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Therapeutics 2 > T2 > Flashcards

T2 Flashcards

1
Q

Capillary action

A

Liquid in a small tube moves upward against gravity (jet neb)

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2
Q

Recommended heat and humidity levels
Nose/mouth

A

Temp. 20-22
Relative humidity -50
Absolute humidity -10

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3
Q

Recommended heat & humidity levels
Hypopharynx

A

Temp - 29-32
Relative humidity- 95
Absolute humidity- 28-34

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4
Q

Recommend heat & humidity levels
Trachea

A

Temp 32-35
Relative humidity - 100
Absolute humidity- 36-40

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5
Q

Humidity

A

Molecular water, invisible moisture, water in a gaseous state, quality of wetness in the air

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6
Q

Absolute humidity

A

Amount of the water in a given volume of gas

Relative humidity • capacity = AH

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7
Q

Relative humidity

A

Ratio between amount of water in a given volume of gas and the amount it can hold (%)

Actual humidity/ capacity • 100 = RH

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8
Q

Body humidity

A

Absolute humidity at body temp (%)

Absolute humidity/ capacity • 100 = BH

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9
Q

Humidity deficit

A

Inspired gas that is not fully saturated the body creates a deficit (mg/L and %)

Humidity deficit (mg/L) = capacity - absolute
Humidity deficit (%) = deficit in mg/L / capacity • 100

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10
Q

Why deliver humidity at body temp?

A

If adequate humidification is not provided , patients airways will dry out . Secretions become thick, tenacious and inspissated. RAW increases and secretions are harder to mobilize

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11
Q

Indications for humidification and warming of inspired gases

A

Primary :
—Humidification of dry medical gases
—Overcome humidity deficit created by bypassed UAW

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12
Q

Indications for humidification and delivery of cool aerosol

A

To treat UAW inflammation from
- laryngotrachealbronchitis LTB (croup)
- Epiglottis
- Post - extubation edema

Sputum induction

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13
Q

Effects / Hazards of lack of humidity and heat

A
  • hypothermia
  • inspissated secretions
  • impaired mucociliary function
  • destruction of AW epithelium
  • mucus plugs & atelectasis
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14
Q

Evaporation

A

Liquid water turning into a water vapor and increasing the RH % of that gas.

Occurs in non-heated and heated humidifiers

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15
Q

Condensation

A

When a gas that is 100% saturated (100% RH) is cooled, it’s capacity decreases and water vapor turns back into liquid

Occurs in ventilator and aerosol tubing as source gas moves towards patient

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16
Q

S&S of inadequate humidification

A

Atelectasis
Dry, nonproductive cough
Increased airway resistance
Increased incidents of infection
Increased work of breathing
Substernal pain
Thick, dehydrated secretions

17
Q

Goal of humidification

A

Provide 100% humidity for patients with bypassed UAW

minimize or eliminate a humidity deficit while breathing dry medical gas

18
Q

Humidifier

A

Adds molecular water to gas

19
Q

Nebulizar

A

Small water particles (aerosol) dispersed into gas for evaporation

20
Q

Aerosol

A

Suspended particle of substance in a gas

21
Q

Principles governing humidification

A

Temperature

Surface area

Contact time

Thermal Mass

22
Q

Bubble humidifier

A

Most common

15 to 20 mg/L absolute humidity

Pressure Pop-off (2 psig)

23
Q

Pass - Over humidifier

A

Reservoir: directs directs gas over surface of water

Wick: Absorbent material to increase the surface area for dry gas to interface with heated water.

Membrane: separates gas by placement of hydrophobic membrane. Water vapor passes thru easily while liquid water & pathogens cannot.
Advantages — maintain saturation of gas at high flow rates , add small amount of resistance to circuit, decrease risk of infection

24
Q

Passive humidifiers - heat & moisture exchanger - HME ( aka artificial nose )

A

Provides 30 mg/L water vapor 70% efficient

3types : simple condenser, hygroscopic & hydroscopic

25
Q

Simple condenser humidifier

A

Condenser element with high thermal conductivity

50% efficiency

26
Q

Hydroscopic condenser humidifiers

A

Condenser element with low thermal conductivity and hygroscopic salt

70% efficiency

May retain more heat

27
Q

Hydrophobic condenser humidifiers

A

Water repellent element

Large surface and low thermal conductivity

70% efficiency

28
Q

ISO

A

Low compliance
Operate at 70% efficiency or better
Simple to use

29
Q

Contraindications for HME use

A

Thick, copious , or bloody secretions

Hypothermia (32C or less)

Expired VT less than 70% of the delivered VT

HME must be removed from the patient circuit during aerosol treatments when the nebulizar is placed in the patient circuit

May be contraindicated in patients with high spontaneous minute volumes (>10L/min)

30
Q

Types of heating systems

A

Electric

-hot plate at base
-wraparound surrounds humidifier
-yolk or collar-between reservoir and outlet
-immersion type in reservoir
-heated wire systems

Servo controlled monitors , temp near AW

New active humidification systems

31
Q

Temperature to the patient should not exceed …

A

37 C

32
Q

For bypassed AW temp must be set to …

A

33 C += 2

To maintain an AW temp of 35-37 C and provide a minimum of 30 mg/L of water vapor content

33
Q

What type of water must be used in reservoir systems

A

Sterile or distilled

34
Q

Hazards for heated systems

A

Potential for electrical shock
Hypothermia
Hyperthermia
Thermal injury to airway
Burns to patient or circuit meltdown
Under hydration and secretion impaction
Inadvertent overfilling

35
Q

Bland aerosol

A

Large particle size than humidity
Use baffling to reproduce particle size
LVN

36
Q

Piezoeléctric transducer

A

Crystal that makes acoustic waves within drug solution

37
Q

Indications for cool bland aerosol

A

Upper AW edema

LTB (croup)

Subglottic edema

Post extubation edema

Post op management of upper AW

Sputum induction

38
Q

Indications for heated bland aerosol

A

Bypassed upper AW

Management of hypothermia

39
Q

Hazards of bland aerosol

A

Wheezing (bronchi spasms)
History of AW hypersensitivity
Nosocomical infectious
Over hydration
Patient discomfort
Caregiver infection

Therapeutics 2 (6 decks)

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