Flashcards in CH35p2 Deck (84):
What is the point in the respiratory track where inspired gas reaches body temperature, ambient pressure, saturated (BTPS) conditions?
a. point of thermal equilibrium
b. hygroscopic saturation boundary
c. thermal inversion boundary
d. isothermic saturation boundary
As inspired gas moves into the lungs, it achieves BTPS conditions (body temperature, 37° C; barometric pressure; saturated with water vapor [100% relative humidity at 37° C]). This point, normally approximately 5 cm below the carina, is called the isothermic saturation boundary.
Which of the following factors cause the isothermic saturation boundary (ISB) to shift farther down into the airways?
1. decreased ambient temperature
2. increased tidal volume (VT)
3. endotracheal intubation
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3
What is the primary goal of humidity therapy?
a. decrease airway reactivity to cold
b. maintain normal physiologic conditions
c. deliver drugs to the airway
d. reduce upper airway inflammation
The primary goal of humidification is to maintain normal physiological conditions in the lower airways
Which of the following inspired conditions should be maintained when delivering medical gases to the nose or mouth?
50% relative humidity (RH) at 20° to 22° C
100% RH at 20° to 22° C
80% RH at 28° to 32° C
100% RH at 32° to 35° C
Clinical indications for delivering cool humidified gas include which of the following?
1. post-extubation edema
2. upper airway inflammation
3. croup (laryngotracheal bronchitis)
a. 2, 3, and 4
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 2 and 3
The delivery of cool humidified gas is used to treat upper airway inflammation resulting from croup, epiglottitis, and post-extubation edema.
What device adds molecular water to gas?
A humidifier is a device that adds molecular water to gas.
What is the most important factor determining a humidifier’s performance?
time of contact
Temperature is an important factor affecting humidifier performance.
Indications for use of Bland Aerosols include all of the following except:
A. Prescence of upper airway edema
D. Prescence of bypassed airway
Contraindications of bland aerosol administration include:
A. History of bronchospasm
C. Past episodes of asthma
D. History of airway hyperresponsiveness
B & D
Hazards of bland aersol administration include:
E. Bronchoconstriction without bypassed airway
A, B, D
The following are signs of the need of bland aerosol treatment:
A. Prior extubation
C. Bypassed upper airway
C, D, G
Name 4 symptoms that would indicate a need for bland aerosol therapy
Brassy, crouplike cough
Patient discomfort due to airway instrumentation
History of upper airway irritation and increased work of breathing
Factors that would need to be considered when monitoring a patients response to aerosol therapy include:
A. Only the objective saturation level
B. Patients level of dyspnea
C. Breath sounds
D. Sputum production
B, C, D
T or F: A patients subjective response should not be considered if their saturation has returned to normal when monitoring the patients progress.
F: A patients subjective response such as pain, discomfort, dyspnea, restlessness should be considered when monitoring patient
Name the contraindications of bland aerosol administration
History of airway hyperresponsiveness
Increasing the FIO2 can be accomplished by :
A. Increasing flow
B. Increasing the diameter of air entrainment ports
C. Decreasing the diameter of air entrainment ports
D. Increasing the amount of corrugated tube
C. Decreasing the diameter of air entrainment ports
When starting treatment, the flowmeter should be set at:
a. 6-8 l/min
b. 10 l/min
C. 15 l/min
d. 8-10 l/min
b. 10 l/min
T or F Doubling your O2 flow will double your flow?
F; can't make it double itself, you can add tandem aerosol
When large unstable particles fall out of suspension or impact on internal surfaces this is called?
The total water output of unheated LVN varies between _____ & ______ mg H2O/L
The total water output on a heated LVN varies from _____ to ______ mg H2O/L
What are 3 types of edema that should be an indication for use of bland aerosol therapy
Prescence of upper airway edema
Goals of aerosol therapy
Improved bronchial hygiene
Humidify gases delivered in patients with artificial airways
Improving bronchial hygiene include:
A. Improving the efficiency of cough mechanism
B. To restore and maintain normal function of mucociliary escalator
C. Inducing sputum
D. Humidify gases
A & B
_______ is associated with decreased compliance and gas exchange and with increased lung resistance.
Hazards & complications of aerosol therapy include:
Edema of airway wall
Caregiver exposure to droplet
Bronchoconstriction, bronchospasm, wheezing
Bronchorestriction is a hazard because it may lead to:
Name 5 indications for bland aerosol therapy
3. Postop management of upper airway
4. Prescence of bypassed upper airway for heated bland aerosol
5. Need for sputum specimens or mobilization of secretions
Name two instances when overhydration may occur in therapy?
A. in infants
B. associated with ultrasonic nebulizers
Bronchoconstriction, bronchospasm, wheezing is seen most frequently in which population of patients
Bland aerosols are composed of what type of solution?
Sterile water or saline
Bland aerosols contain:
A. Particles of water
B. Gas vapor
A. particles of water
The range of air entrainment ports range from what percentage?
35 to 100%
Always analyze inspired O2:
A. Near the patient
B. At the flowmeter
C. In the room
D. At the source of the LVN
A. Near the patient
Aerosol tubing & back pressure decrease the entrained air & raise O2 percentage T or F
All LVN have a liquid reservoir of at least?
A. 500 ml
B. 300 ml
C. 250 ml
D. 200 ml
C. 250 ml
Risks of heated rods include:
A. change in FIO2 levels
B. Burns to practitioner
D. Increased flow if not measured properly
B & C
What indicates that flow is sufficient with an aerosol mask?
