Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles and Practices of Resp Therapy 1 > Chap 15 Hess Exam > Flashcards

Chap 15 Hess Exam Flashcards

1
Q

Mucosal lining of nose, sinuses, trachea, and bronchi Aid in

A

heating and humidifying inspired gases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

During expiration, the expired gas

A

transfers heat and humidity back to the mucus lining of the upper airway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Isothermic Saturation Boundary. Body Temp Pressure saturation

A

Normally present 5cm below the carina, 100% relative humidity at 37 deg celsius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Factors that can cause a shift

A

mouth breather, artificial airway, increased minute ventilation, drop in environment temp and humidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Norm temp and humidity in Pharynx

A

29-32’C, 95% RH, 28-34 mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Norm temp and humidity in airway opening (nose and mouth)

A

20-22’C, 50% RH, 10 mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Norm temp and humidity in Trachea

A

32-34’C, 100% RH, 36-40 mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Norm temp and humidity in Isothermic saturation

A

37’C, 100% RH, 44mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hazards and Complications of insufficient humidity

A

loss of heat and water, Ciliary motility is reduced, airway become irritable, mucus prod increases, pulmonary secretions become thick due to dehydration, tracheal epi can be damaged when upper airway is bypassed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

as long as the inspired humidity is at least what %BTPS, no injury occurs in normal lungs

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Goals of Humidity Therapy

A

To provide adequate heat and humidity, to treat hypothermia, to prevent airway response to cold air, to aid removal of thick secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

For premature and newborn infants, a neutral thermal environment should be

A

maintained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bubble Humidifier

A

dry gas is directed toward the bottom of a water filled reservoir, where the stream of gas is broken up (diffused into bubbles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Passive Humidifier

A

uses exhaled heat and moisture to humidify inspired gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Active Humidifier

A

adds water or heat or both to inspired gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

nebulizer

A

produces aerosol, or suspension of particles in gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How to improve humidity delivery

A

Temp, Surface area, contact time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Temp in improvement of humidity delivery

A

Greater the temp, the more water vapor it can hold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Surface area in improvement of humidity delivery

A

Greater the area of contact, greater the opportunity for evaporation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contact time in improv of humidity delivery

A

greater the contact time, greater the opportunity for evaporation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bubble humidifier= water vapor=

A

nasal cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Passive=HME=

A

Water vapor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Active= passover and wick= heated=

A

mechanical ventilation or non-invasive ventilation (high flows of dry medical gas are delivered to the patient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Aerosol bland- sterile water for inhalation=

A

continuous aerosol (air entrainment large volume nebulizer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Aerosol Bland- Normal saline, hyper or hypo tonic saline=

A

Induce sputum= small volume neb for intermittent therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Aerosol for medication delivery-

A

to treat lung disease or complications= SVN for intermittent therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bubble Humidifier

A

Oxygen passes through sterile water, picks up humidity. NEVER HEATED. Added to NC- 4lpm or greater. Efficiency decreases with increase of O2 flow. Pop off valve warns of obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pop off valve

A

warns you off obstruction in bubble humidifier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bubble humidifier NC LPM

A

4LPM or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Can you heat bubble humidifier

A

NEVER, because condensation would build up in small bore tubing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

HME (heat moisture exchange)

A

Artificial nose, captures expired moisture and is delivered during the next inspiration, 70% efficient, problems of occluding filter with secretions, position is crucial, mainly used inline on the ventilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How efficient is an HME

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Active Humidity types

A

passover, bubble humidifier, Jet nebulizer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Passover - Reservoir

A

Most commonly used with mechanical ventilation and noninvasive ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How Passover - Reservoir is used

A

gas flow passes over a reservoir of water, water evaporates into the gas, increasing the humidity of the gas, efficiency is increased by adding heat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Local Brand name for Passover Reservoir

A

Fisher Paykel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Heated Wire Circuit

A

Heating wires, Temp probes, passover reservoir, heater, sterile water for inhalation, correct expiratory filter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Wick

A

Cylinder of absorbent material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Passover wick humidifier

A

Water wicks up the side, is heated and evaporates into the inspired gas being delivered to the patient,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Concha-

A

made by Hudson RCI (passover wick humidifier)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Delivered through high flow large bore tubing devices (heated or cool humidity) examples

A

Heated- ventilators, non-invasive ventilators, heated high flow NC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Delivered with bubble humidifier (heated or Cool humidity)

A

Cool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Used when upper airway is bypassed ETT or tracheostomy tube (heated or cool humidity)

A

Heated Humidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Used when high flows delivered exceed the bodies ability to heat and humidify dry inspired medical gases (HFNC) - heated or cool humidity?

A

Heated Humidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Delivered with continuous aerosol set up- heated or cool humidity?

