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Fundamentals of RT

Fundamentals of RT - Units 9, 10 SPC

QuestionAnswer
What are the 3 evaporation factors? Temperature, Atmospheric Pressure, Surface Area
Calculate Relative Humidity Content(what you measure)/ Max capacity x 100
Maximum Absolute Humidity 44mg/L
Humidity Deficit 44mg/L - what you measure
What size aerosol particles target the upper airways like the larynx, pharynx? 5-20 microns
What size aerosol particles target the lower airways from the trachea to terminal bronchioles? 2-5 microns
What size aerosol particles target the parenchyma know as the gas exchange area? 1-3 microns
What is inertial impaction? Particles >5 microns stay on at bends. Think of the pic of the particles at the bend in the tube.
What factors increase inertial impaction? Turbulent flow, Airway branching, Hi Inspiratory flow > 30L/M
What is Graviational Sedimentation? particles between 1-5 microns. Time increases G.S. with a 10 sec breath hold deposition increases up to 10%
What patient factors affect G.S.? Ventilation Pattern. Hi Insp. Flow, Slow Rate, Large Tidal V, Mouth breathing
Inadequate Humidification results in? Impaired ciliary activity, Impaired mucus flow, Retained Secretions, Infections, Pneumonia
What are the goals of Humidification? Humidify Inspired Gas(Jet Neb), Deliver Meds(MDI), Improve Bronchial Hygiene(Ultrasonic) which thins secretions and promotes cough and expectoration
What are the Hazards of Humidification? Bronchospasm with mucolytic and proteolytic aerosols(Asthmatics)
ANSI Standards for Humidification Devices Minimum level of A.H. to aviod mucosal damage to upper airway is 10mg/L for spontaneous breathing. Pts w/bypassed airways(ET tube, trach tube)minimum 30mg/L
Bubble Humidifier Low Flow Device - Think bubbler in fish tank. Cannula to partial and non rebreather. Output 15-20mg/L
Passover Humidifier used in Vent circuits, Uses Wick or hydrophobic membrane(Membrane). Output 35-50mg/L. Lots of secretions
HME = Heat Moisture Exchanger Pennies. Captures pt exhaled gas and uses it to warm and humidify next inspiration. Uses hydrophobic condenser. Output 20-30mg/L
Nebulization Baffles or plates to decrease particle MMAD
Categories of Nebs Pneumatic(powered by gas) include Jet,SVN, LVN, MDI, DPI. Electric- ultrasonic
What's the primary goal of Jet Neb? AKA Air entrainment neb Humidify Inspired Gas
What's the primary goal of SVN? Deliver Meds
What's the number one factor affecting SVNs? Baffles.
What are the 2 types of LVNs? SPAG and Heart/Hope
SPAG Neb = Small Particle Aerosol Generator Deliver Ribavirin for RSV
Heart/Hope Neb = High output Extended Aerosol Respiratory Therapy Continuous Bronchodilator delivery
MDI Deliver Med
MDI Factors Patient Technique. Use spacers and holding chambers and use flow triggered MDI to reduce oropharyngeal depostion
DPI Breath accuated to Deliver Meds
DPI Factors High Inspiratory Flow - >40 L/M therefore not on infants or pts w/SOB. High Humidity causes Clumping of MEd
What is the primary goal of Ultrasonic? Thin and Mobilize secretions. Outputs as much as 500mg/L. Saturates the airways
Drug Dilution Ex. 1:200. 1gram/200ml H2O = 1000mg/200ml = 5mg/ml
Percent Solution divide mg/ml/10 for % solution or % solution x 10= mg/ml
Autonomic NS Sympathetic - neurotransmitter is norepinephrine. Receptors termed adrenergic. Parasympathetic - transmitter is Acetylcholine and receptor termed cholinergic
Adrenergic Drugs that stim receptors sensitive to norepinephrine
Cholinergic Drugs that stim receptors sensitive to acetylcholine
Anitcholinergic Drugs that block receptors sensitive to acetylcholine
Cholinergic Effects(Parasympathetic) Decrease Heart Rate, Bronchoconstriction, Vasodilation in Pulmonary Bl. Vessels
Alpha Stimulation Pulmonary BL. V. = vasoconstrition
Beta 1 Stim Heart rate increase and contraction
Beta 2 Stim Bronchodilation and vasodilation
Adrenergic Action (Sympathetic) Alpha drugs vasoconstrict to increase BP or decrease mucusal edema. B1 increase HR and Inotropic. B2 = brocho and vaso dilation
Anticholinergic Action (Blocks Para) Bronchodilation, Increase HR, Dry secretions
Catecholamines Racemic Epinephrine is the only one still used. Hits all receptors. Is the quickest.
Noncatecholamines - Quick Onset/Short Duration Alupent- Neb/MDI/Tab
Noncatecholamines - Slower onset(15 min)/Longer Duration Albuterol, Levalbuterol, Formoterol, Salmeterol
Noncatecholamines - Quick Onset(5 min)/Long Duration(8-12 hours) Maxair, Brovana, Tornalate
Adrenergic Side Effects Tachycardia, Tremor, Headache, Insomnia, Nervousness
Anticholinergic Drugs Atrovent, Spirvia
Anticholinergic Side Effects Increase HR, Increase BP, Decrease Secretions
What Mediator Antagonist are Mast Cell Stabilizers? Intal, Tilade
What Mediator Antagonist are Leukotriene Blockers? Accolate, Zyflo, Singulair(most popular)
What do mast cells contain? Histamine and inflammatory mediators
Stim of Leukotriene receptor cause what? Bronchoconstriction, Mucus Secretions, and Release of Inflammatory Cells
What are Glucocorticosteroids used for? Maintenance of Asthma
Steroids Agents Prednisone(Tab), Pulmicort(MDI,DPI)
Steroid Side Effects Thrush, Weak Bones, Immunosuppresion(more pulmonary infection), Peptic Ulcers, Muscle Wasting, Hair, Moon Face, Fat Deposits
What is the device of choice for Wetting Agents? Ultrasonic
Saline Solutions - Use Ultrasonic Neb(USN) Iso(.9%) = Thin secretions, Hypo(<.9%) = Thin, Hyper(>.9%) Sputum induction
What is the only Mucolytic agent? Mucomyst. Disrupts the disulfide bonds in mucus
Mucolytic Side Effects Bronchospasm in Astmatics, Nausea, Smell, Rhinorrhea
Proteolytic Agents Pulmozyme w/special neb. Used in Cystic Fibrosis pts. Digests DNA in purulent solutions
Proteolytic Side Effects Pharyngitis, Laryngitis, Conjuctivitis(Pink Eye)
Created by: mac6672 on 2008-12-05



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