Gas Therapeutics Exam 4

Front 1

1. What happens to mucus production and secretions when airways are exposed to cold, dry air? (give 2)

Back 1

a.↑ mucus production
b.↑ airway irritability

Front 2

2. Where is the isothermic saturation boundary located?

Back 2

About 5cm below the carina at the level of the 3rd generation airways

Front 3

3. What can move the isothermic saturation boundary deeper into the lungs? (give 2)

Back 3

a.Mouth breathing
b.↑ in VT

Front 4

4. What is the PRIMARY goal of humidity therapy?

Back 4

To maintain normal physiological conditions

Front 5

5. In patients suffering from reactive airways, what happens to RAW when they breathe cold air

Back 5

↑ RAW

Front 6

6. What is commonly used to treat upper airway inflammation due to croup, epiglottitis, and swelling following extubation?

Back 6

Cool humidified gases and aerosols

Front 7

7. What does an active humidifier do?

Back 7

Adds H2O, heat, or both to inspired gases

Front 8

8. How does a passive humidifier work?

Back 8

Uses exhaled heat and moisture to humidify inspired gas

Front 9

9. What is an example of a passive humidifier?

Back 9

HME

Front 10

10. How often should HMEs be changed?

Back 10

Every 24 - 48 hours

Front 11

11. What are the contraindications of HMEs? (give 2)

Back 11

a. Thick copious secretions
b. Blood secretions

Front 12

12. What are possible hazards with HME use?

Back 12

a.↑ deadspace
b.↑ resistive WOB

Front 13

13. What provides humidification with solutions like saline for therapeutic and diagnostic purposes?

Back 13

Bland aerosol therapy

Front 14

14. What is used to provide treatment of upper airway inflammation with cold mist for local vasoconstriction?

Back 14

Large volume pneumatic nebulizers

Front 15

15. What is used to induce sputum production for diagnostic purposes?

Back 15

Large volume pneumatic nebulizers

Front 16

16. What are some of the things to consider when selecting humidity therapy for a patient? (give 2)

Back 16

a. Humidity of gas
b. Point of entry for gas

Front 17

17. What are the advantages of aerosol drug administration? (give 2)

Back 17

a. Smaller dose
b. Onset of action occurs more quickly

Front 18

18. What devices are used for aerosol drug administration?

Back 18

a. Nebulizers
b. MDI
c. DPI

Front 19

19. What aerosol particle size is most likely to deposit in the lower respiratory tract?

Back 19

1 – 5µm

Front 20

20. What aerosol particle size is most likely to deposit in the upper airway?

Back 20

Larger than 5µm

Front 21

21. What aerosol particle size is so small that it will be likely exhaled?

Back 21

0.1 – 1µm

Front 22

22. How long should a patient perform a breath hold to allow for adequate particle deposition?

Back 22

4 – 10 seconds

Front 23

23. What drugs must reach the epithelium to be effective?

Back 23

Broncodilators and steroids

Front 24

24. What drugs are most effective when dispersed in infected airway secretions at the sites of maximum airway obstructions?

Back 24

Aerosolized antibiotics and mucokinetic agents

Front 25

25. What affect does high inspiratory flow have on aerosol drug delivery?

Back 25

↑ aerosol impaction in larger airways

Front 26

26. What results in reduced amount of medication available for inspiration when using a DPI?

Back 26

low inspiratory flow

Front 27

27. What affect does humidity have on the delivery of aerosol medications?

Back 27

Humidity ↓ delivery of aerosol medications

Front 28

28. How much of the aerosol is lost during the patient’s expiratory phase during a neb treatment? Why?

Back 28

About 75% because nebs are operated throughout the patient’s respiratory cycle

Front 29

29. What are some of the technical factors that affect aerosol delivery by nebulizer? (give 2)

Back 29

a. Manufacturer flow
b. Fill volume

Front 30

30. What are some of the patient factors that affect aerosol delivery by nebulizer? (give 2)

Back 30

a. Breathing pattern
b. Nose vs. mouth breathing

Front 31

31. What is the most commonly prescribed method of aerosol delivery for bronchodilators, anticholinergics, anti-inflammatory agents, and steroids?

Back 31

MDI

Front 32

32. What is the preferred method to deliver bronchodilators to both spontaneously breathing and mechanically ventilated patients?

Back 32

MDI

Front 33

33. What is the most commonly used propellant in today’s MDIs?

Back 33

HFA

Front 34

34. Why should MDI actuators be cleaned weekly?

Back 34

HFAs can clog

Front 35

35. Instruct a patient in MDI use.

Back 35

Shake MDI 1-2 mins, tell to breathe out a regular breathe and seal lips around spacer, give 1 puff and breathe in deeply and slowly through the mouth, hold breath 4-10 seconds and breathe out slowly

Front 36

36. What causes DPIs to clump leading to problems with aerosolization?

Back 36

High ambient humidity

Front 37

37. What increases particle size regarding aerosol delivery during mechanical ventilation? What effect does this have?

Back 37

Heat and humidity ↑ particle size causing particle loss in the vent circuit.

Front 38

38. What must be done if an HME is in-line during mechanical ventilation?

Back 38

It must be removed or bypassed

Front 39

39. What is the minimal VT needed for adequate aerosol delivery during mechanical ventilation?

Back 39

500mL

Front 40

40. What are some things that should be considered when selecting an aerosol delivery device? (give 2)

Back 40

a. Which devices are least costly?
b. What device is the patient likely to be able to use properly?

Front 41

41. The physiological nose in an example of a superior HME

Back 41

True

Front 42

42. Your patient has a temperature of 98.6F. To saturate the inhaled air, how much absolute humidity must be provided by the humidifier device?

Back 42

44mg/L

Front 43

43. It is best to coach your patient to breathe in the following pattern for particle deposition in smaller airways and alveoli

Back 43

a. Inhale an IC
b. Hold breath for up to 10 seconds before exhaling
c. Inhale at a slow speed

Front 44

44. What is RH at BTPS?

Back 44

100%

Front 45

45. The doctor ordered cool humidified gas for a patient on your floor. This is most likely due to what?

Back 45

The patient having upper airway inflammation

Front 46

46. A ↓ in gas flow will result in an ↑ in rainout.

Back 46

True

Front 47

47. A shorter breathing circuit will tend to have less rainout.

Back 47

True

Front 48

48. The best way to use a dry powder inhaler (DPI) is to inhale deeply and lightly.

Back 48

False

Front 49

49. A 4-year old patient with asthma is about to be discharged and needs to take an inhaled bronchodilator medication at home. What device would you recommend?

Back 49

MDI with holding chamber

Front 50

50. For an aerosolized medication to be primarily deposited in the larger airways, what breathing pattern would you recommend?

Back 50

Inhale a VT