RCP Exam 3 part 2

MDI Administration: Patient Positioning

Good positioning is key to lung expansion (Patient should be sitting up)

MDI Administration: Patient Requirements

Patient must be awake and able to follow directions.

Advantages and Disadvantages of MDIs

Cheaper and more portable, but not all meds come in MDI form.

Function of Spacers and Holding Chambers

Allow propellant to evaporate, slow delivery, and let larger particles fall out.

Spacers vs. Holding Chambers Rule

All holding chambers can be spacers, but not all spacers can be holding chambers.

Holding Chamber Characteristics

Has one-way valve holding medication for a few seconds; good for patients with poor coordination.

Spacer Characteristics

No one-way valve, medication goes directly to patient so it's not being held so patient has to be able to take a good breathe in

Best Lung Deposition for MDIs

Achieved using an MDI with a spacer or holding chamber.

Dry Powder Inhalers (DPIs)

Aerosol in a dry powder form.

DPI Airflow

Ambient air drawn through a small dose.

Propellant Status in DPIs

No propellant needed; the patient is the propellant.

DPI Inspiratory Flow Requirement

Pt must have sufficient inspiratory flow (40 to 60 L/min minimum) so they have to breathe fast and deep

Purpose, Usage and Setting of DPIs

Controller meds to prevent problems; mostly used for home setting. (must keep DPI level and steady to avoid dry powder falling out).

Definition of Propellants

What mixes with medication to make the particles smaller.

Steroid DPI Post-Use Care

Rinse mouth after steroid DPI use.

Large Volume Nebulizers (> 30 ml)

Used to provide continuous aerosol therapy; large-bore aerosol tubing maximizes delivery.

Large Volume Nebulizer Outputs and Purpose

May deliver either cool/warm mist (upper airway edema) or aerosolized medication

-Giving a larger volume of medication over a longer period of time

Small vs. Large Volume Nebulizers

Small volume neb = usually side stream. Large volume neb = usually main stream.

Heart Nebulizer

High Output Extended Aerosol Respiratory Therapy intended for continuous administration of aerosolized meds.

Heart Nebulizer Specifications

Has a 240 mL reservoir and delivers 2.2 - 3.5 microns.

Small-Particle Aerosol Generator (SPAG) primary use

Delivery of ribavirin as a treatment for RSV.

SPAG mean particle diameter

1.3 microns.

SPAG gas supplies and pressure

Two supplies at 26 psi (one creates aerosol, secondary supply that dries larger particles in the drying chamber and lets smaller particles through).

Ribavirin administration methods

Administered via tent, hood, or aerosol mask.

Potential toxic effects of ribavirin

Conjunctivitis, rash, and bronchospasm.

Ribavirin exposure restrictions

No exposure for pregnant or nursing individuals.

Precautions for ribavirin administration

Negative pressure room, HEPA mask, gloves, gown, and goggles.

Ultrasonic nebulizers mechanism

Utilize high-frequency sound waves (Hz, amplitude).

Ultrasonic nebulizer components

Generator, cable, piezoelectric crystal, reservoir, and fan.

Frequency and particle size in ultrasonic nebulizers

Inverse relationship; increased frequency produces smaller particles (1-10 microns).

Amplitude and output in ultrasonic nebulizers

Directly proportional; increased amplitude produces greater output.

Hazards of ultrasonic nebulizers

Shock and nosocomial infections.

Gas source requirement and Cleaning for ultrasonic nebulizers

None required (no gas source) & Clean with sterile water.

Small-volume ultrasonic nebulizers fill volume

Less than 10 mL.

Small-volume ultrasonic nebulizers power sources

Internal battery, 12v, and 120v adapters.

Small-volume ultrasonic nebulizers particle size

Smaller particles than conventional gas-powered nebulizers.

Vibrating mesh nebulizers mechanism

Pumps push fluid through vibrating mesh to create aerosol.

Vibrating mesh nebulizers particle size

Ranges from 2 to 5 μm.

Vibrating mesh nebulizers propellants and gas

Do not require propellants or gas to produce an aerosol; no gas is added to aerosol stream.

Vibrating mesh nebulizers efficiency

Shown to be more efficient than jet nebulizers.

Aerogen (type of VMN) advantage

Low dead volume because it aerosolizes all the medicine so there is no residual volume.

Aerogen nebulizer time for thick medicine

Long nebulizer time.

Croupette primary use and features

Commonly used for pediatric aerosol therapy providing cool mist for upper airway edema; difficult to regulate temperature, medicine, and sterilization due to hands-on treatment.

Ohmeda Pediatric Aerosol Tent

Self-contained refrigerated aerosol generator that keeps the tent cool and regulates temperature regardless of hands-on treatment.

Mistogen Child Adult Mist (CAM) Tent

Chills and circulates H2O to cool the tent; incorporates a Mistogen HV-12 neb (this is the specific nebulizer for this device so this device can't use any other nebulizer)

Bronchial Hygiene Acute Indications (Helpful)

Copious secretions, respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities secondary to consolidation.

Bronchial Hygiene Acute Contraindications (Not Helpful)

COPD exacerbation (sometimes), pneumonia without sputum, and uncomplicated asthma.

Bronchial Hygiene Chronic Indications (Helpful)

CF, bronchiectasis, chronic bronchitis, and sputum production > 25-30 mL/day (copious secretions).

Overall Purpose of Bronchial Hygiene

Helps with atelectasis/consolidation or secretion management.