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# Fundamentals Unit 9

### SPC Fundamentals Unit 9 Exam 4

What are the 3 factors of Evaporation? 1. Temperature 2. Atmospheric Pressure 3. Surface Area
What relationship is "Temperature" as an atmospheric pressure? Direct
What relationship is "Atmospheric Pressure" as an atmospheric pressure? Inverse
What relationship is "Surface Area" as an atmospheric pressure? Direct
Define Absolute Humidity? The weight of water in a gas sample expressed in mg/L Referred to as content
Define Maximum Absolute Humidity? A fully saturated gas sample. Referred to as 100% water capacity
Define Relative Humidity? Content/Capacity X 100 or Absolute/Max. Absolute x 100
Calculate Normal Values @ "Room Temp" @25 Degrees C / Max. A.H.=23mg/L / If you measure 10mg/L / Calculate R.H.? Answer 10/23=.43x100=43%
Calculate Normal Values @ "Body Temp" @37 Degrees C / Max. A.H.=44mg/L / % of body humidity is R.H. @37 Degrees C / If you measure 30mg/L / Calculate B.H.? Answer 30/44=.68x100=68%
Define Humidity Deficit? Content below 100% B.H. (Body Humidity) i.e. 44mg/L--If you measure 10mg/L calculate H.D. (Humidity Deficit) Answer 44-10=34mg/L
Define Aerosol? A suspension of solid or liquid particles in a gas.
What does M.M.A.D. stand for? Mean Mass Aerodynamic Diameter
What is MMAD? The distribution of particle diameter around which 50% of the particles are larger and 50% of the particle are smaller.
What is the size needed for particles to be visible? >50 microns in diameter
What is the size for microns in the upper airways? 5-20 Microns
What is the size of microns in the lower airways? 2-5 Microns
What is the size of particles in the parenchyma? 1-3 Microns
T/F Parenchyma is the functional part of the lung? True
What are the 3 Physical Properties of Aerosol Deposition? 1. Inertial Impaction 2. Gravitational Sedimentation 3. Diffusion
What are the 3 factors that increase Inertial Impaction? 1. Turbulent Flow 2. Airway Branching 3. High Inspiratory Flow >30L/M
What is the factor that increase Gravitational Sedimentation? Time- A 10 second breath hold will increase deposition up to 10%
What is the factor that increase Diffusion? Inconclusive
Particle size of Inertial Impaction is... >5 Microns
Particle size of Gravitation Sedimentation is... 1-5 Microns
Particle size of Diffusion is... <3 Microns
What is the Patient Factor of Aerosol Deposition? Ventilatory Pattern
What are the 4 variable of Ventilatory Pattern? 1. High Inspiratory Flow 2. Slow Rate 3. Large Vt (Tidal Volume) 4. Mouth Breathing
What are the 5 chain of events with Inadequate Humidification? 1. Impaired Ciliary Activity 2. Impaired Mucus Flow 3. Retained Secretions 4. Infection 5. Pneumonia
What are the 3 Goals of Aerosol Therapy? 1. Humidify Inspired Gas 2. Deliver Medications 3. Improve Bronchial Hygiene
What does it mean to Improve Bronchial Hygiene? To thin & mobilize secretions and to promote cough and expectoration (cough something up)
What are the 3 Hazards of Aerosol Therapy? 1. Bronchospasm (Asthmatics at risk) 2. Fluid Overload (Infants at risk) 3. Cross Contamination (droplet borne pathogens)
What does A.N.S.I. stand for? American National Standard Institue
What are the A.N.S.I standards for Humidifiers? 1. Minimum Level of A.H. (Absolute Humidity) is 10mg/L 2. Patients w/ bypass of upper airways is 30mg/L
What are the 3 types of Humidifiers? 1. Bubble 2. Passover 3. Heat Moisture Exchanger
What is the clinical use and output of a Bubble Humidifier? Clinical: Pass through a diffuser to create small bubbles, typically used w/ low-flow oxygen devices Output: 15-20mg/L
What is the clinical use and output of a Passover Humidifier? Clinical: A simple reservoir with a wick and membrane, typically used in ventilator circuits. Output: 35-50mg/L
What is the clinical use and output of a Heat Moisture Exchange Humidifier? Clinical: Captures a patients exhaled gas and uses it to warm & humidify the next inspiration. Use with a hydrophobic or hydroscopic condenser, typically used in ventilator circuits Output: 20-30mg/L
What is Nebulization? Production of an aerosol w/ narrow range of particles vis the use of baffles.
