chapter 39 Flashcards
what liquids can be used for bland aerosol therapy?
Sterile water, Sterile Saline (Hypotonic, Isotonic,Hypertonic)
ISB
isothermic saturation boundary
how does temperature differ above ISB with inspiration and expiration
increase during exhalation- airway warms and regains moisture
decrease during inhalation- air cools down and loses moisture
Indications for bland aerosol therapy.
-presence of upper airway edea-cod, bland aerosol
-laryngotarachebronchitis (croup)
-subglottic edema
-post-extubation edema
-postoperative management of the upper airway
-presence of a bypassed upper airway
-need for sputum specimens or mobilization of secretions
what outside factors can cause a shift in ISB
-upper airway bypass (trach)
(endotracheal tube)
-minute ventilation greater than normal
(increase RR)
-Shifts in ISB compromises body normal heat.
Describe body humidity and humidity deficit
body:
-expressed as percentage
-water capacity of 44mg/L at 37C
-body humidity =absolute humidity 44mg/L x 100
Deficite:
-Not fully saturated inspired air at 37C
-corrected by body’s own humidification system
-humidity deficit = 44mg/L absolute humidity
Hazards/complications of bland aerosol therapy.
-wheezing or bronchospasm
-infection
-patient discomfort
-over hydration
-caregiver exposure to air bone contagious produced during coughing or sputum indication
what would happen if temperature decreased suddenly (a heated humidifier was turned off)
relative humidity increases due to less moisture
atelectasis bronchospasm thick secretions
What types of patients can benefit from cool aerosol therapy?
-upper airway edema/swelling
-bypassing upper airway
-sputum induction
indications for humidity
Primary
-dry medical gases
-bypass upper airway
Secondary
-treating bronchospasm caused by cold air
to set-up a large-volume nebulizer, what equipment do you need?
-connected directly to flowmeter
-variable air entrainment port
clinical signs of inadequate airway humidification
-atelectasis
-dry nonproductive cough
-increased airway resistance
-infection
-increased WOB
-patient complaint of substernal pain /airway dryness
-thick dehydrated secretions
How does condensation pose a risk?
-It can block the flow of gas through the tubes, making it harder for the patient to breathe
-It can also be dangerous if pt accidentally inhales this water, leading to aspiration water going into the lungs.
what can cause cross contamination?
-water in circuit can be source of bacterial colonization
-minimizing condensation is helpful to reduce risk of colonization
-wick-or membrane-type passover humidifier prevent formation of bacteria -carrying aerosols
-frequently changing circuit is not needed to reduce chance of nosocomial infection
What is used to monitor the temperature of inspired gas received by patients?
-regularly measuring patients inspired FiO2 levels
-providing ventilatory care and monitoring selected pressures, volumes, and flows
-using hygrometer-thermometer system
factors affecting humidifier performance
temperature, surface area, time of contact
temperature
increase temp of gas = increase water carrying capacity
surface area
increased gas/water contact area = increased evaporation
What is the purpose of mists tents/hoods?
-promotes vasoconstriction
- reduces edema
-diminishes upper airway obstruction
time of contact
increased gas water contact area time = increased evaporation
What are the hazards?
-Heat retention
-CO2 buildup in tents
what is the difference between active and passive humidifiers?
active
–activily adding heat/water to the device - patient interface
passive
–recycling exhaled heat/humidity from patient
–heat moisture exchange (HME)
Hazards of aerosol therapy
-Infection
-airway reactivity
-pulmonary & systemic effects
-drugs concentration changes
-eye irritation
-exposure to secondary aerosol drugs
Problem Solving:
Inadequate mist production
-check electrical power supply, carrier gas is actually flowing through device, amplitude control, and couplet chamber
