chapter 15 aerosol therapy

what are two example of passover humidity devices?

(1) Wick (2) reservoir (used on mechanical ventilation or non-invassive

HME ( passive humidifier)

(a) 70% effecient (1) Artificial nose (2) Traps expired moisture & is delivered in the next inspiration (4) Position is crucial (5) Used in inline on the ventilator

Types of water vapor humidity (active and passive) (cool and heated

(a) Active humidity --> Passover --> reservoir and wick --> heated --> mechanical ventilation or non-invasive ventilation: an active humidifier adds water or heat or both to the inspired gas (b) Passive humidifier: uses exhaled heat and moisture on humidifying inspired gas (c) Heated aerosol: used for pt.s with bypassed airways (d) Cool aerosol: for pt.s who have upper airway inflammation or edema

whats the 15 and 22 mm adapter used for?

(a) Adapters used to connect O2 therapy equipment's between the wall and the patients

breath hold for both 10 seconds or comfortable length

(a) Breath holding increases deposition of medication in the lungs and affected area

Hand-held nebulizer (HHN)

(a) Delivers 10% of medication to the responsive airways (1-5 micron - lower airways (b) holds about 10ml of solution

why is heat is applied throughout the ventilator circuit and why temperature probes are used?

(a) Heat is applied to reduce condensation. (b) Temperature probe is used to maintain the set temperature

whats blender ?

(a) Helps to adjust FIO2 and flow are separately

Sterile water for inhalation (used with continuous aerosol)

(a) How we generate the aerosol, for humidity purposes (b) For pt.s with bypassed upper airway ( Trach collar and brigs T-adapter are devices used for these pt.s)

technique and education are everything

(a) Inspiratory flow rate and pattern is ways to coach the pt.s

bland aerosol therapy

(a) Involves delivery of sterile water (b) hypotonic (c) hypertonic (d) isotonic saline aerosols (1) Normal saline is a brand aerosol (Isotonic 0.9%) (2) Helps with sputum induction

What's a "Peak Flow Meter"?

(a) It measures the patients expiratory breath flow (b) Coach pt.s to blow as hard and fast as they can while sealing lips around the device (c) patient should be standing s or sitting up straight position

whats the valve T-adapter?

(a) It's used when delivering aerosolized medication with HHN

Bubble humidity --> water vapor --> nasal canula

(a) O2 passes through sterile H2O, picks up humidity (b) Can NOT be heated b/c condensation would build up in small bore tubing (c) Can be added to nasal cannula at least 4lpm (e) Efficiency decreases with an increase of O2 flow (f) Pop-off valve warns obstructions

what percent of medication reaches the lower airway?

(a) Only 10%

what are two types of upper airway edema?

(a) Sub-glottis (below the glottis) and supra-glottis (above the glottis)

Passover humidifier

(a) air passes over moisture, not very effective (b) concha wick and Fischer-paykel

Bland aerosol with large volume jet nebulizer (sterile water)

(a) also known as continuous aerosol (b) Isotonic saline (0.9%) (c) hypertonic saline ( 3% or at st Lukes 7% to induce sputum) (d) hypotonic saline (0.45%) - hydrates the airway and improve in secretion production

Whats water vapor?

(a) dissolved in the gas. Can be used for heat or humidity

Whats the benefits of cool aerosol ?

(a) helps Pt.s with by passed upper airway edema (b) Promotes local vasoconstriction which reduces swelling (c) croups disease pt.s

Metered dose inhaler (MDI)

(a) inspiratory effort activates aerosol delivery (b) HFA propellant

whats aerosol?

(a) liquid molecule that's suspended in the gas. Used in continuous aerosol, either cool or heated aerosol.

dry powder inhaler (DPI)

(a) types of breath-activated delivery methods for inhaled medications (b) DPI medication will clump up if it gets contact with humidity (affected by humidity) (c) Expose medication before delivering to pt.s

Normal today volume

500 ml

10-minute intermittent treatment

· Frequency based on how long the medication is effective are (1) Q4 hours(every 4 hours) (2) QID ( 4x a day) (3) TID ( 3x a day) (4) BID (2x a day)

Hazard - tied to the medication being delivered

· Loss of heat and water · Ciliary motility is reduced · Airway become irritable and increase mucus production · Mucus production increases, drug concentration increases, adverse reaction, cool aerosol may cause bronchospasm.

Bleed in adapter

Attached to CPAP machine to transfer O2 to patients

When do you switch HME?

Switch if the pt has: (1) hypothermia (2) increased sputum (3) thick secretion (4) increased ventilation

What does a baffle do?

Takes large particles in rains it back to the cup then small particles continue to go to the patients to breath in or out of the mouth piece