What are baffles? Spheres or plates against which the aerosol is impacted in order to decrease particle "MMAD"
What are the 2 categories of nebulizers? Pneumatic & Electric
What are the 5 Pneumatic Nebulizers? 1. Jet 2. SVN (Small Volume Nebulizer) 3. LVN (Large Volume Nebulizer) 4. MDI (Metered Dose Inhaler) 5. DPI (Dry Powdered Inhaler)
What are the 2 Electric Nebulizers? 1. Ultrasonic 2. Mesh
Jet Nebulizers are also known as? Air-entrainment Nebulizers
What's the clinical goal of Jet Nebulizers? Humidify Inspired Gas
What's the Output of Jet Nebulizers? 25-35mg/L cold 35-55mg/L heated
What's the clinical goal of SVN (Small Volume Nebulizers)? Deliver Medication
What are the 4 factors affecting SVN (Small Volume Nebulizers)? 1. Baffles-decrease the MMAD 2. Neb. Positioning- tilting stops output 3. Fill Volume- Drug delivered 4. Reservoirs- Drug delivered
What are the 3 gas source factors of SVN (Small Volume Nebulizers)? 1. Compressor Pressure- output and particle size 2. Flow- output and particle size 3. Gas Density- Heliox decreases output
What are the 2 types of LVN (Large Volume Nebulizers)? 1. SPAG (Small Particle Aerosol Generator) 2. Heart/Hope Nebulizer
What does SPAG stand for? Small Particle Aerosol Generator
What is the clinical goal of the LVN SPAG? Deliver Ribavirin
What is the clinical goal of the LVN Heart Nebulizer? Continuous Bronchodilator Therapy
What does MDI stand for? Metered Dose Inhaler
What are MDI's? Pressurized canisters w/ drug, propellant, and dispersing agent.
T/F Propellants CFC will become HFA? True
T/F Dispersing agents are called Surfactants? True
What is the clinical goal of MDI's? Deliver Medication
What are the two MDI factors? 1. Flow-Triggered MDI 2. Spacers & Holding Chambers
What does DPI stand for? Dry Powder Inhaler
What is a DPI? A breath-actuated MDI that creates the aerosol as the patient draws air through a finely milled drug powder.
What is the clinical goal of DPI's? Deliver Medication
Patient must have what to use a DPI? High Inspiratory Flow >40L/M
Who should NOT use a DPI? Infants <5y/o & S.O.B adults
High humidity causes what with use of DPI? Clumping of Powder
What is a Ultrasonic Nebulizer? Use of a Piezoelectric Crystal Transducer to generate aerosol.
What the clinical goal of Ultrasonic Nebulizers? Thin & Mobilize Secretions
What is the output of Ultrasonic Nebs? As much as 500mg/L
What are MESH Nebulizers? Pass liquid through an aperture or plate to create an aerosol.
What are two types of MESH Nebs? Passive & Active
What is the clinical goal of the MESH Nebs? Deliver Medication
Catecholamines and Non-Catecholamines are classified as what? Adrenergics
What is Catecholamines? When the Benzene Ring is rapidly metabolized by COMT (Catechol-O-methyl transferase) in the gut
What is Non-Catecholamines? When the Benzene Ring has been altered blocking COMT (Catechol-O-methyl transferase)
What is the onset for Catecholamines? <10min
What is the duration for Catecholamines? <3hrs
T/F Catecholamines are effective PO (by mouth)? False
What are the 4 Catecholamine medications, delivery, and actions? 1. Epinephrine (Adrenaline) -SC (Subcutaneous)- Alpha 1&2, Beta 1&2 2. Recemic Epinephrine (Vaponefrin)-Neb-Alpha 1&2, Beta 1&2 3. Isoprotererenol (Isuprel)-Neb & MDI-Beta 1&2 4. Isoetherine (Bronkosol)-Neb/MDI-Beta 2
What is the duration of Non-Catecholamines? Up to 12hrs
What action are all Non-Catecholamines? Beta 2 Agonists
T/F Non-Catecholamines are effective PO (by mouth)? True
What are the 4 SHORT DURATION Non-Catecholamines medications and delivery? 1. Metaproternol (Alupent)-MDI/Neb/tablet 2. Pirbuterol (Maxair)-MDI 3. Albuterol (Proventil/Ventolin)-Neb/MDI/DPI/tablet 4. Levalbuterol (Xopenex)-Neb & MDI
What is the time frame of short duration Non-Catecholamines? <8hrs
