MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01CCA9CE.5BF742B0" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Windows® Internet Explorer®. ------=_NextPart_01CCA9CE.5BF742B0 Content-Location: file:///C:/D68A9279/GasNotesforUnit10,aerosoltherapy.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Notes for Unit 10, Aerosol Therapy

Notes for Unit 10, Aerosol Therapy

 

1.         = Aerosol- particles of liquid or solid suspended in a gas.

 

2.         = Aerosol measured by:  particle size: m= ass median aerodynamic diameter (MMAD), microns

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  total output: ml/min, factor or particle size and numb= er of particles

 

3.         = Particle Size important because it will determine where particle deposits in airway.=

 

4.         = Stability- ability to stay in suspension for significant period of time.

 

5.         = Deposition- maximum depth particles can be carried via inhaled air into respiratory tra= ct.

 

6.         = Particle size and deposition in airway. 

 

        &= nbsp;           &nbs= p;            &= nbsp;  >100 microns      =             &nb= sp;       do not enter respiratory tract

        &= nbsp;           &nbs= p;            &= nbsp;  5-100 microns      =             &nb= sp;      mouth, nose, and upper airway

        &= nbsp;           &nbs= p;            &= nbsp;  2-5 microns      =             &nb= sp;          bronchi and bronchioles

        &= nbsp;           &nbs= p;            &= nbsp;  0.5-2 microns      =             &nb= sp;       can enter alveoli

        &= nbsp;           &nbs= p;            &= nbsp;  < 0.5 microns     &n= bsp;            = ;        usually not deposited

 

7.         = Factors affecting aerosol deposition:

A)    gravity- larger partic= les affected by gravity more

B)    inertia- larger partic= les tend to travel more straight path, can’t make turns needed to deposit deep in airway

C)    kinetic activity- more particle motion creates less stability

D)    ph= ysical nature of the particl= es- if particle tends to absorb water, particle size will increase and deposit soo= ner.

E)     Temperature and humidi= ty of gas- hot, humid gases tend to increase particle size

F)     ***patient’s ventilatory pattern- best results with: slow, deep inhalation; large volume; inspiratory holds

 

8.         = Ideal ventilatory pattern for maximal deposition: slow, deep inhalation; large volume; inspiratory holds

 

9.         = If too much aerosol delivered to non-target areas: irritation, less of desired effect, more side effects

 

10.      =         Aerosol clearance- how the respiratory tract eliminates aerosol particles.

 

11.       Ways aerosol particles can be cleared- exhale, rinse out mouth, cough, mucociliary escalator, phagocytosis, suctioning, swallow.<= /p>

 

12.       Indic= ations for aerosol therapy

1)      decrease mucosal edema, anti-inflammation, croup, post-extubation laryngeal edema=

2)      mobilize secretions

3)      b= ronchodilation

4)      deliver antimicrobials=

5)      m= oisturization of respiratory tract<= o:p>

6)      anesthetize=

 

 

 

 

 

13.       Hazar= ds of aerosol therapy

1)      infection, contaminati= on

2)      bronchospasm

3)      o= verhydration- mainly in infants

4)      obstruction due to swe= lling of retained secretions

5)      drug reconcentration

6)      m= isdosing

7)      reaction to other drug= s

8)      thermal injury

9)      increased airways resi= stance

10)  secondary exposure to medication

 

14.       Nebul= izer- equipment that produces aerosol

        &= nbsp;   Baffle- device placed in path of aerosol to remove larger particles and create over= all smaller particles

        &= nbsp;   Atomizer- nebulizer without a baffle

 

15.       Jet nebulizer- uses a jet and Bernoulli principle, gas flow creates a drop in lateral pressure which allo= ws capillary tube to draw liquid up into path of gas, gas flow hits liquid and breaks into aerosol particles, baffle may remove larger particles.

 

16.       Small volume jet nebulizer- small jet nebulizer which holds small amount of liquid, usually used for medication delivery, can be mainstream or sidestream, particle size is 0.5-40 microns, most particles (0.5-3 microns) total outpu= t is 0.10-0.50 ml/min.

 

            Large volume jet nebulizer- larger jet nebulizer which can hold larger volumes of fluid, usually used for moisturization of respi= ratory tract but can be used for continuous delivery of medications, particle size= is usually 1-40 microns with most in the 2.2-3.5 micron range, total output is= 0.5 – 1.0 ml/min.