A

Cool humidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Used to treat inflammation of the upper airway- heated or cool humidity?

A

Cool humidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Used to treat hypothermia- heated or cool humidity?

A

Heated humidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Aerosol Therapy

A

Consists of liquid particles suspended in a gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Bland aerosol consists of

A

sterile water for inhalation (continuous aerosol), Isotonic Saline, Hypertonic Saline, Hypotonic Saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Air entrainment large volume jet neb

A

Liquid is shattered into particles, large unstable particles rain out, small stable particles are delivered to the patient. You can add heat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Can you add heat to Air entrainment large colume jet nebulizer

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ultrasonic Neb

A

Uses piezoelectric crystal to generate aerosol, converts radio waves into high frequency mechanical vibrations, create very high output of aerosol particles, used for bland aerosol delivery

53
Q

Recently- what is found in homes as room humidifiers

A

Ultrasonic Nebs

54
Q

Coverts radio waves into high frequency mechanical vibrations

A

Ultrasonic neb

55
Q

Indications for bland aerosol

A

upper airway edema, postextubation edema, bypassed upper airway, need for sputum or mobilization of secretions, croup

56
Q

Assessment of need for bland aerosol

A

stridor, croup like cough, hoarseness following extubation, bypassed upper airway

57
Q

Bland Aerosol, sputum induction involves

A

Short term delivery (approx. 15-30 min) of hypertonic saline (3-10%) aerosol via small volume neb

58
Q

Assists in mobilizing secretions

A

increased volume of fluid in airway, cause irritation which stimulates couch, pt expectorates sputum into specimen cup to be sent to the lab for a culture and sensitivity test

59
Q

How the particles fall

A

Impact, Sedimentation, diffusion

60
Q

Impact

A

effective filter of the upper airway, particle sizes 10 microns or greater

61
Q

sedimentation

A

aerosol particles fall due to gravity, primary mechanism for particles sizes 1 to 5 microns

62
Q

diffusion

A

when gas flow ceases, aerosol particles collide and deposit on alveolar cell surfaces

63
Q

Deposition Particle size

A

Unaided eye cannot see particles less than 50-100 microns (um)

64
Q

VMD

A

Volume median diameter- laser diffraction

65
Q

MMAD

A

Mass median aerodynamic diameter- cascade impaction

66
Q

heterodisperse

A

term used to describe resp aerosols with the particles of all different sizes

67
Q

In an aerosol distribution with a specific MMAD, what % of the particles are small and have less mass and what percent are larger and have greater mass

A

50%, 50%

68
Q

Determinants of deposition

A

particle size, inspiratory flow rate, flow pattern, RR, Inhaled volume, I:E Ratio, Obstruction

69
Q

Upper airway particle size (MMAD)

A

5 to > 50 microns

70
Q

Lower airways particle size (MMAD)

A

2 to 5 microns

71
Q

Parenchyma: alveolar region particle size (MMAD)

A

1 to 3 microns

72
Q

Parenchyma particle size

A

<0.1 microns

73
Q

Hazards of Aerosol therapy

A

Nosocomial infections, adverse reaction to med being delivered in aerosol form, cool aerosol can cause bronchospasms, wheezing, precaution when delivery to infants, drug concentration may increase

74
Q

Drug concentration increase usually seen with

A

continuous aerosol drug delivery

75
Q

Bronchospasm and bronchoconstriction

A

abnormal contraction of smooth muscle in the conduction small airways resulting in acute narrowing and obstruction

76
Q

Aerosol drug delivery systems

A

MDIs, DPIs, SVN=HHN, LVN, Ultrasonic neb, plus more

77
Q

MDI- Metered dose inhalers

A

Pressurized canister, contains prescribed drug and propellant, HFA, Aerosol prod takes approx 20 millisec, initially particle size is 35 microns. the propellant evaporates and particle size becomes smaller

78
Q

Most commonly ordered method of delivery

A

MDI- Compact portable relatively easy to use. commonly misused by patients

79
Q

Preferred method for delivery bronchodilator therapy to spontaneously breathing pts and pts who are mechanically ventilated

A

MDI

80
Q

MDI Particle size delivered

A

3-6 microns

81
Q

MDI pulmonary deposition ranges between

A

10-20%

82
Q

How much of MDI deposits in oropharynx

A

80%.. medication swallowed in turn entering systemic circulation

83
Q

Before initial use- MDIs should be

A

primed by actuating the device 1 to 4 times

84
Q

All new MDIs are required to have a

A

counter which keeps track of actuations (puffs) left

85
Q

MDI techniques

A

warm canister, shake, prime, breathe out normally, slowly breath in, continue inspiration to TLC, hold breath for up to 10 secs, wait one min between puffs

86
Q

Wait how long in between MDI puffs

A

one minute

87
Q

Open mouth MDI technique

A

open wide, keep tongue down, place canister 4cm (2fingerbreaths), this improves deposition by reducing oroparyngeal rain out (impaction)

88
Q

Closed mouth MDI technique

A

place mouthpiece between lips with tongue out of the path of the outlet

89
Q

Breath actuated MDIs

A

Removes: actuation to inspiration timing technique complication…. inspiratory effort activates aerosol delivery

90
Q

Spacers reduce

A

oropharyngeal impaction and the need for precise actuation/ inspiration coordination.

