BRTP09 Aerosol Medication Administration Flashcards
Aerosol
A suspension of solid or liquid particles in a gas
Stability
The ability of an awrsol to remin in suspension over time
Instability
The tendency for particles to be removed from suspension
Ideal state
Particles that range from 0.01-3.0 microns in diameter
100-1000 particles per ml of gas
SIZE THAT PENETRATES ALVEOLI IN THE LUNGS
Penetration
Refers to the MAXIMUM DEPTH that suspended particles can be carried into the pulmonary tree by inahled tidal air
Deposition
Result of an aerosols eventual instabiltiy; particles “fall out” on a newrby surface
“Where it ends up landing”
Retention
Proportion of particles deposited within the respiratory tract
“How much enters the lungs and stay in the lungs”
Clearance
Removal, the fact that some particles are exhaled
Coalescence
Two particles form one larger particle
Nebulizer
A device that generates aerosol of uniform size
particle deposition
5-50 microns— get trapped in nose and upper airways
2 to 5 micron—— lower airways: bronchi
0.5 to 3 microns —– Parenchyma: alveolar region
(Anything less than 3 is acceptable)
The main goal with administering medicine is to reach the alveolar level
5 Factors that affect deposition (where it lands) and penetration (how far can it go)
- Gravity
- Kinetic Activity
- Particle Inertia
- Physical nature of aerosol
- Ventilatory pattern
Goal of aerosol therapy
Deliver directly to the site of action
Therapeutic action with selected agent (medication) with minimal systematic side effects (WHOLE BODY SIDE EFFECTS)]
Greater efficacy and safety
Hazards of aerosol therapy (Adverse drug reaction)
Cardiovascular effects (tachycardia and arrhythmias) Muscle tremors nervousness headache insomnia
We stop treatment when HR increases by 20 bpm or a 20% increase in HR
More hazards of aerosol therapy
infection (not due to drug rather due to poor cleaning of equipment) airway reactivity (bronchospasm) pulmonary and systemic effects drug concentration eye irritation secondhand exposure
Patient assessment includes
Vital signs: HR, RR, BP breath pattern breath sounds pulse oximetry peak flow rates (PEFR)
Peak flow meter
A small, handheld device used to monitor a person’s ability to breath out air.
When to use it?
assessing effectiveness of treatment
before taking meds and after
Optimal use of Peak flow meter
Move marker to bottom of scale stand up straight ensure tight seal deep breath in blow hard and fast Repeat 3 times taking the best of three
MDI
metered-dose inhaler
DPI
Dry powder inhaler
Nebulizers
SVN (small volume)
LVN (large volume)
Hand bulb atomizer or spray pump
spray pump used for aerosol delivery to the UPPER RESPIRATORY Tract
Uses simple jet to produce large particles
Example: Nose sprayers to treat symptoms of allergic rhinitis and upper airway inflammation
3 types of MDI (metered-dose inhaler)
- conventional
- air actuated
- soft-mist
Advantages of a metered dose inhaler
Portable, compact multidose convenience short treatment time reproducible emitted dose (which means it give a MEASURED dose of meds) No drug preparation required difficult to contaminant
Disadvantages of a metered dose inhaler
Hand-breath coordination required
patient has to activate and properly inhale
fixed drug dosage and doses
often gets caught in oropharyngeal deposition
difficulty determining remaining dose if theres no counter
Factors affecting the MDI performance and drug delivery
Must shake canister Storage temp nozzle size and cleanliness timing of actuation priming ( wasting a puff) characteristics of the patient overall technique
Optimal technique for MDI
warm and shake canister in hand
assemble and uncap mouthpiece
sit up straight (45-90 degrees) or stand
breathe out normally
open mouth technique: keep mouth open and tongue down
closed mouth technique: place mouthpiece between lips with tongue out of the path
Optimal use continued for MDI
slowly breathe in as you activate the MDI
Continue inspiration to total lung capacity (TLC)
Hold breathe for 10 seconds
wait 1 minute between puffs
IF TAKING STEROID PATIENT MUST RINSE MOUTH AFTER
RINSING MOUTH AFTER STERIOD PREVENTS ORAL THRUSH
During treatment or inbetween meds the RT should
monitor patients vitals
observe improvements or adverse reactions
Troubleshoot absent or low aerosol output
Qday
once a day
BID
twice a day
TID
three times a day
QID
four times a day
Q4
every 4 hours
Advantages to using accessory devices with a MDI
reduce oropharyngeal drug impaction
INCREASED DRUG ALMOST 4 TIMES MORE THAN JUST MDI ALONE
no drug prep needed
simplifies coordination and inhalation
