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Basic Respiratory Therapy Procedures And Lab > BRTP09 Aerosol Medication Administration > Flashcards

BRTP09 Aerosol Medication Administration Flashcards

1
Q

Aerosol

A

A suspension of solid or liquid particles in a gas

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2
Q

Stability

A

The ability of an awrsol to remin in suspension over time

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3
Q

Instability

A

The tendency for particles to be removed from suspension

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4
Q

Ideal state

A

Particles that range from 0.01-3.0 microns in diameter

100-1000 particles per ml of gas

SIZE THAT PENETRATES ALVEOLI IN THE LUNGS

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5
Q

Penetration

A

Refers to the MAXIMUM DEPTH that suspended particles can be carried into the pulmonary tree by inahled tidal air

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6
Q

Deposition

A

Result of an aerosols eventual instabiltiy; particles “fall out” on a newrby surface

“Where it ends up landing”

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7
Q

Retention

A

Proportion of particles deposited within the respiratory tract

“How much enters the lungs and stay in the lungs”

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8
Q

Clearance

A

Removal, the fact that some particles are exhaled

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9
Q

Coalescence

A

Two particles form one larger particle

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10
Q

Nebulizer

A

A device that generates aerosol of uniform size

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11
Q

particle deposition

A

5-50 microns— get trapped in nose and upper airways

2 to 5 micron—— lower airways: bronchi

0.5 to 3 microns —– Parenchyma: alveolar region

(Anything less than 3 is acceptable)

The main goal with administering medicine is to reach the alveolar level

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12
Q

5 Factors that affect deposition (where it lands) and penetration (how far can it go)

A
  1. Gravity
  2. Kinetic Activity
  3. Particle Inertia
  4. Physical nature of aerosol
  5. Ventilatory pattern
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13
Q

Goal of aerosol therapy

A

Deliver directly to the site of action

Therapeutic action with selected agent (medication) with minimal systematic side effects (WHOLE BODY SIDE EFFECTS)]

Greater efficacy and safety

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14
Q

Hazards of aerosol therapy (Adverse drug reaction)

A 
Cardiovascular effects (tachycardia and arrhythmias)
Muscle tremors
nervousness
headache 
insomnia

We stop treatment when HR increases by 20 bpm or a 20% increase in HR

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15
Q

More hazards of aerosol therapy

A 
infection (not due to drug rather due to poor cleaning of equipment)
airway reactivity (bronchospasm)
pulmonary and systemic effects
drug concentration
eye irritation
secondhand exposure
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16
Q

Patient assessment includes

A 
Vital signs: HR, RR, BP
breath pattern
breath sounds
pulse oximetry
peak flow rates (PEFR)
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17
Q

Peak flow meter

A

A small, handheld device used to monitor a person’s ability to breath out air.

When to use it?

assessing effectiveness of treatment
before taking meds and after

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18
Q

Optimal use of Peak flow meter

A 
Move marker to bottom of scale
stand up straight
ensure tight seal
deep breath in
blow hard and fast
Repeat 3 times taking the best of three
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19
Q

MDI

A

metered-dose inhaler

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20
Q

DPI

A

Dry powder inhaler

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21
Q

Nebulizers

A

SVN (small volume)

LVN (large volume)

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22
Q

Hand bulb atomizer or spray pump

A

spray pump used for aerosol delivery to the UPPER RESPIRATORY Tract
Uses simple jet to produce large particles
Example: Nose sprayers to treat symptoms of allergic rhinitis and upper airway inflammation

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23
Q

3 types of MDI (metered-dose inhaler)

A
  1. conventional
  2. air actuated
  3. soft-mist
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24
Q

Advantages of a metered dose inhaler

A 
Portable, compact
multidose convenience
short treatment time
reproducible emitted dose (which means it give a MEASURED dose of meds)
No drug preparation required
difficult to contaminant
25
Q

Disadvantages of a metered dose inhaler

A

Hand-breath coordination required
patient has to activate and properly inhale
fixed drug dosage and doses
often gets caught in oropharyngeal deposition
difficulty determining remaining dose if theres no counter

26
Q

Factors affecting the MDI performance and drug delivery

A 
Must shake canister
Storage temp
nozzle size and cleanliness
timing of actuation
priming ( wasting a puff)
characteristics of the patient
overall technique
27
Q

Optimal technique for MDI

A

warm and shake canister in hand
assemble and uncap mouthpiece
sit up straight (45-90 degrees) or stand
breathe out normally
open mouth technique: keep mouth open and tongue down
closed mouth technique: place mouthpiece between lips with tongue out of the path

28
Q

Optimal use continued for MDI

A

slowly breathe in as you activate the MDI
Continue inspiration to total lung capacity (TLC)
Hold breathe for 10 seconds
wait 1 minute between puffs
IF TAKING STEROID PATIENT MUST RINSE MOUTH AFTER

RINSING MOUTH AFTER STERIOD PREVENTS ORAL THRUSH

29
Q

During treatment or inbetween meds the RT should

A

monitor patients vitals
observe improvements or adverse reactions

Troubleshoot absent or low aerosol output

30
Q

Qday

A

once a day

31
Q

BID

A

twice a day

32
Q

TID

A

three times a day

33
Q

QID

A

four times a day

34
Q

Q4

A

every 4 hours

35
Q

Advantages to using accessory devices with a MDI

A

reduce oropharyngeal drug impaction
INCREASED DRUG ALMOST 4 TIMES MORE THAN JUST MDI ALONE
no drug prep needed
simplifies coordination and inhalation