What is the time frame of long duration Non-Catecholamines? 12hrs
What are the 3 LONG DURATION Non-Catecholamines medications and delivery? 1. Formoterol (Foradil)- DPI 2. Salmeterol (Servent)-MDI & DPI 3. Arformoterol Tartrate (Brovana)-Neb
What is the onset of Anticholinergics Medications? Rapid onset <5min
What is the duration of Anticholinergics? Long 4-24hrs
What are the 2 medication and delivery of Anticholinergics? 1. Ipratropium Bromide (Atrovent)-MDI & Neb 2. Tiotropium Bromide (Spiriva)-DPI
What are the side-effects of Anticholinergics? Increase Heart Rate/Increase Blood Pressure/Decrease Secretions
What are Mediator Antagonist used for? Used to treat Asthma
5 Medications used to treat Asthma? 1. Intal 2. Tilade 3. Accolate 4. Zyflo 5. Singulaire
The 5 medications used to treat asthma are maintenance or rescue drugs? Maintenance Drugs
What are Mast Cells? Mast Cells contain Histamine & other inflammatory mediators
What are the two Mast Cell stabilizers and their delivery method? 1. Intal-MDI/Neb/DPI 2. Tilade-MDI
LRA stands for? Leukotriene Receptor Antagonist
Leukotriene receptor stimulation causes what? bronchoconstriction/mucus secretion/release of inflammatory cells
LRA's is what? Drugs that either block leukotriene actions or inhibit the formation of leukotrienes.
What are the 3 LRA Medications and Delivery? 1. Accolate-tablet 2. Zyflo-tablet 3. Singulaire-tablet
Glucocorticoid Steroids are maintenance or rescue drug? Maintenance Drugs
What does Glucocorticoid Steroids do? Inhibit Anibody Formation/Inhibit Histamine Formation/Non-specific Anti-Inflammatory/Used to treat asthma
What steroid medication is administered through tablet only? Prednisone (Deltasone)
What 4 steroid medications are administered through MDI only? 1. Belcomethasone (Beclovent) 2. Triamcinolone Acetonide (Azmacort) 3. Flunisolide (Aerobid) 4. Ciclesonide (Alvesco)
What steroid medication is administered through DPI only? Mometasone (Asmanex)
What 2 steroid medications are administered through DPI & MDI? 1. Budesonide (Pulmicort) 2. Fluticasone Propionate (Flovent)
What are the 3 Combination steroids and delivery methods? 1. Serevent + Flovent = Advair-MDI & DPI 2. Foradil + Pulmicort = Symbicort-MDI 3. Atrovent + Proventil = Combivent-MDI
MDI Steroid Side-Effect Oropharyngeal fungal infection
Systemic Steroid Side-Effects Osteoporosis/Immunosuppression/Peptic Ulcers
Cushingnoid Steroid Side-Effects Truncal Obesity (buffalo hump/moon face) & Hirsutism (Increase hair growth/muscle wasting)
What are the 3 wetting agents? 1. Hypotonic Saline (thin secretions) 2. Isotonic Saline (thin secretions) 3. Hypertonic Saline (will cough sputum)
What is a mucolytic agent? An amino acid preparation that disrupts disulfide bonds in mucus and thus reduces viscosity of thick secretions.
What medication is a Mucolytic? Acetylcycteine (Mucomyst)-Neb- 10 to 20% solution
What are side-effects of Mucolytic? Bronchospasm (must pretreat with bronchodilator) (Great risk in asthmatics) Nausea/Bronchorrhea/Rhinorrhea
What is a proteolytic agent? A clone of pancreatic Dnase enzyme which digest DNA in secrestions. Used in treating cystic fibrosis patients.
What medication is a Proteolytic? Dornsa Alpha (Pulmozyme)-Neb- 0.1% solution
What are side-effects of Proteolytic? Pharyngitis/Laryngitis/Conjunctivitis
What is the Max Absolute Humidity for Body Temperature? 44mg/L @37 Degrees C
What is the Max Absolute Humidity for Room Temerature? 23mg/L @25 Degrees C
List the 8 Steroid Medication 1. Prednisone (Deltasone) 2. Belcomethasone (Beclovent) 3. Triamcinolone (Azmacort) 4. Flunisolide (Aerobid) 5. Fluticasone Propionate (Flovent) 6. Budesonide (Pulmicort) 7. Ciclesonide (Alvesco) 8. Mometasone (Asmanex)
Created by: Langhout1418
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