91
Q

what kind of particles impact on spacer walls

A

large

92
Q

ALL spacers add

A

distance between the MDI and the mouth

93
Q

Holding chambers

A

Spacer which contains a one way valve, holds med in chamber until there is no inspiratory effort, can take 2-7 breaths with one actuation (6-10 for children), can attach a mask, has a training whistle

94
Q

Dry powdered inhaler (DPI)

A

Breath actuated, med is in powder form, dispersion is dependent on turbulent flow, carrier substance is used(lactose or glucose)

95
Q

What affects DPIs drug delivery

A

humidity

96
Q

DPIs require what kind of inspiratory flow

A

High inspiratory flow

97
Q

DPIs % delivered to respiratory tract similar to MDIs

A

10-20%

98
Q

DPIs particle size

A

Dry powder (med): 1-3 microns, Propellant (carrier); 20-65 microns

99
Q

Most of the DPIs carrier is deposited in

A

oropharynx

100
Q

DPI Technique

A

Assemble, Load Dose, Exhale slowly to FRC, Seal lips around mouth piece, inhale deeply and forcefully, breath hold (10 sec), Repeat process until dosage complete

101
Q

Liquid = aerosol (MDI or DPI)

A

MDI

102
Q

Solid= aerosol (MDI or DPI)

A

DPI

103
Q

Can use spacer / chamber (MDI or DPI)

A

MDI, spacer isnt needed for DPI

104
Q

Must be able to take a slow deep breath and hold (MDI or DPI)

A

MDI

105
Q

Must create turbulent inspiratory flow (MDI or DPI)

A

DPI

106
Q

Oral deposition compared to other without spacer

A

DPI

107
Q

Must keep track of doses (MDI or DPI)

A

MDI, DPI has a counter or are indiv wrapped

108
Q

Coordinate delivery of dose and inspiration (MDI or DPI)

A

MDI, DPI is no coordination involved

109
Q

Small volume neb (SVN) HHN

A

Delivers aerosolized medication or bland aerosol!, small= holds less than 10mls, Pneumatically powdered, 10 psi at home (electric compressor)

110
Q

Pneumatically powered

A

which means they are powered by a pressurized gas source (50PSI in hospital)

111
Q

Electric Compressor

A

10psi at home

112
Q

How is aerosol produced

A

high pressure stream of gas shot through a restricted orifice, the liquid is drawn up a capillary tube created by low lateral pressure, the liquid then passes over the jet and is shattered

113
Q

Aerosol particle size

A

is b/w 0.1 to 500 micron range

114
Q

Liter flow is inversely proportional to

A

droplet size and neb time (treatment time)

115
Q

higher the liter flow, what the droplets, and treatment time

A

higher the liter flow, smaller the droplets, shorter the treatment time

116
Q

for neb treatments in hospital with a 50 psi gas source the liter flow used is

A

6-10 L/m (usually always 10)

117
Q

Deposition for nebulizer treatment

A

12% or less, 2% in infants

118
Q

Infants are natural

A

nose breathers

119
Q

Delivering aerosol to infants and children

A

well fitting aerosol masl vs. mouth piece, blow by, never to crying baby

120
Q

Breath actuated neb

A

only produces aerosol during inspiration, increases treatment time, aerosol production is triggered with inspiratory flow

121
Q

If the patient is unable to generate enough flow for and adequate period of time usuing a breath actuated neb

A

the treatment will be ineffective

122
Q

Bronchodilator

A

reverses bronchoconstriction, opens up the airway

123
Q

corticosteroid (inhaled)

A

Reduces inflammation in lung only, may enhance bronchodilator, can cause oral thrush

124
Q

Mucolytic

A

thins or breaks up secretion

125
Q

antibiotic

A

treats bacterial infections

126
Q

Mouthpiece vs Mask issue

A

Patient ability, preference, and comfort

127
Q

Aerogen neb

A

uses electricity not flow

128
Q

Large volume neb

A

heart/ hope, mini heart

129
Q

How are we going to assess patient response, how should a patient improve

A

aeration

Principles and Practices of Resp Therapy 1 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions