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Chpt 36

Bland Aerosols

Which of the following best defines an aerosol? D. Suspension of liquid or solid particles in a gas
What devices generate therapeutic aerosols? A. I & II- Atomizers & Nebulizers
The mass of aerosol particles produced by a nebulizer in a given unit time best describes which quality of the aerosol? C. Output
Which of the following describes the mass of drug leaving the mouthpiece of a nebulizer as aerosol? B. Emitted Dose
Which of the following is a common method to measure aerosol particle size? C. Cascade Impaction
What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol? C. mean mass aerodynamic diameter(MMAD)
what is the retention of aerosol particles resulting from contact with respiratory tradct mucosa called? D. Deposition
What is the primary mechanism for deposition of large, high mass particles(greater than 5 um) inthe respiratory tract? A. Inertial Impaction
What will increase aerosol deopisiton by inertial impaction? A. II & III-Variable or irregular passages & turbulent gas flow
Where do most aerosol particles in the 5-10 um range deposit? D. Upper airways
Where do most aerol particles in the 1-5 um range deposit? C. Central airways
What term describes the primary mechanism for deposition of small particles? C. Brownian diffusion
Which of the following aerosols would have the highest rate of deposition by diffusion? MMAD of 0.1 um
Where do most aerosol particles that are less than 3 um deposit? A. Alveoli
What is teh process by which aerosol suspension changes over time? C. Aging
What is the primary hazard of aerosol drug therapy? A. untoward drug reactions
To minimize risk of infection associated with aerosol drug therapy, whjat should you do? D. I, II, III-Sterilize nebs b/w pts, Frequently replace in use units, rinse nebs with sterile water
To monitor a pt for possibility of reactive bronchospasm during aerosol drug therapy what should u do? D. I,II,III,IV-Measure pre & post peak flow and/or %forced expiratory volume in 1 second, Auscultatefor adventitious breath sounds, Observe pt's response & Communicate with pt during therapy
After heated water aerosol tx thru jet nebs you notice a dramatic increase in the magnitude of coarse crackles heard on auscultation. Recommendations? C. Add coughing and postural drainage to the therapy
What is the preferred method for delivering bronchodilators to spntaneously breathing and intubated, ventialted pts? C. MDI(Metered Dose Inhaler)
Immediately aftert firing, the aerosol produced by most MDI's are about how large? D. 35 um
Most of the spray generated by the majority of MDI's consist of what? B. Propellant
When fired inside the mouth what % of the drug dose delivered by a simple MDI deposits in the oropahrynx? D. About 80%
Before inspiration and actuation of a MDI, the pt should exhale to which of the following? C. Functional residual capacity
To ensure delivery of proper drug dosage with an MDI, which of the following must be done first? C. II&III- Canister should be warmed to hand or body temp, & canister should be vigorously shaken.
What groups of pts are most likely to have difficulty using a simple MDI inhaler for aerosol drug therapy? D. I,II,III- Pts in acute distress, infants & young children, elderly persons
What is a potential limitation of flow triggered MDI devices? C. High flows necessary for actuation
For which pts would you recommend against using a flow triggered MDI as the sole bronchodilator delivery system? A. Pt likely to develop acute severe bronchospasm
The key difference b/w and MDI holding chamber and a spacer is that the holding chamber incorporates what? B. One way inspiratory valve
What device would you select to deliver an aerolized bronchodilatoir to a young child? B. MDI, holding chamber, and mask
Proper use of a dry powder inhaler(DPI) requires that the pt be able to do what? A. Generate inspiratory flows of 60 l/min or higher
What device depends the pt's inspiratory effort to dispense the dose? C. Dry Powder Inhaler(DPI)
For what pt groups is the DPI for bronchodilator administration NOT recommended? A. I&II- Infants and children under 5, pt's with an acute bronchospastic episode
Exhalation into what device can result in loss of drug delivery? C. Dry powder inhaler
SVN ouput drops after lowering pt's bed while giving a treatment but there is 3ml of solution still left in reservoir. Correct Problem? C. Reposition pt so that the SVN is more upright.
What happens as the pressure for flow delivered thru a SVN gets higher? D. I,II,III-Tx time becomes shorter, Patricle size becomes smaller, Aerosol output becomes greater.
