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Fundamentals Of Respiratory Care > Module 5: Humidity And Aerosol Therapy > Flashcards

Module 5: Humidity And Aerosol Therapy Flashcards

1
Q

What is the primary goal of humidity therapy?

A

Maintain normal physiologic conditions in the lower airway

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2
Q

What is the requirement for supplemental humidification?

A

Administration of medical dry gases of 4L/min or greater.

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3
Q

What are the risks of inhaling dry gases?

A

Increase viscosity of secretions and impairs mucciliary motility (structural) and increases airway irritability.

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4
Q

What happens when we lose humidification?

A

Immediate heat and water loss.

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5
Q

What is used for upper airway inflation?

A

Cool humidification.

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6
Q

What are some indicators for cool humidity?

A

Post extubation edema
Croup
Epiglottitis

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7
Q

What are the indicators for warm humidification?

A

Hypothermia (raises core body temperature)

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8
Q

How is bronchospasm treated?

A

Warm humidification

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9
Q

What is another indication for warm humidity?

A

Bypassed airway from an artificial airway
(Endotracheal tube or Tracheostomy tube)

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10
Q

What are the clinical signs and symptoms of inadequate airway humidification?

A

Atelectasis
Dry, nonproductive cough
Increased airway resistance (RAW)

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11
Q

What are three clinical signs and symptoms of inadequate airway humidification?

A

High risk of infection
Increased work of breathing
Patient, complaint of substernal pain and airway dryness

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12
Q

What is the concern behind thick, dehydrated secretions (inspissated)?

A

A clinical sign of inadequate airway humidification

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13
Q

How do you increase humidity output of a humidifier?

A

Increase the temperature of either the water or the gas

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14
Q

What are the different types of humidifiers?

A

Active and Passive

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15
Q

How do you treat a patient with an active humidifier?

A

Actively add heat or water or both to the device -patient interface

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16
Q

How does a passive humidifier work?

A

Recycle exhaled heat and humidity from the patient

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17
Q

What do active humidifiers typically include?

A

🫧Bubble humidifiers
Passover humidifiers
Nebulizers of bland aerosols and vaporizers

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18
Q

What is the purpose of a simple unseated bubble humidifier?

A

Humidify gases in the oronasal airway

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19
Q

How can you protect tubing from kinking up or being obstructed?

A

Simple pressure relief valve or pop off (2psig) to warn (acts as an alarm system) of flow-path obstruction and to prevent bottle from bursting

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20
Q

Why are unseated bubble humidifiers used for with a nasal cannula in hospitals?

A

To prevent gas from being delivered (>4L/min) or at the patient’s request (nasal dryness and irritation) and are of limited effectiveness at flows above 10 L/min

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21
Q

What are the three types of active humidifiers?

A

Simple reservoir, wick, and membrane type

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22
Q

What is the purpose of a simple reservoir type? (Active humidifier)

A

Typically used to heat fluids with mechanical ventilation
(Directs gas over a surface of a volume of water)

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23
Q

What is the purpose of a wick type? (Active humidifier)

A

Increase surface area and enhances evaporation by incorporating an absorbent material partially submerged in a water reservoir that is surrounded by a heating element
Also absorb material increases surfaces surface area for dry air to interface with heated water

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24
Q

What is the purpose of a membrane type? (Active humidifiers)

A

Separate water from gas stream by means of hydrophobic membrane, no bubble activity is present

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25
Q

How does a membrane type work? (Active humidifier)

A

Water heats up, it evaporates, causing the water vapor to pass through the membrane into the gas stream

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26
Q

Contraindication for HMEs

A

Presence of thick, copious, or bloody secretions
Presence of a large leak around an artificial airway (Endotracheal Tube- ETT or Tracheostomy Tube)
Patients minute ventilation (VE) exceeds 10 L/min

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27
Q

What are heated humidifiers used for?

A

Used primarily for patients with bypassed upper airways and/or receiving long term receiving mechanical ventilation

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28
Q

What are some problems that arise with condensation?