 

            Ultrasonic nebulizer- electric current produces sound waves that are used to break flu= id into particles; uses piezoelectric crystal; frequency of sound waves determ= ines particle size (can’t set); amplitude of sound waves determines total output (can set); particle size 1-10 microns, output: 0.5-6 ml/min; not recommended for use in small infants; usually NOT used for medication deliv= ery.

 

            Babington nebulizer- fluid flows over hollow glass sphere; gas flow enters glass sphe= re and blasts out of small hole creating aerosol particles from thin film of fluid; particle size 3-5 microns; total output: 1-6 ml/min.  (DON’T NEED TO KNOW THIS)

 

            Small Particle Aerosol Generator (SPAG)- gas-powered j= et nebulizer; uses three jets; uses drying chamber to shrink particles; baffle= is sides of container; mainly used to deliver Ribavirin for RSV bronchiolitis.=   (DON’T NEED TO KNOW THIS)

 

            HEART nebulizers- mainly used for continuous aerosol medication delivery, particle size 2.2-3.2 microns;

Mini-HEART used for aerosol delivery to neonates= on mechanical ventilator, flow usually 2 lpm.

 

Aeroneb system-primarily used in line with ventilator circuit.  Will nebulize with smaller volume= (1 ml).  Very little re= sidual volume.  Most particles around 2 microns.  <= /span>Shorter treatment time.

 

Pari Nebulizer- small = volume nebulizer known for its narrow range in particle size.  Most all particles are in therapeu= tic range.  Co= mmonly used in research.  Prim= arily used for medication delivery.

 

           

17.       Mainstream nebulizer- main g= as flow goes through the aerosol generator.

        &= nbsp;   Sidestream nebulizer- aerosol produced outside of mai= n gas flow.

 

 

18.       Metho= ds for heating large volume jet nebulizer:

        &= nbsp;   1) immersion, 2) wrap around, 3) donut, 4) plate

 

19.       Drug re= concentration- mainly with small volume nebulizers, diluent(NS) tends to nebulize fir= st leaving higher concentration of drug left towards end of treatment.  If drug not emptied at end of trea= tment, could cause higher dose delivered with next treatment.

 

20.       Albuterol<= /p>

        &= nbsp;           &nbs= p;   Trade names: Ventolin, Proventil

        &= nbsp;           &nbs= p;   Use: bronchodilator

        &= nbsp;           &nbs= p;   Adult dosage: 2.5 mg

        &= nbsp;           &nbs= p;   Side Effects: tremor, tachycardia. Palpitations, hypertension, hypoxemia, hypokalemia

 

        &= nbsp;   Levalbuterol

        &= nbsp;           &nbs= p;   Trade names: Xopenex

        &= nbsp;           &nbs= p;   Use: bronchodilator

        &= nbsp;           &nbs= p;   Adult dosage: 0.63-1.25 mg

Side Effects: tremor, tachycardia. palpitations, hypertension, hypoxemia, less side effec= ts than albuterol?

 

        &= nbsp;   Ipratropium Bromide

        &= nbsp;           &nbs= p;   Trade name: Atrovent

        &= nbsp;           &nbs= p;   Use: bronchodilator

        &= nbsp;           &nbs= p;   Adult dosage: 0.5 mg

        &= nbsp;           &nbs= p;   Side Effects: pupil dilation, dryness of mouth, nervousness, tachycardia

        &= nbsp;  

        &= nbsp;   Racemic Epinephrine

        &= nbsp;           &nbs= p;   Trade name: Vaponefrin, Micronef= rin

        &= nbsp;           &nbs= p;   Use: vasoconstrictor to reduce upper airway swelling

        &= nbsp;           &nbs= p;   Dosage: 0.5 ml 0f 2.25% solution

        &= nbsp;           &nbs= p;   Side Effects: tremor, tachycardia. Palpitations, hypertension, hypoxemia

 

        &= nbsp;   Acetylcysteine

        &= nbsp;           &nbs= p;   Trade name: Mucomyst

        &= nbsp;           &nbs= p;   Use: mucolytic

        &= nbsp;           &nbs= p;   Dosage: 2-4 ml of 10% solution

        &= nbsp;           &nbs= p;   Side Effects: bronchospasm, nausea, rhinorrhea<= /o:p>

        &= nbsp;           &nbs= p;   ** ALWAYS GIVE A BRONCHODILATOR WITH MUCOMYST

 

11/11

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