during Positive pressure LET?

A

Patients pain level, discomfort and shortness of breath

116
Q

What assessments are necessary when performing Positive Pressure LET

A

HR
RR
Skin color
Breath sounds
Breathing pattern, chest expansion and movement
Pulse oximetry
Blood pressure

117
Q

Discontinue Positive Pressure therapy if the patient exhibits significant changes in

A

HR
EKG
BP
Breath sounds
Respiratory rate , pattern or chest expansion
Comfort
Color
Oxygen saturation
Mental function

118
Q

An elderly weak female patient with chronic obstructive pulmonary disease has a peak inspiratory flow of 20 L/min. The physician wishes to order a bronchodilator with a steroid BID (twice a day). The respiratory therapist recommends a(n):

A

Small jet nebulizer

119
Q

T/F: With the open mouth technique, steroid medications have a decreased incidence of opportunistic oral yeast infection and dysphonia

A

False

119
Q

Respiratory therapists use large volume medication nebulizers to

A

Give a longer treatment with more medication

120
Q

After a nebulized steroid treatment a patient should:

A

Rinse and spit

121
Q

To protect the respiratory therapist, when delivering pentamidine the therapist should:

A

Use valves and expiratory filters

122
Q

When administering a dry powder inhaler (DPI) what is the lowest acceptable flow a patient should be able to generate?

A

at least 30 L/min.

122
Q

When administering Spiriva, one of the most important directions the therapist should give a patient is to

A

Place the capsule inside the handihaler

122
Q

An effective medication small volume nebulizer should deliver 50% of the volume as aerosol in less than:

A

10 minutes

123
Q

T/F: Atomizers can be inserted into the nasal passages to deliver medication

A

True

124
Q

Mr. X. cannot coordinate his breath with an actuation of an aerosol for his bronchodilator short acting beta agonist (SABA) treatment. The therapist should recommend:

A

A nebulizer

125
Q

A patient has increased ocular pressure. He takes his Atrovent (anticholinergic) treatment as a nebulizer with a mask. The therapist should recommend:

A

Using a mouthpiece with the nebulizer treatment

Switching to a metered dose inhaler (MDI with a spacer

Switching to a dry powder inhaler

126
Q

Priming the metered dose inhaler should occur:

A

Before the administration of medication if 2 weeks between administrations has occured

Before the first administration of the medication

127
Q

The advantage(s) of spacers or valved holding chambers include:

A

More medication is delivered
Oropharyngeal drug deposition is decreased.
Pharyngeal impaction is reduced.
A face mask may be used.

128
Q

To actuate the Flex haler, the patient must

A

Turn the bottom all the way to the right and back to the left

129
Q

Select ALL that apply. A patient is complaining that they don’t feel they are benefiting from metered dose inhaler therapy. The respiratory therapist should check:

A

For spacer use

For debris around the nozzle

The baffles

The patient’s technique

130
Q

A patient complains that their dry powder inhaler is not improving their breathing. The therapist should

A

Check for “grinding” in the device

Check the patient’s technique for administration

Measure the patient’s peak inspiratory flow

Check for powder around the mouthpiece

131
Q

A 16 year old male with new onset exercise induced asthma has joined the cross country track team at school. To treat this patient’s asthma the respiratory therapist recommends a(n):

A

Metered dose inhaler (MDI)

Clinical lab (4 decks)

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