A. Aerosol mist can be seen flowing in and out of side ports
B. Aerosol mist can be seen flowing out during inspiration of side ports
C. The flowmeter is set at 10 l/min
D. Aerosol is seen leaving the side ports during exhalation
B. Aerosol mist can be seen flowing out during inspiration
As humidified gas cools on its way to the patient ________ results in water drainage to lowest point
Heating water ________ patients humidity
If secretions are thick water should be:
C. can remain at room temperature
Name 4 things an incubator is used for:
A. maintain the infants temperature
B. Manage humidity
C. Isolate the infant from outside environment
D. Control infants inspired o2
The internal temperature of an incubator should be:
36 to 36.5 C
When maintaining oxygen levels, what should be used?
A. The built in O2 delivery system
C. Mist Tent
A _______ _________ may be positioned over an incubator to keep infant in NTE
With an aerosol tent:
A. Supplemental O2 will be needed
B. You must be sure their are no escape wholes for air
C. No supplemental O2 is used
D. Top of canopy should be left open for better flow & ventilation
C & D
If a child has layngotracheobronchits, what type of aerosol is preferred?
Which is not a goal of Aerosol Therapy
A. Reduce the work of breathing during an asthma attack
B. Improve efficiency of cough
C. Remove the mucociliary escalator
D. Deliver meds by SVN, MDI, DPI
What is the nebulizer output of jet nebulizer:
1 - 1.5 ml/min
What is the output of USN?
Up to 6 ml/min
What is the particle size of jet nebulizer?
55% are between 1 to 5 um
What is the particle size of ultrasonic nebulizer?
97 % at 1 to 5 um
With ultrasonic nebulizer the particles are ______ proportional to signal frequency?
With USN the rate of aerosol production is ________ proportional to signals amplitude
Name 7 parts of the aerosol generator?
DISS flow meter inlet
Variable entrainment port
A. Water vapor
B.. Liquid particles
C. Suspended water
D. Gas & water vapor
B. Liquid particles
Jet nebulizers operate at a flow range of _____ to ____l/min
6 to 15
What type of nebulizer is not seen anymore but was used for mist tents?
What is a high flow device capable of delivering flows up to 100 l/min
What type of nebulizer is not really seen in hospitals but used mostly in homes, it is known for its infection causing qualities?
Spinning disk nebulizer
With a USN what determines the volume of aerosol output?
T or F USN are a good device for continuous aerosol treatment
What would you use to induce sputum production?
A. Hypertonic saline
B. jet nebulizer
D. Mist Tent
A. Hypertonic saline
In a USN you would always use what type of water in the coupling chamber?
A. Sterile water
C. Tap water
C. Tap Water
How do you determine flow?
Add ratio parts and X by flow
What is the O2 to air ratio when O2 is 24 %
1 o2 to 25 air mix
What is the Air to O2 ratio at 35% FIO2
What is the Air to O2 ratio at 50% FIO2
1.7 to 1
What is the formula for O2: Air?
O2:Air = 1: 100 - %O2 / %O2 - 21
What is the formula to find total flow?
Add ratio parts & multiply by flow
What is the total flow when you have a ratio of 1 : 1.7 at flow meter setting of 10 l/min
What is the formula to find FIO2?
FIO2 = Oxygen flow + (airflow x 0.2) / totalflow
What is the FIO2 if your O2 flow is 5 and airflow is 10
In some cases you will need to determine the individual O2 and air flow rates based on the total flow needed. What is the formula to obtain individual O2 flow?
O2 flow = Total flow (%O2 - 21) / 79
Once you know the individual O2 flow based on a normal inspiratory rate based on the minute volume x 3 how would you know their individual air flow?
60 lmin minus O2 flow
What is the O2 flow & Air flow if you have a total flow of 90 & FIO2 of 50%
A: 90(50-21) / 79 = 2610 / 79 = 33.04 O2 flow
90 - 33.04 = 56.96 air flow
Identify the components of an USN:
1. air-entrainment orifice
2. radiofrequency generator
3. nebulizer chamber
4. piezoelectric transducer
5. blower or fan
a. 1, 3, and 4
b. 2, 3, 4, and 5
c. 1, 2, 3, 4, and 5
d. 3, 4, and 5
The particle size produced by an ultrasonic nebulizer depends mainly on which of the following?
a. blower (fan) speed
b signal amplitude
c. signal frequency
d. chamber baffling
The frequency at which the crystal vibrates, preset by the manufacturer, determines aerosol particle siz
Which of the following mean mass aerodynamic diameter (MMAD) aerosol suspensions is produced by an ultrasonic nebulizer operated at 1.25 MHz?
a. 1 to 2 μm
b. 6 to 10 μm
c. 4 to 6 μm
d. less than 1 μm
A nebulizer operating at 1.25 MHz produces an aerosol with an MMAD of between 4 and 6 μm.
The aerosol output (in mg/L) of an ultrasonic nebulizer depends mainly on which of the following?
a. signal amplitude
b. chamber baffling
c. source current
d. signal frequency
Amplitude affects water output
To get the highest density of Aerosol from a USN how would you set the Amplitude & Flow? Would they be High or Low
High Amplitude, Low flow
What are some problems common to mist tents?
1. heat retention
2. CO2 buildup
a. 1, 2, and 3
b. 1 and 2
c. 2 and 3
d. 1 and 3
Any body enclosure poses two problems: CO2 build-up and heat retention
After administering a 30-minute bland water aerosol treatment to a dehydrated elderly patient with chronic bronchitis, you note increased wheezing and a general decrease in the intensity of breath sounds. Which of the following has probably occurred?
a. Reactive bronchospasm has occurred and worsened airway obstruction.
b. Inspissated secretions have swollen and worsened airway obstruction.
c. Nothing; this is a normal response to bland aerosol therapy.
d. The patient is developing atelectasis due to overhydration
In addition to overhydration of the patient, inspissated pulmonary secretions also can swell after high-density aerosol therapy, worsening airway obstruction.