Chap 15 Hess Exam Flashcards
(129 cards)
1
Q
Mucosal lining of nose, sinuses, trachea, and bronchi Aid in
A
heating and humidifying inspired gases
2
Q
During expiration, the expired gas
A
transfers heat and humidity back to the mucus lining of the upper airway.
3
Q
Isothermic Saturation Boundary. Body Temp Pressure saturation
A
Normally present 5cm below the carina, 100% relative humidity at 37 deg celsius
4
Q
Factors that can cause a shift
A
mouth breather, artificial airway, increased minute ventilation, drop in environment temp and humidity
5
Q
Norm temp and humidity in Pharynx
A
29-32’C, 95% RH, 28-34 mg/L
6
Q
Norm temp and humidity in airway opening (nose and mouth)
A
20-22’C, 50% RH, 10 mg/L
7
Q
Norm temp and humidity in Trachea
A
32-34’C, 100% RH, 36-40 mg/L
8
Q
Norm temp and humidity in Isothermic saturation
A
37’C, 100% RH, 44mg/L
9
Q
Hazards and Complications of insufficient humidity
A
loss of heat and water, Ciliary motility is reduced, airway become irritable, mucus prod increases, pulmonary secretions become thick due to dehydration, tracheal epi can be damaged when upper airway is bypassed
10
Q
as long as the inspired humidity is at least what %BTPS, no injury occurs in normal lungs
A
60%
11
Q
Goals of Humidity Therapy
A
To provide adequate heat and humidity, to treat hypothermia, to prevent airway response to cold air, to aid removal of thick secretions
12
Q
For premature and newborn infants, a neutral thermal environment should be
A
maintained
13
Q
Bubble Humidifier
A
dry gas is directed toward the bottom of a water filled reservoir, where the stream of gas is broken up (diffused into bubbles
14
Q
Passive Humidifier
A
uses exhaled heat and moisture to humidify inspired gas
15
Q
Active Humidifier
A
adds water or heat or both to inspired gas
16
Q
nebulizer
A
produces aerosol, or suspension of particles in gas
17
Q
How to improve humidity delivery
A
Temp, Surface area, contact time
18
Q
Temp in improvement of humidity delivery
A
Greater the temp, the more water vapor it can hold
19
Q
Surface area in improvement of humidity delivery
A
Greater the area of contact, greater the opportunity for evaporation
20
Q
Contact time in improv of humidity delivery
A
greater the contact time, greater the opportunity for evaporation
21
Q
Bubble humidifier= water vapor=
A
nasal cannula
22
Q
Passive=HME=
A
Water vapor
23
Q
Active= passover and wick= heated=
A
mechanical ventilation or non-invasive ventilation (high flows of dry medical gas are delivered to the patient)
24
Q
Aerosol bland- sterile water for inhalation=
A
continuous aerosol (air entrainment large volume nebulizer)
25
Aerosol Bland- Normal saline, hyper or hypo tonic saline=
Induce sputum= small volume neb for intermittent therapy
26
Aerosol for medication delivery-
to treat lung disease or complications= SVN for intermittent therapy
27
Bubble Humidifier
Oxygen passes through sterile water, picks up humidity. NEVER HEATED. Added to NC- 4lpm or greater. Efficiency decreases with increase of O2 flow. Pop off valve warns of obstruction
28
Pop off valve
warns you off obstruction in bubble humidifier
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Bubble humidifier NC LPM
4LPM or greater
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Can you heat bubble humidifier
NEVER, because condensation would build up in small bore tubing
31
HME (heat moisture exchange)
Artificial nose, captures expired moisture and is delivered during the next inspiration, 70% efficient, problems of occluding filter with secretions, position is crucial, mainly used inline on the ventilator
32
How efficient is an HME
70%
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Active Humidity types
passover, bubble humidifier, Jet nebulizer
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Passover - Reservoir
Most commonly used with mechanical ventilation and noninvasive ventilation
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How Passover - Reservoir is used
gas flow passes over a reservoir of water, water evaporates into the gas, increasing the humidity of the gas, efficiency is increased by adding heat
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Local Brand name for Passover Reservoir
Fisher Paykel
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Heated Wire Circuit
Heating wires, Temp probes, passover reservoir, heater, sterile water for inhalation, correct expiratory filter
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Wick
Cylinder of absorbent material
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Passover wick humidifier
Water wicks up the side, is heated and evaporates into the inspired gas being delivered to the patient,
40
Concha-
made by Hudson RCI (passover wick humidifier)
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Delivered through high flow large bore tubing devices (heated or cool humidity) examples
Heated- ventilators, non-invasive ventilators, heated high flow NC
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Delivered with bubble humidifier (heated or Cool humidity)
Cool
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Used when upper airway is bypassed ETT or tracheostomy tube (heated or cool humidity)
Heated Humidity
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Used when high flows delivered exceed the bodies ability to heat and humidify dry inspired medical gases (HFNC) - heated or cool humidity?