A

Pose risks to patient and caregivers
Can waste a lot of water
Can occlude gas flow through circuit
Can be aspirated
Problem can be minimized with use of water traps and heated circuits, by positioning circuits so it drains condensate away from patient, and checking humidifier and nebulizer often

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29
Q

What is a common cross contamination risk when using humidity therapy devices?

A

Water in circuit can be a source of bacterial colonization

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30
Q

When does the circuit need to be changed?

A

Frequent change is not needed to reduce chance of nosocomial infection

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31
Q

What are the two types of bland aerosol therapy?

A

Large volume nebulizer (LVN)
Ultrasonic Nebulizer (USN)

32
Q

Which patients are treated with bland aerosol therapy?

A

History of airway hyper responsiveness
Patients with a bypassed upper airway
Patients with an active bronchoconstriction (upper airway edema)
Patients that need to provide a sputum specimen

33
Q

What other patients need bland aerosol therapy for?

A

Patients with a decreased work of breathing (WOB)
An improvement in vital signs
A decrease in strider from dyspnea
An improved O2 saturation

34
Q

What are some troubleshoots that cause a ultrasonic nebulizer to not shoot mist?

A

Electrical power source
Carrier gas fling through the device
Output control is set to the maximum setting
Inspect couplant chamber to confirm cleanliness and fill level

35
Q

What do the American College of Chest Physicians recommend in terms of bubble humidifiers?

A

To not use a bubble humidifier at flow O2 rates of 4 L/min or less, as the entrained gas provides sufficient humidity

36
Q

What is another recommendation from The American College of Chest Physicians?

A

When a patient complains of nasal dryness or irritation when receiving low flow O2, a humidifier hound be added to the delivery system

37
Q

How do you identify hypoxemia?

A

Pao2 less than 60 mmHg or SaO2, less than 90% in subjects breathing room air
PaO2 or SaO2 below desirable range for a specific clinical situation

38
Q

What are the signs and symptoms associated with severe hypoxemia?

A

Tachypnea, tachycardia, cyanosis, and paleness

39
Q

What is an indicator for when to force oxygen therapy?

A

Suspected hypoxemia is suspected
Severe trauma
Acute myocardial infarction
Short-term therapy or surgical intervention (post anesthesia surgery)

40
Q

What are the normal ranges for oxygenation? (PaO2)

A

-80-100 mmHg normally on RA
-100-120 mmHg max on RA (21% FiO2)
-100-600 mmHg max on O2 (100% FiO2 O2)

41
Q

What are the ranges for hypoxemia?

A

60-79 mmHg: Mild Hypoxemia
40-59 mmHg: Moderate Hypoxemia
<40 mmHg: Severe Hypoxemia and needs immediate intervention

42
Q

What are the ranges of a patient with chronic lung disease and an accompanying acute-on-chronic hypoxemia episode?

A

-Uses minimal oxygen requirements
-Acute-on-chronic hypoxemia episode
-SaO2 of 85-90%
-PaO2 of 50-60 mmHg

43
Q

What are some precautions or possible complications when using oxygen therapy on neonatals?

A

-Retinopathy of Prematurity (ROP) is a potentially serious management problem in premature or low-birth weight infants

44
Q

What is retinopathy of prematurity (ROP)?

A

Increases the ocular pressure in the eyes causing blindness due to the vessels bursting in their eyes.

45
Q

What can contribute to retinopathy of prematurity?

A

A PaO2 greater than 80 mmHg (in premature infants)
Therefore The American Academy of Pediatrics recommends keeping PaO2 below this level

46
Q

Oxygen therapy can decrease the following?

A

Ventilatory demand
Work of breathing
Cardiac output

47
Q

What are the three basic designs for O2 delivery system?