Normally, when using a 50-psi flowmeter to drive a SVN, you set the flow at what? C. 6-8 L/min
To minimize a pt's infection risk b/w drug tx's with a SVN what would you do? A. Rinse the SVN with sterile water; air dry
Physician has ordered an anitviral agent ribavirin(Virazole) to be administered by aerosol to an infant with bronchiolitis. Use which device? B. SPAG-Small particle aerosol generator
When using a SPAG to administer Virazole to an infant which air flow settings would you use? A. NEB-8L/min Drying Chamber-8L/min
What serious problems are associated with the delivery of Virazole using the SPAG? B. I&III-Caregiver exposure to drug aerosol, drug precipitation in ventilator circuits
Virazole aerosol precipitation causing malfunction of vent circuits can be overcome by what? A. I&II-Placing a one way valve b/w SPAG and circuit, Placing HEPA filter proximal to exhgalation valve
Advantages of SVUN (Small volume ultrasonic Nebs) for drug delivery include all of the following except: D. Decreased Cost
For maintenance administration of bronchodilators to adult pt w/adequate inspiratory flow, which aersol devices would u recommend? D. III&IV- DPI, pMDI and holding chamber
What aerosol drug delivery system would you recommend against using with a toddler or small child? A. I&II- MDI & SVN
On average, what % of an aerosol drug delivery device's output actually deposits in the lungs? B. 10%-20%
Possible complications associated w. the selection of an aerosol drug delivery device include all except: B. Overhydration or fluid imbalances
What would you recommend as initial therapy for pt admitted to ER w/ acute airway obstruction? A. I&II- Asess dose response of MDI albuterol (up to 12 puffs), & Provide up to 3 SVN tx's w/albuterol q 20 minutes.
Appropriate documentation when conducting point of care assessment of a pt's response to bronchodilator therapy includes all except: D. blood levels of the bronchodilator agent
What is false about the use of PEFR in assessing pts response to bronchodilator therapy? B. PEFR is the standard for determining bronchodilator response
When assessing a pt's response to bronchodilator therapy u notice a decrease in wheezing accompanied by an overall decrease in breath sounds. Whats most likely? A. Increasing airway obstruction
When assessing a pt's response to bronchodilator therapy u notice a decrease in wheezing accompanied by an overall increase in breath sounds. Whats most likely? C. Decrease in airway obstruction
What is teh proper dose response assessment of an MDI bronchodilator? B. Give 4 puffs 1-2 minutes apart; repeat up to 12 puffs w/continued improvement. Best dose provides max subjective relief and highest PEFR w/o side effects.
Ina dose response seessment of pt's response to MDI bronchodilator, you would stop increasing the dose when? A. I,II,&III-When PEFR improves <10%to15%, When tachycardia occurs, when tremors are evident
Asthma pt in severe resp distress presents to ER and is started on albuterol by SVN. Approaches recommended to assess therapy to pt.? D. I,II,III,IV-Perform ABG analysis, Monitor SpO2, Asses breath sound & vitals before & after each tx., Measure PEFR or forced expiratory volume(FEV1) in 1 second before & after tx.
An asthmatic in severe ditress is admitted to ER. After full asessment and obatining a pre-tx baseline, you start pt on albuterol with a SVN. When should you stop documentation & tx? A. The pt's symptoms are relieved pr PEFR/FEV1 in 1 second exceeds 70% of personal best.
What factor is most crucial in developing an effective program of aerosol drug self administration in an adult pt requiring maintenance bronchodilator therapy? D. good patient education
Best way to confirm that an asthmatic OP can prpoerly self manage a newly prescribed aerosol drug therapy? B. Have pt provide a repeat or return demo.
Physician ordes continuous bronchodilator therapy with 1:200 albuterol for asthma pt at dosage of 20mg/hr. How much 1:200 albuterol will be needed for 1st hr of tx? C. 4 ml
Indications of an adverse drug response during continuous bronchodilator therapy include all except: A. decreased consciousness
When using a chamber style adapter with an MDI to deliver a bronchodilator to a pt receiving mech ventilation, with what would you coordinate MDI firing? A. beginning of inspiration
Created by: crystal71653