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