A
  1. Low Flow Systems (<35% FiO2)
  2. Reservoir Systems (35-60% FiO2)
  3. High- Flow Systems (>60% FiO2)
48
Q

What are some questions we need to keep in mind when determining how a device should be used? (O2 DELIVERY SYSTEM)

A

How much O2 can the system deliver?
Does the delivered FiO2 remain fixed or vary under changing patient demands?

49
Q

When selecting a proper O2 delivery device the what are the following factors that should be used to determine the proper choice?

A

Knowledge of the general performance of the device
Individual capabilities of the equipment

50
Q

What are some patient considerations when selecting a O2 therapy equipment?

A

Type of airway (natural or artificial)
Severity and cause of hypoxemia
Age group (infant, child, adult)
Stability of minute ventilation

51
Q

What causes a low flow device causing supplemental oxygen to be diluted with room air?

A

Unpredictable 2/2 the patients flow usually exceeds that from a low flow device

52
Q

What kind of devices provide variable oxygen concentrations?

A

Low flow devices (all)

53
Q

What is the variable-performance system?

A

A delivery system that provides only a portion of the patients inspired gas

54
Q

What are the rule of fours?

A

FiO2 estimates when using a nasal cannula:
Room Air 21%

55
Q

Rule of fours

A

1L/min= 24%

56
Q

2L/min equals?

A

28%

57
Q

3L/min equals?

A

32%

58
Q

4L/min equals?

A

36%

59
Q

5L/min equals?

A

40%

60
Q

6L/min equals?

A

44%

61
Q

What causes the mask volume to act as dead space and cause carbon dioxide (CO2) rebreathing?

A

At a flow less than 5L/min

62
Q

What happens to the total output flow when the O2 concentration increases?

A

Total output flow decreases

63
Q

What are the physiologic effects of hyperbaric oxygen therapy?

A

Bubble reduction (Boyle’s Law)
Hyperoxygenation of blood and tissue (Henry’s Law)
Vasoconstriction
Enhanced host immune function
Neovascularization

64
Q

What are the three main indication of acute conditions?

A

Decompression sickness
Air or gas embolism
Carbon monoxide and cyanide poisoning

65
Q

What are other indications of acute conditions from hyperbaric oxygen therapy?

A

Acute traumatic ischemia (compartment syndrome, crush injury)
Acute peripheral arterial insufficiency
Intracranial abscesses

66
Q

What are the last few indications of acute conditions for hyperbaric oxygen therapy?

A

Crush injuries and suturing of severed limbs
Clostridia gangrene
Necrotizing soft tissue infection
Ischemic skin graft or flap

67
Q

What a re the three main complications and hazards of HBO?

A
  1. Barotrauma
  2. Oxygen toxicity
  3. Other
68
Q

What are some examples of barotrauma?

A

Ear or sinus trauma
Tympanic membrane rupture
Alveolar over distention and pneumothorax
Gas embolism

69
Q

What are some examples of oxygen toxicity?

A

CNS toxic reaction
Pulmonary toxic reaction

70
Q

What are some other examples of complications from HBO?

A

Fire
Sudden decompression
Reversible visual changes
Claustrophobia
Decreased cardiac output

71
Q

What are some potential uses for inhaled nitric oxide?

A

ARDS
Persistent pulmonary hypertension of the newborn (PPHN)
Primary pulmonary hypertension
Cardiac transplantation
Acute pulmonary embolism
COPD
Congenital diaphragmatic hernia
Sickle cell disease
Testing pulmonary vascular responsiveness

72
Q

What is the main adverse effect associated with nitric oxide therapy?

A

Rebound hypoxemia and pulmonary hypertension

73
Q

What is the correction for an 80:20 helium-O2 mixture?

A

1.8; for every 10L/min indicated flow, 10 x 1.8, or 18L/min is delivered

74
Q

What is the factor for a 70:30 helium mixture?

A

1.6

75
Q

How do you maintain normal physiologic conditions in the lower airway?

A

Which involves adding water vapor and sometimes heat to the inspired gas.

Fundamentals Of Respiratory Care (8 decks)

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