36
Q

Disadvantages of accessory devices for mdi

A

Larger
more expensive and bulky
some assembly may be required
patient errors (firing multiple puffs into chamber
could be a source of contamination if not cleaned well

37
Q

2 types of MDI accessory devices

A

Valved holding chamber

Spacer

38
Q

Valved holding chamber

A

Incorporates one or more low resistance valves to prevent aerosol in the chamber from clearing on exhalation

reduces oral deposition and increases pulmonary deposition

better for coordination issues than spacer

feedback if inspiratory flow too fast (device will whistle or make “musical sound”)

39
Q

Spacer

A

simple VALVELESS extension device that adds distance between patients mouth and MDI outlet

distance allows for reduction in particle size and decreases oral deposition

helps with patient coordination of inhalation and actuation

40
Q

DPI aka dry powdered inhalers

A

BREATH ACTUATED dosing system. The patient creates aerosol by generating inspiratory flow and volume

41
Q

Major disadvantage to DPI

A

Adequate inspiratory flow is required for medication to be delivered
Can result in high pharyngeal deposition
Humidity can cause powder to clump and reduce fine particle mass

PATIENT HAS TO BE ABLE TO HAVE INSPIRATORY FLOW FROM 40-60

42
Q

Jet nebulizers

A

gas powered directed through a restricted orifice (the jet)

Incorporates baffles to decrease the number of large aerosol particles

Can be small volume neb or large volume neb due to reservoir size

sidestream or mainstream

43
Q

If you had to choose between a spacer and holding chamber which should you choose?

A

Valved holding chamber

44
Q

Factors that affect performance of jet nebulizer

A 
Gas flow and pressure
humidity and temp
drug formulation
gas density
nebulizer design- baffle and residual drug volume
breathing pattern
45
Q

advantages of Small volume nebulizer (SVN)

A

aerosolize several drugs
can mix drugs if compatible
minimal cooperation and coordination required
works in several patients (age, distressed, debilitated)
drug dose can be modified
normal breathing pattern can be used

46
Q

Small volume nebulizer disadvantages

A

Total treatment time can be 5-30 mins
equipment required
power source required
if using a mask, drug delivery to the eyes is possibility
variability of performance can be brand dependent

47
Q

important facts about small volume nebulizers

A

USUALLY RUNS ON FLOW OF 6-8 LPM
Can be driven on oxygen or air
generally hold 2-6 ml of solution
SHOULD BE USED INSTEAD OF MDI OR DPI IF PATIENT IS TACHYPNEIC

48
Q

Medication delivery to Larger airways

A
  1. Inhale at tidal volume
  2. Inhale at a normal or slow speed
  3. breathe a normal pattern
49
Q

Medication delivery to smaller airways

A
  1. Inhale through mouth
  2. inhale slowly
  3. Take a deep breath and hold it for a few seconds
50
Q

Large volume Nebulizers

A

Useful when traditional dosing isn’t working
Large volume reservoirs continuous neb (heart)
can be hooked to iv pump and premixed drip in a standard reservoir

Potential problem and main concern with LVN: drug reconcentration

51
Q

4 other types of nebulizers

A

Breath enhanced nebulizers

Breath actuated nebulizers

Vibrating mesh nebulizer

Ultrasonic nebulizers

52
Q

Breath enhanced nebulizer

A

Breath enhanced nebulizers— generate aerosol continuously, using vents and valves to reduce the aerosol waste

53
Q

Breath actuated nebulizer

A

Breath actuated nebulizers— synchronize aerosol generation with the inspiratory effort of the patient reducing the waste of aerosol; GIVE MORE MEDS TO PATIENTS; ENVIRONMENT IS LESS CONTAMINATED.

54
Q

vibrating mesh nebulizer

A

active or passive based on design
can generate aerosol from small drug concentration
does not generate much flow
particle size created small

55
Q

ultrasonic nebulizer (small)

A

Piezoelectric crystal to generate aerosol

Uses crystal transducer convert to a higher frequency

creates less residual drug volume

can be portable

56
Q

Goals of bland aerosol therapy

A

***No medication/ only water/ only saline

Bronchial hygiene 
hydrate dried secretions
promote cough
restore mucous blanket
humidity inspired gas
induce sputum
57
Q

Hazards of bland aerosol therapy

A

rehydrated secretions causing airway obstruction

bronchospasm or wheezing

cross-contamination

patient discomfort

infection

58
Q

Large volume jet nebulizer (heated)

A

Pneumatically powered, attached flow meter, and gas source

a small jet orifice

impacting surfaces baffles decrease large particle

remaining small particles leave nebulizer

Heating increases water content

NOT USED FOR MEDICATION

HEATING MEDICINE DEGRADES IT

59
Q

What to consider when selecting aerosol delivery system?

A 
age, physical and cognitive abilities
patient preference (more important for home use)
availability of drug
convenience and durability
cost and reimbursement

Basic Respiratory Therapy Procedures And Lab (11 decks)

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