Chapter 11

Question 1

1. What are the things to consider with children? when giving medications? Tell. 7

Answer 1

1. Large tongue in proportion to airway
2. Nose breathers
3. Narrow airway diameter
4. Rapid respiratory rate
5. Smaller tidal volume
6. Can’t do breath hold
7. High inspiratory flow rates when in distress or crying

Question 2

2. What are the Indications medications? Mention three? Three

Answer 2

1. Bronchodilators
2. Mucolytics
3. Steroids

Question 3

3. What are the Aerosolized Drug Therapy? Four

Answer 3

1. Small volume nebulizer (SVN)
2. Metered Dose Inhaler (MDI)
3. Dry Powder Inhaler (DPI)
4. Small Particle Aerosol Generator (SPAG)

Question 4

4. What are the Equipment of SVN? Tell 6

Answer 4

Interface

1. Mask
2. Blow by
3. Mouth piece
4. New breath actuated or enhanced nebulizers Types
5. Jet nebulizer (most commonly used) Ultra sonic
6. Mesh nebulizer

Question 5

5. What are the Inline with vent Neb?

Answer 5

1. Adds tidal volume if run off different source
2. Increases peak pressure on volume ventilation
3. Pressure ventilation will still only reach preset pressure
4. Add near humidifier and neb on exhalation, fills the inspiratory limb
5. Cool gas to run neb cools down gas and causes more rainout, losing meds to
   rainout.
6. Intermittent vs. continuous nebulization
   - Up to Q 15minute treatments until relief
   - Continuous nebulization, between 7.5mg to 15 mg per hour
   * Need special nebulizer (HEART OR HOPE)
   * Must have continuous heart monitoring

Question 6

6. What is undiluted albuterol? Three

Answer 6

1. Large enough dose in nebulizer to work properly
2. Nebulize 1 to 2 ml (5 – 10 mg)
3. Continuous monitoring

Question 7

7. MDI uses three things what are they?

Answer 7

1. Mouthpiece
2. Spacer
3. Chamber
   Optimal, best deposition with least rainout in mouth
   Mask with chamber
   Arthritis aids
   MDI on ventilator circuit should have a chamber too. Chamber not practical with neonate due to deadspace/weight/compressible volume. Also, a puff of an MDI is totally without oxygen so may cause hypoxemia on pt with less than 100ml Vt

Question 8

8. DPI. Tell two things

Answer 8

1. Each DPI is different

2. Need flowrate of 30 to 60 lpm

Question 9

9. What is advantage or disadvantage of SVN?

Answer 9

Advantages

1. No pt co-op needed
2. Acute distress
3. Any drug

Disadvantages
Cost
1. Not easy to transport
Cleaning
1. Cold wet spray
2. Bacteria growth
3. Particle grow with moisture

Question 10

10. What is advantage or disadvantage of MDI?

Answer 10

Advantage

1. Portable
2. Efficient dosage
3. Short preparation

Disadvantage
Co-ordination
1. Limited drug choice
Propellants
1. Difficult to count doses

Question 11

11. What is advantage or disadvantage of DPI?

Answer 11

Advantage

1. Same as MDI
2. Less coordination
3. No propellants

Disadvantage

1. Limited Drugs
2. Irritation to throat
3. High flow rates

Question 12

12. What is SPAGE used to deliver?

Answer 12

1. Used to deliver Ribaviron

SPAGE
Small Particle Aerosol Generator

Question 13

13. What are the Other medications?

Answer 13

1. Antibiotics
2. Mucoactive agents
3. Surfactant (usually instilled down ETT not nebulized) 4. Hypertonic saline
4. Misc1
   - Insulin (DM) Gene therapy (CF)