Respiratory Therapy Unit 5 – Flashcards
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Relative Humidity
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The ratio that compares the (AH) absolute humidity present to the gases capacity to hold water vapor or become saturated, It is usually expressed as % (RH) Relative Humidity.
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Aerosol
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Water in droplets (groups of liquid molecules) suspended in the air.
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Absolute Humidity
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Actual mass or content of water in a measured volume of air, It is usually expressed in grams per cubic meter or pounds.
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Nebulizer
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A device that produces an aerosol suspension of liquid particles in a gaseous medium, using baffling to control the particle size.
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Humidifier
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A device that delivers humidity in the form of water vapor.( A device that adds molecular water to gas).
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What are 5 factors affecting Humidifier efficiency?
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Surface Area of gas - water interface, Time of gas - water contact, Height of water column in diffuser system,Flow rate of gas through humidification system,Temperature of gas and water
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How is tubing condensate properly collected and discarded?
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Loop tubing below pt. level, Use condensation collection bags/ jars,Use heated wire systems for ventilator circuits
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What Areosol generating device has a hand pump mechanism,sqeeze bulb or plunger, Jet nebulizer with no impact ball, and produces large droplets for deposition in the nose and oropharynx?
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Atomizers
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Describe the potential negative physiological effects of sustaining a continuing humidity deficit.
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1. Drying out (inspiration) of secretions, which leads to secretion retention. 2. It decreases or slows down the mucociliary escalator(the removal of mucos from the body) causing secretion retention. 3. Causes an increased risk of infection, which can lead to pneumonia, increased secretions and actelactisis. 4. Energy loss due to an increased evaporation (heat of evaporation 540 cal/g H2O)
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Humidity Deficit
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The absolute humidity the body must add to inhaled gases to achieve 100 % RH (relative humidity) @ BTPS.
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What is the relative humidity output at operating (room) temperature of the common, disposable, bubble humidifier: Passover, Bubbble Diffuser, Bubbler, and Jet.
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90-100 % RH
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This nebulizer design delivers larger, heavier droplets (5-10 microns) apropriate for deposition in the upper airways and larger lower airways, it's normal max total flow through aerosol generation is about 50 L/ min. Is it the Mainstream or the Sidestream Nebulizer design?
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Mainstream design
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This nebulizer delivers smaller, lighter droplets (2-4 microns) appropriate for deposition in medium and small larger lower airways, it's normal max total flow through aerosol generation is about 10 L/ min. Is it the Mainstream or the Sidestream Nebulizer design?
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Sidestream design
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Explain why aerosol particles less than 1 u, in diameter are of little use in pulmonary therapy.
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They are so small they just float in and rite back out again; they can't deposit on anything.
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What is the effect of "back pressure" on FIO2 output?
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INCREASES with a DECREASED amount of entrained air to dilute the oxygen.
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What is the average humidification rating for common, disposable, bubble- humidifiers when the output gas is heated to body temperature?
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40%. RH, (Relative Humidity)
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What are 4 factors which affect temperature delivery in a heated humidification system.
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Resevoir Temperature,Gas flow rate, Length of delivery tube, Thermal insulation properties of tube material
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What is the site of deposition for particle size 2-5 u, in the respiratory tract?
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Small airways (<2mm diameter)
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Humidity Deficit
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The absolute humidity the body must add to inhaled gases to achieve 100% RH @ BTPS.
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The theraputic goal of a large volume ultra sonic nebulizer (USN) is to?
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Hydrate inspissated (thick) secretions
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What are the 3 general purposes (theraputic goals) of humidification therapy?
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Humidify dry medical gases, Humidify inspired gases which bypass normal upper airways, To relieve some types of broncho constriction
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What is the construction like in a HHJN (hand held jet nebulizer)SVN (small volume nebulizer)?
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They have baffle ball elements like, impact ball, solution surface, resevoir walls/ tops, right angle turns in gas pathway. the baffle is used to reduce droplet size.
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What are the major theraputic gaols for large, unheated, air entrained jet nebulizers?
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Control FI02 and provide at high flow Rates, Humidify high oxygen percent gases, Cool inflamed larynx after intubation
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How does the MDI (Metered Dose Inhaler) operate?
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operates by volatile gas propelling a metered dose of medications.
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An RT wants to give their patient meds such as bronchodialtors, steroids, and cromolyn sodium which have a particle size or MMD of 2-4 u. How can the RT instruct the patient, so the meds deposit in the target area (pulmonary periphery)?
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Ask their patient to take long, slow inspirations,(laminar flow), with sustained end inspiratory holds.This will help to increase the deposition of the particles.
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What type of scenarios would an RT, not have to use humidification therapy?
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If the patient was on dry oxygen therapy, if the patient was getting oxygen through a venti mask <.40 FIO2, If the patient was receiving oxygen through a nasal cannula at a flowrate < 4L / min.
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What element to the transducer sets the Quantity/ Density of aerosol droplets?
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Amplitude (signal strenth)
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At what frequency does the transducer of the Devilbiss USN (ultra sonic nebulizer) operate?
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A factory set 1.35 MHz (average 1-2 MHz)
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What are the common applications of both the cool and heated large resevoir jet nebulizers?
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Hydration of secretions
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What are the potential hazards of any given humidifier?
