| Question |
Answer |
| 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) |
Cardio Block2anatomy