Heated Humidity
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Delivered with continuous aerosol set up- heated or cool humidity?
Cool humidity
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Used to treat inflammation of the upper airway- heated or cool humidity?
Cool humidity
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Used to treat hypothermia- heated or cool humidity?
Heated humidity
48
Aerosol Therapy
Consists of liquid particles suspended in a gas
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Bland aerosol consists of
sterile water for inhalation (continuous aerosol), Isotonic Saline, Hypertonic Saline, Hypotonic Saline
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Air entrainment large volume jet neb
Liquid is shattered into particles, large unstable particles rain out, small stable particles are delivered to the patient. You can add heat
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Can you add heat to Air entrainment large colume jet nebulizer
Yes
52
Ultrasonic Neb
Uses piezoelectric crystal to generate aerosol, converts radio waves into high frequency mechanical vibrations, create very high output of aerosol particles, used for bland aerosol delivery
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Recently- what is found in homes as room humidifiers
Ultrasonic Nebs
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Coverts radio waves into high frequency mechanical vibrations
Ultrasonic neb
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Indications for bland aerosol
upper airway edema, postextubation edema, bypassed upper airway, need for sputum or mobilization of secretions, croup
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Assessment of need for bland aerosol
stridor, croup like cough, hoarseness following extubation, bypassed upper airway
57
Bland Aerosol, sputum induction involves
Short term delivery (approx. 15-30 min) of hypertonic saline (3-10%) aerosol via small volume neb
58
Assists in mobilizing secretions
increased volume of fluid in airway, cause irritation which stimulates couch, pt expectorates sputum into specimen cup to be sent to the lab for a culture and sensitivity test
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How the particles fall
Impact, Sedimentation, diffusion
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Impact
effective filter of the upper airway, particle sizes 10 microns or greater
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sedimentation
aerosol particles fall due to gravity, primary mechanism for particles sizes 1 to 5 microns
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diffusion
when gas flow ceases, aerosol particles collide and deposit on alveolar cell surfaces
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Deposition Particle size
Unaided eye cannot see particles less than 50-100 microns (um)
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VMD
Volume median diameter- laser diffraction
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MMAD
Mass median aerodynamic diameter- cascade impaction
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heterodisperse
term used to describe resp aerosols with the particles of all different sizes
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In an aerosol distribution with a specific MMAD, what % of the particles are small and have less mass and what percent are larger and have greater mass
50%, 50%
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Determinants of deposition
particle size, inspiratory flow rate, flow pattern, RR, Inhaled volume, I:E Ratio, Obstruction
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Upper airway particle size (MMAD)
5 to > 50 microns
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Lower airways particle size (MMAD)
2 to 5 microns
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Parenchyma: alveolar region particle size (MMAD)
1 to 3 microns
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Parenchyma particle size
<0.1 microns
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Hazards of Aerosol therapy
Nosocomial infections, adverse reaction to med being delivered in aerosol form, cool aerosol can cause bronchospasms, wheezing, precaution when delivery to infants, drug concentration may increase
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Drug concentration increase usually seen with
continuous aerosol drug delivery
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Bronchospasm and bronchoconstriction
abnormal contraction of smooth muscle in the conduction small airways resulting in acute narrowing and obstruction
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Aerosol drug delivery systems
MDIs, DPIs, SVN=HHN, LVN, Ultrasonic neb, plus more
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MDI- Metered dose inhalers
Pressurized canister, contains prescribed drug and propellant, HFA, Aerosol prod takes approx 20 millisec, initially particle size is 35 microns. the propellant evaporates and particle size becomes smaller
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Most commonly ordered method of delivery
MDI- Compact portable relatively easy to use. commonly misused by patients
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Preferred method for delivery bronchodilator therapy to spontaneously breathing pts and pts who are mechanically ventilated
MDI
80
MDI Particle size delivered
3-6 microns
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MDI pulmonary deposition ranges between
10-20%
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How much of MDI deposits in oropharynx
80%.. medication swallowed in turn entering systemic circulation
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Before initial use- MDIs should be
primed by actuating the device 1 to 4 times
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All new MDIs are required to have a
counter which keeps track of actuations (puffs) left
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MDI techniques
warm canister, shake, prime, breathe out normally, slowly breath in, continue inspiration to TLC, hold breath for up to 10 secs, wait one min between puffs
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Wait how long in between MDI puffs
one minute
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Open mouth MDI technique
open wide, keep tongue down, place canister 4cm (2fingerbreaths), this improves deposition by reducing oroparyngeal rain out (impaction)
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Closed mouth MDI technique
place mouthpiece between lips with tongue out of the path of the outlet
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Breath actuated MDIs
Removes: actuation to inspiration timing technique complication.... inspiratory effort activates aerosol delivery
90
Spacers reduce
oropharyngeal impaction and the need for precise actuation/ inspiration coordination.
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what kind of particles impact on spacer walls
large
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ALL spacers add
distance between the MDI and the mouth
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Holding chambers
Spacer which contains a one way valve, holds med in chamber until there is no inspiratory effort, can take 2-7 breaths with one actuation (6-10 for children), can attach a mask, has a training whistle
94
Dry powdered inhaler (DPI)
Breath actuated, med is in powder form, dispersion is dependent on turbulent flow, carrier substance is used(lactose or glucose)
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What affects DPIs drug delivery
humidity
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DPIs require what kind of inspiratory flow
High inspiratory flow
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DPIs % delivered to respiratory tract similar to MDIs
10-20%
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DPIs particle size
Dry powder (med): 1-3 microns, Propellant (carrier); 20-65 microns
99
Most of the DPIs carrier is deposited in
oropharynx
100
DPI Technique
Assemble, Load Dose, Exhale slowly to FRC, Seal lips around mouth piece, inhale deeply and forcefully, breath hold (10 sec), Repeat process until dosage complete
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Liquid = aerosol (MDI or DPI)
MDI
102
Solid= aerosol (MDI or DPI)
DPI
103
Can use spacer / chamber (MDI or DPI)
MDI, spacer isnt needed for DPI
104
Must be able to take a slow deep breath and hold (MDI or DPI)
MDI
105
Must create turbulent inspiratory flow (MDI or DPI)
DPI
106
Oral deposition compared to other without spacer
DPI
107
Must keep track of doses (MDI or DPI)
MDI, DPI has a counter or are indiv wrapped
108
Coordinate delivery of dose and inspiration (MDI or DPI)
MDI, DPI is no coordination involved
109
Small volume neb (SVN) HHN
Delivers aerosolized medication or bland aerosol!, small= holds less than 10mls, Pneumatically powdered, 10 psi at home (electric compressor)
110
Pneumatically powered
which means they are powered by a pressurized gas source (50PSI in hospital)
111
Electric Compressor
10psi at home
112
How is aerosol produced
high pressure stream of gas shot through a restricted orifice, the liquid is drawn up a capillary tube created by low lateral pressure, the liquid then passes over the jet and is shattered
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Aerosol particle size
is b/w 0.1 to 500 micron range
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Liter flow is inversely proportional to
droplet size and neb time (treatment time)
115
higher the liter flow, what the droplets, and treatment time
higher the liter flow, smaller the droplets, shorter the treatment time
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for neb treatments in hospital with a 50 psi gas source the liter flow used is
6-10 L/m (usually always 10)
117
Deposition for nebulizer treatment
12% or less, 2% in infants
118
Infants are natural
nose breathers
119
Delivering aerosol to infants and children
well fitting aerosol masl vs. mouth piece, blow by, never to crying baby
120
Breath actuated neb
only produces aerosol during inspiration, increases treatment time, aerosol production is triggered with inspiratory flow
121
If the patient is unable to generate enough flow for and adequate period of time usuing a breath actuated neb
the treatment will be ineffective
122
Bronchodilator
reverses bronchoconstriction, opens up the airway
123
corticosteroid (inhaled)
Reduces inflammation in lung only, may enhance bronchodilator, can cause oral thrush
124
Mucolytic
thins or breaks up secretion
125
antibiotic
treats bacterial infections
126
Mouthpiece vs Mask issue
Patient ability, preference, and comfort
127
Aerogen neb
uses electricity not flow
128
Large volume neb
heart/ hope, mini heart
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How are we going to assess patient response, how should a patient improve
aeration
