| Question | Answer |
| What are the 3 evaporation factors? | Temperature, Atmospheric Pressure, Surface Area |
| Calculate Relative Humidity | Content(what you measure)/ Max capacity x 100 |
| Maximum Absolute Humidity | 44mg/L |
| Humidity Deficit | 44mg/L - what you measure |
| What size aerosol particles target the upper airways like the larynx, pharynx? | 5-20 microns |
| What size aerosol particles target the lower airways from the trachea to terminal bronchioles? | 2-5 microns |
| What size aerosol particles target the parenchyma know as the gas exchange area? | 1-3 microns |
| What is inertial impaction? | Particles >5 microns stay on at bends. Think of the pic of the particles at the bend in the tube. |
| What factors increase inertial impaction? | Turbulent flow, Airway branching, Hi Inspiratory flow > 30L/M |
| What is Graviational Sedimentation? | particles between 1-5 microns. Time increases G.S. with a 10 sec breath hold deposition increases up to 10% |
| What patient factors affect G.S.? | Ventilation Pattern. Hi Insp. Flow, Slow Rate, Large Tidal V, Mouth breathing |
| Inadequate Humidification results in? | Impaired ciliary activity, Impaired mucus flow, Retained Secretions, Infections, Pneumonia |
| What are the goals of Humidification? | Humidify Inspired Gas(Jet Neb), Deliver Meds(MDI), Improve Bronchial Hygiene(Ultrasonic) which thins secretions and promotes cough and expectoration |
| What are the Hazards of Humidification? | Bronchospasm with mucolytic and proteolytic aerosols(Asthmatics) |
| ANSI Standards for Humidification Devices | Minimum level of A.H. to aviod mucosal damage to upper airway is 10mg/L for spontaneous breathing. Pts w/bypassed airways(ET tube, trach tube)minimum 30mg/L |
| Bubble Humidifier | Low Flow Device - Think bubbler in fish tank. Cannula to partial and non rebreather. Output 15-20mg/L |
| Passover Humidifier | used in Vent circuits, Uses Wick or hydrophobic membrane(Membrane). Output 35-50mg/L. Lots of secretions |
| HME = Heat Moisture Exchanger | Pennies. Captures pt exhaled gas and uses it to warm and humidify next inspiration. Uses hydrophobic condenser. Output 20-30mg/L |
| Nebulization | Baffles or plates to decrease particle MMAD |
| Categories of Nebs | Pneumatic(powered by gas) include Jet,SVN, LVN, MDI, DPI. Electric- ultrasonic |
| What's the primary goal of Jet Neb? AKA Air entrainment neb | Humidify Inspired Gas |
| What's the primary goal of SVN? | Deliver Meds |
| What's the number one factor affecting SVNs? | Baffles. |
| What are the 2 types of LVNs? | SPAG and Heart/Hope |
| SPAG Neb = Small Particle Aerosol Generator | Deliver Ribavirin for RSV |
| Heart/Hope Neb = High output Extended Aerosol Respiratory Therapy | Continuous Bronchodilator delivery |
| MDI | Deliver Med |
| MDI Factors | Patient Technique. Use spacers and holding chambers and use flow triggered MDI to reduce oropharyngeal depostion |
| DPI | Breath accuated to Deliver Meds |
| DPI Factors | High Inspiratory Flow - >40 L/M therefore not on infants or pts w/SOB. High Humidity causes Clumping of MEd |
| What is the primary goal of Ultrasonic? | Thin and Mobilize secretions. Outputs as much as 500mg/L. Saturates the airways |
| Drug Dilution | Ex. 1:200. 1gram/200ml H2O = 1000mg/200ml = 5mg/ml |
| Percent Solution | divide mg/ml/10 for % solution or % solution x 10= mg/ml |
| Autonomic NS | Sympathetic - neurotransmitter is norepinephrine. Receptors termed adrenergic. Parasympathetic - transmitter is Acetylcholine and receptor termed cholinergic |
| Adrenergic | Drugs that stim receptors sensitive to norepinephrine |
| Cholinergic | Drugs that stim receptors sensitive to acetylcholine |
| Anitcholinergic | Drugs that block receptors sensitive to acetylcholine |
| Cholinergic Effects(Parasympathetic) | Decrease Heart Rate, Bronchoconstriction, Vasodilation in Pulmonary Bl. Vessels |
| Alpha Stimulation | Pulmonary BL. V. = vasoconstrition |
| Beta 1 Stim | Heart rate increase and contraction |
| Beta 2 Stim | Bronchodilation and vasodilation |
| Adrenergic Action (Sympathetic) | Alpha drugs vasoconstrict to increase BP or decrease mucusal edema. B1 increase HR and Inotropic. B2 = brocho and vaso dilation |
| Anticholinergic Action (Blocks Para) | Bronchodilation, Increase HR, Dry secretions |
| Catecholamines | Racemic Epinephrine is the only one still used. Hits all receptors. Is the quickest. |
| Noncatecholamines - Quick Onset/Short Duration | Alupent- Neb/MDI/Tab |
| Noncatecholamines - Slower onset(15 min)/Longer Duration | Albuterol, Levalbuterol, Formoterol, Salmeterol |
| Noncatecholamines - Quick Onset(5 min)/Long Duration(8-12 hours) | Maxair, Brovana, Tornalate |
| Adrenergic Side Effects | Tachycardia, Tremor, Headache, Insomnia, Nervousness |
| Anticholinergic Drugs | Atrovent, Spirvia |
| Anticholinergic Side Effects | Increase HR, Increase BP, Decrease Secretions |
| What Mediator Antagonist are Mast Cell Stabilizers? | Intal, Tilade |
| What Mediator Antagonist are Leukotriene Blockers? | Accolate, Zyflo, Singulair(most popular) |
| What do mast cells contain? | Histamine and inflammatory mediators |
| Stim of Leukotriene receptor cause what? | Bronchoconstriction, Mucus Secretions, and Release of Inflammatory Cells |
| What are Glucocorticosteroids used for? | Maintenance of Asthma |
| Steroids Agents | Prednisone(Tab), Pulmicort(MDI,DPI) |
| Steroid Side Effects | Thrush, Weak Bones, Immunosuppresion(more pulmonary infection), Peptic Ulcers, Muscle Wasting, Hair, Moon Face, Fat Deposits |
| What is the device of choice for Wetting Agents? | Ultrasonic |
| Saline Solutions - Use Ultrasonic Neb(USN) | Iso(.9%) = Thin secretions, Hypo(<.9%) = Thin, Hyper(>.9%) Sputum induction |
| What is the only Mucolytic agent? | Mucomyst. Disrupts the disulfide bonds in mucus |
| Mucolytic Side Effects | Bronchospasm in Astmatics, Nausea, Smell, Rhinorrhea |
| Proteolytic Agents | Pulmozyme w/special neb. Used in Cystic Fibrosis pts. Digests DNA in purulent solutions |
| Proteolytic Side Effects | Pharyngitis, Laryngitis, Conjuctivitis(Pink Eye) |