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Source of Leaks, Increased air way resistance, More weight on Airway,More tidal volume (VT) lost to compliance/ comppression, Source of occlusion with secretions, Less effective long term humidification
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What is a SPAG unit?
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Small Particle Aerosol Gennerator (SPAG).
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What is the SPAG (Small Particle Aerosol Generator) used for?
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It is used to areosilize Ribaviran. Ribaviran is used to treat pediatric/infant Pneumonia caused by RSV (respiratory insycytial virus).
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Aerosol Penetration is?
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How far aerosol particles enter into the pulmonary system.
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Aerosol Deposition is?
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Where aerosol particles land on the pulmonary tisue.
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What are the 4 safety features designed into humidifier units?
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DISS fittings, Pressure Pop- Offs, Translucent Plastic, Maximum / Minimum Lines
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What would happen to the amount of gas entrained if you decrease the Jet Orifice Size?
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It would cause an INCREASED velocity leading to a DECREASE in the lateral pressureand then, causing an INCREASE in gas entrainment, Which causes a DECREASED oxygen percent.
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What would happen to the amount of gas entrained if you increased the entrainment port size?
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It would cause a DECREASE in resistance to entrainment leading to MORE gas being entrained which causes a DECREASED oxygen percent.
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What happens to the FIO2 when there is a decrease in entrained air to dilute the oxygen?
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INCREASES
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What happens to the Total delivered Flow Rates when there is a decrease in entrained air?
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DECREASE.
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What happens to the oxygen flow rates, from the effects of non-occluding "back pressure"?
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Nothing (they remain constant)
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What are the effects on entrained air flow, from an increased "back pressure" or Partial Occlusion?
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Decreases with an increased partial occlusion and back flow.
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What are some potential hazards from Aerosol Therapy?
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Bacterial Contamination, Drug Reactions ( increased HR), Bronch Spasms ( NOT as a drug reaction), Cardiovascular Fluid Overload, Swelling of Inspissated (thick) secretions, Thermal airway burns
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What parts of the nebulizer may provide some type of Baffle ball effect?
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ball (impact baffle), water surface, neb walls on top, 90 degree angle to exit chamber
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Which treatment would you use if you wanted to avoid the risk of a nosocomial infection,(Aerosol,Humidifier)?
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Humidifier because it produces only molecular sized water droplets, which are to small to carry microorganisms.
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In what ways is water normally lossed from the body?
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From U.O (urinary output) and as fecal matter
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In what ways is water insesible lossed from the body?
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Sweating and Ventilation, Fever, Increased Minute Ventilation.
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What is the normal humidity conditions below the Carina (during resting ventilation)?
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Water Vapor Pressure is 47 mmHg, Body temp. 37 degrees celcius. RH is 100 %, AH is 43.9 mgH2O/L air
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What are the 6 factors that affect penetration and deposition?
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Aerosol particle size or MMAD, GSD,Inertial Impact, Sedimentation,Diffusion Brownian Motion @<3 u, Aging:Physical nature of aerosol particles and hygroscopic tendencies, Aerosol density Coalescence
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Humidity
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Is water vapor in the air
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What are the hazards of tubing condensate in a heated humidification system?
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Bacterial Growth Medium, Aspiration (Airway Occlusion, Bronchospasm,Pneumonia),Potential for increased WOB with non- rebreathing circuits (vent. circuits)
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MMAD
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Mass Median areodynamic diameter
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GSD
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Geometric standard deviation
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Aerosol
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water in droplets (groups of liquid molecules) suspended in the air.
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Nebulizer
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A device that produces an aerosol suspension of liquid particles in a gaseous medium, using baffling to control size.
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How is the Piezoelectric effect applied to Ultrasonic Nebulizers (USN)?
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The Piezoelectric disk vibrates with an applied voltage
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What are the 5 major uses for Aerosol Therapy?
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1. Humidify delivered gases 2.Hydrate Airway Secretions 3.Reduction of Upper Airway Inflamation 4.Induce Sputum Expectorant 5. Deliver Medications
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What is the main application of an Atomizer?
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To have Large droplets deposit in the Nose and Oropharynx
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What does the Bernoulli Principle state?
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Gas pressure decreases perpendicular to a stream of fluid,and The higher the fluids streams velocity the greater the pressure drop.
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BTPS
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Body temperature and pressure, saturated
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What is the AH at 37 degrees celcius?
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43.9 mgH2O/ L Air
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What is the AH at 100 degrees celcius?
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598.0 mgH2O/ L Air
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What is the AH at 0 degrees celcius?
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4.8 mgH2O/ L Air
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What is the AH at 22 degrees celcius?
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19.4 mgH20/ L Air
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RH is always at what percent?
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100
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How would you treat a patient who has a slowing down of the mucociliary escalator?
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Have patient drink more wateras well as applying humidity to their airways.
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What size droplets / particles does the Mainstream Nebulizer deliver?
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larger, heavier droplets (5-10 microns)
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What size droplets / particles does the Sidestream Nebulizer deliver?
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smaller, lighter droplets (2-4 microns)
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What areas is the Mainstream Nebulizer's droplets designed to reach?
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upper airways and larger lower airways.
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What areas is the Sidestream Nebulizer's droplets designed to reach?
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medium and small larger lower airways
