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RCP 111
Aerosol Therapy
| Question | Answer |
|---|---|
| What is an aerosol ? | particles suspended in a gas |
| AARC CPG divides aerosols into 3 categories? | 1. Delivery of Bland Aerosols. 2. Delivery to upper airways. 3. Delivery of medicated aerosols. |
| Bland aerosols are used for the upper airway to do what? | - Reduce edema -Promote vasoconstriction |
| What are aerosols for upper airways used for? | - stridor - largynotracheobronchitis - hoarseness (post- extubation, post-op) |
| medicated aerosols are usually used for? | the lower airway |
| What does tonicity mean? | - How salty it is - isotonic - hypertonic - hypotonic |
| Electric charge? | - Like charges repel - Opposite attract |
| Hygroscopic | - Tendency to absorb water - increase size and mass (2 to 3 fold) - Deposit sooner in the pulmonary system |
| Isotonic Solution | 0.9% NaCl, equal to body fluid. |
| Hypertonic Solution | - >0.9% NaCl - Will gain water from body fluids - When aerosolized they become hygroscopic |
| Hypotonic Solution | < 0.9% NaCl |
| Why will hypotonic solution lose water? | Because its solute concentrations are less, compared to that of body fluid. |
| Hypotonic solution when aerosolized decreases in what? | Size and mass |
| Successful aerosol therapy depends upon what factor? | - Particle size - Amount of aerosol produced. - Physical characteristics of the medication. - Breathing pattern (flow, VT) - An atomy of airways. |
| Most aerosols are heterodisperse (wide range of particle size) vs monodisperse (same size) | Irregular in size and varying in diameters and shapes. |
| MMAD | Mass Median Aerodynamic Diameter. |
| GSD | Geometric Standard Deviation |
| What are the two ways to measure particle size? | - MMAD - GSD |
| How is MMAD measured? | Micrometers, 1 millionth of a meter. |
| MMAD is the diameter around which the mass of the aerosol is equally divided? | 50% are lighter 50% are heavier |
| What is the average or median diameter of the distribution for MMAD? | The primary factor indicating how much and where a dose of aerosolized drug will be deposited in the lung. |
| What does it mean, the greater the GSD? | The wider the range of particle size, hence the aerosolize more heterodispense |
| What does GSD describes? | - The range of particle size in an aerosol at one standard deviation above and below the median. - Most particles lie in this range. - This index reflects "typical" particle size in this range. |
| If an aerosol's MMAD is 1.8 and GSD is 2.0, then the range of particle size is within 1 SD is between 0.9 um and 3.6 um? | -1.8/2, 1.8x2 |
| If a particle is less than 1 um that means? | Particles are exhaled |
| If a particle is greater than 5 um that means? | Particles are deposited in upper airways. |
| Particles NEED 1-5u size? | Called respirable mass |
| Bronchodilators particles are best at? | 2-5 um. (most clinical respiratory aerosols 1-10 um) |
| What are some factors influencing aerosol penetration and deposition in the airways? | - Particle size and gravity. - Inertia - Temp. and humidity. - Resp. pattern - Less important factors are diffusion, sedimentation, and impaction. |
| What are the primary determinant of lung deposition, distribution, and efficiency? | Particle size and gravity |
| What happens as the particle size and mass increase? | - Gravitational forces act on the particle to a greater degree. |
| What happens as particle size and mass increase, gravitational forces act on the particle to a greater degree? | Tendency to remove it from suspension |
| Inertia is also related to what? | Particle size and mass |
| Which law is: inertia equals mass time velocity? | Newtons Law |
| What will happen with a particle with greater mass, when it is placed in motion? | Will have a greater inertia than a particle with a smaller mass. (Can't make turns) |
| What happens when the temp. of the carrier gas increases with humidity held constant? | The aerosol particles will have a tendency to evaporate into the carrier gas. |
| Respiratory pattern | A significant factory influencing aerosol deposition in the airways. |
| What is a slow, maximum inspiration, through the mouth followed by a brief hold, increases aerosol deposition into the lungs( slow exhalation) | OPTIMUM RESPIRATORY PATTERN |
| What is a MUST with an optimum respiratory pattern? | Good pt instruction and monitoring |
| What are the three Physical Principles for deposition mechanisms? | 1. Impaction 2. Sedimentation 3. Diffusion |
| What effects particles greater than 5u due to high inertia? | Impaction |
| What occurs from gravitational forces acting on particles primarily between 0.5 and 5u? | Sedimentation |
| What is caused by Brownian forces and effects submicronic particles in the low-flow regions of the lungs? | Diffusion |
| Respiratory pattern with a SVN? | Slow inhalation |
| Respiratory pattern with a MDI? | Normal inhalation |
| Respiratory pattern with a DPI? | Rapid inhalation |
| Respiratory pattern used with racemic epinephrine (epiglottitis) to deposit in the upper airway? | Short, rapid, gasping inhalations |