Disadvantages of accessory devices for mdi
Larger
more expensive and bulky
some assembly may be required
patient errors (firing multiple puffs into chamber
could be a source of contamination if not cleaned well
2 types of MDI accessory devices
Valved holding chamber
Spacer
Valved holding chamber
Incorporates one or more low resistance valves to prevent aerosol in the chamber from clearing on exhalation
reduces oral deposition and increases pulmonary deposition
better for coordination issues than spacer
feedback if inspiratory flow too fast (device will whistle or make “musical sound”)
Spacer
simple VALVELESS extension device that adds distance between patients mouth and MDI outlet
distance allows for reduction in particle size and decreases oral deposition
helps with patient coordination of inhalation and actuation
DPI aka dry powdered inhalers
BREATH ACTUATED dosing system. The patient creates aerosol by generating inspiratory flow and volume
Major disadvantage to DPI
Adequate inspiratory flow is required for medication to be delivered
Can result in high pharyngeal deposition
Humidity can cause powder to clump and reduce fine particle mass
PATIENT HAS TO BE ABLE TO HAVE INSPIRATORY FLOW FROM 40-60
Jet nebulizers
gas powered directed through a restricted orifice (the jet)
Incorporates baffles to decrease the number of large aerosol particles
Can be small volume neb or large volume neb due to reservoir size
sidestream or mainstream
If you had to choose between a spacer and holding chamber which should you choose?
Valved holding chamber
Factors that affect performance of jet nebulizer
Gas flow and pressure humidity and temp drug formulation gas density nebulizer design- baffle and residual drug volume breathing pattern
advantages of Small volume nebulizer (SVN)
aerosolize several drugs
can mix drugs if compatible
minimal cooperation and coordination required
works in several patients (age, distressed, debilitated)
drug dose can be modified
normal breathing pattern can be used
Small volume nebulizer disadvantages
Total treatment time can be 5-30 mins
equipment required
power source required
if using a mask, drug delivery to the eyes is possibility
variability of performance can be brand dependent
important facts about small volume nebulizers
USUALLY RUNS ON FLOW OF 6-8 LPM
Can be driven on oxygen or air
generally hold 2-6 ml of solution
SHOULD BE USED INSTEAD OF MDI OR DPI IF PATIENT IS TACHYPNEIC
Medication delivery to Larger airways
- Inhale at tidal volume
- Inhale at a normal or slow speed
- breathe a normal pattern
Medication delivery to smaller airways
- Inhale through mouth
- inhale slowly
- Take a deep breath and hold it for a few seconds
Large volume Nebulizers
Useful when traditional dosing isn’t working
Large volume reservoirs continuous neb (heart)
can be hooked to iv pump and premixed drip in a standard reservoir
Potential problem and main concern with LVN: drug reconcentration
4 other types of nebulizers
Breath enhanced nebulizers
Breath actuated nebulizers
Vibrating mesh nebulizer
Ultrasonic nebulizers
Breath enhanced nebulizer
Breath enhanced nebulizers— generate aerosol continuously, using vents and valves to reduce the aerosol waste
Breath actuated nebulizer
Breath actuated nebulizers— synchronize aerosol generation with the inspiratory effort of the patient reducing the waste of aerosol; GIVE MORE MEDS TO PATIENTS; ENVIRONMENT IS LESS CONTAMINATED.
vibrating mesh nebulizer
active or passive based on design
can generate aerosol from small drug concentration
does not generate much flow
particle size created small
ultrasonic nebulizer (small)
Piezoelectric crystal to generate aerosol
Uses crystal transducer convert to a higher frequency
creates less residual drug volume
can be portable
Goals of bland aerosol therapy
***No medication/ only water/ only saline
Bronchial hygiene hydrate dried secretions promote cough restore mucous blanket humidity inspired gas induce sputum
Hazards of bland aerosol therapy
rehydrated secretions causing airway obstruction
bronchospasm or wheezing
cross-contamination
patient discomfort
infection
Large volume jet nebulizer (heated)
Pneumatically powered, attached flow meter, and gas source
a small jet orifice
impacting surfaces baffles decrease large particle
remaining small particles leave nebulizer
Heating increases water content
NOT USED FOR MEDICATION
HEATING MEDICINE DEGRADES IT
What to consider when selecting aerosol delivery system?
age, physical and cognitive abilities patient preference (more important for home use) availability of drug convenience and durability cost and reimbursement