| Pulmonary deposition, at best approximately ______% is emitted into the lung? | 10% |
| Approximately ________% is emitted into the atmosphere (exhaled)? | 10% |
| Up to _________% is deposited in the upper airway or aerosol generator? | 80% |
| What is the mechanism called that is distal to the jet, and the capillary tube stabilizes the aerosol particle size by inertia impaction? | Baffle |
| A baffle mat be a ball or wall, where? | Downstream from the nozzle exit. |
| Why is it important to know the limitations of each aerosol therapy device? | So you can choose the appropriate device to meet the needs of your patient. |
| Diagnostic and therapeutic aerosols are produced by? | - Mechanical, pneumatic, or ultrasonic nebs. - Pressurized MDI - DPIs |
| Nedulizers is placed directly in the path of what? | Carrier gas |
| Why do particle size tend to be larger? | The aerosol flows in a relatively straight path. |
| What are mainstream and sidestream nebs name based upon? | - The nebs placement in relation to the flow of carrier gas. - Carrier gas is the main gas flow that carriers the aerosol particles to the patient. |
| Sidestream are placed? | Adjacent to the flow of the carrier gas. |
| What should the aerosol output must change? | Direction before merging with the carrier gas |
| What are the particle sizes of the sidestream neb. vs mainstream? | Sidestream particles are smaller |
| SVN are classified by what? | The volume of the reservoirs that the posses. |
| What is the volume of a SVN? | less than 30 mL |
| What size aerosol particles do SVN produce? | 0.1 to 500 micrometers in diameter |
| What are the parts of a SVN? | - Reservoir - Baffle - Jet - Capillary tube |
| Anormal SVN fill volume is ? | 3 to 5 mL |
| Driving pressure or flow rate affects? | Aerosol output and particle size |
| The greater the interior surface area within a nebulizer, the greater _________ is lost on the nebulizer walls? | The volume of drug solution |
| What is it called when approximately 0.5 to 2mL of concentrated solution is left in the reservoir at the end of nebulization, when no further aerosol is produced? | dead volume |
| Factors influencing function of SVN: | - Neb construction - Gas flow 6- 10L/m (8L/m is best) - Diluent volume - Drug solution nedulized - Gas used (air or oxygen) - Other finger port, tilt function |
| What does a Respigard II SVN incorporates? | - Two, one- way valves - A wye - Expiratory filter |
| Respigard II SVN is capable of producing what? | Particle sizes of less than 2 um |
| What does nebulizers with expiratory filters do? | Prevent exhaled contamination |
| Small- Particle Aerosol Generator (SPAG) | Mostly used with RSV in kids |
| MDI | - Small self- contained neb designed for administration of meds. - CFC or HFA along with surfactant |
| What is it called when the accuracy of drug delivery decreased as the MDI begins to run out of formulation? | Tail off |
| When does the tail off occur? | After the labeled number of doses has been delivered from the MDI (measured amount) |
| Other problems from the tail off? | - Loss of prime - Seperation of drug from propellant |
| MDI spacer device: | - Enhances the effectiveness of aerosol deposition by reducing oropharyngeal deposition. - Larger particles impact the walls of the spacer, removing them from suspension. |
| Holding chambers have a? | One- way valve |
| Spacers | Do not have a one- way valve |
| What are the basic concepts for spacer devices? | - Open tube design - Reservoir or valve holding chamber - Reverse flow design |
| All spacers reduce what? | The initial forward velocity of the pMDI droplets |
| Cooperative patient | - Good mask seal - Patient is calm - Large, slow Vt - Patient coordination most important |
| Aerosols of dry powder are created by? | Directing air through an aliquot (portion) of loose powder |
| Most DPIs require use of carrier substance mixed into the drug to enable the drug powder to? | More readily flow out the device. Sugars, lactose, or glucose |
| DPI facts? | - Particle size is in the order of 1-3 micron. - Need correct technique - Most carriers deposits in the oropharynx - Ambient humidity also effects drug delivered from DPIs |
| Large volume USNs are mainly used for? | Bland aerosol therapy |
| What delivers mist to the patient? | Blowers |
| USNs produce aerosol with? | MMAD between 2-12 micrometers |
| USNs output 2-3 fold more than? | most jet nebulizers |
| Small volume USNs used for aerosol drug delivery are usually? | battery operated |
| DeVilbiss Ultra- Neb99 | -Can deliver meds - Produces a minimum of 6L/ min of aerosol - Reservoir holds up tto 200mL of solution |
| Breath- enhanced nebulizer? | Entrain air through the neb during inspiration |
| Breath- actuated neb? | Reduce or eliminate aerosol generation during patient expiratory rate |
| Continuous Medication Nebs ? | - Neb for status asthmaticus patients. - High out put at low flows - Reservoir of 240 mL Ex: is H.E.A.R.T neb. |
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tracyb34
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