Exam 3 Review RCP 120 Fall 2023 Study Guide PDF

**Exam 3 -- RCP 120** **Study Guide & Review -- Fall 2023** 1. Define these terms: a. Aerosol -- A suspension of fine solid particles or liquid droplets in a gas. b. Humidity/Humidification -- Amount of water vapor in the air. Relative H. is a %. c. Deposition --...

**Exam 3 -- RCP 120** **Study Guide & Review -- Fall 2023** 1. Define these terms: a. Aerosol -- A suspension of fine solid particles or liquid droplets in a gas. b. Humidity/Humidification -- Amount of water vapor in the air. Relative H. is a %. c. Deposition -- When molecules settle out of a solution. (Reverse to dissolution). d. Density -- Having parts that are close together; mass of a unit volume of a substance. e. Evaporation -- Water changing from a liquid to a gas. f. Body Humidity -- Humans like 30 -- 60% humidity. Levels ↑ or ↓ can affect us. ↑ = swelling, infection, "feeling" of temp. ↓ = Increases coughing, wheezing, 'colder' feeling. Water vapor pressure = 47 mmHg, measured as 44mg/L. g. Inertial Impaction -- A particle's inability to follow sudden changes in gas flow direction. h. MMAD -- Mean Mass Aerodynamic Diameter -- Average size of particles. i. Ideal Particle Sizes -- 5 μm. 2. Humidifier -- A device that adds molecular water to a gas (air or O2). j. Occurs simply by evaporation. k. Variables that affect humidifiers: i. Temperature (Biggest influence) ii. Surface area -- Greater the surface area with more evaporation will occur. 1. Main theory of "wick" humidifiers. iii. Time of contact with water source l. Bubble-Diffusion (Think of the bubble humidifier on a nasal cannula) iv. Gas source (O2) is directed underwater where it is broken down into small bubbles which rise to the surface, creating greater evaporation and increasing water vapor content. v. Greatest factor is gas flow rate. m. Main types of humidifiers: vi. Bubble vii. Passover viii. HME -- Heat & Moisture Exchanger 2. Captures exhaled heat and moisture from the patient which then heats and humidifies the next inspiratory breath. n. Heated Humidifiers -- Often used on vents. ix. 37^0^ C. for intubated patients. x. 31^0^ C. to 34^0^ C. for mask vents. o. Hazards -- Condensation xi. Treat as infectious waste. xii. Use a water trap or install heated circuits. xiii. Do NOT: 3. Drain condensate back into reservoir or toward the patient to suction waste. 3. Aerosol Therapy p. Indications xiv. Retained secretions xv. Delivery of medications to the airways xvi. Humidification of inspired gas for patients with artificial airways xvii. Sputum induction xviii. Upper airway inflammation (cool mist most effective): Examples -- croup, epiglottitis. q. Bland Aerosol Therapy -- Delivery of sterile water saline. xix. Isotonic = 0.9% NaCl (sodium chloride) xx. Hypotonic = \< 0.9% NaCl xxi. Hypertonic = \> 0.9% NaCl 4. Commonly 3%, 5%, 7%, or 9% NaCl. xxii. These solutions have many uses, but for RTs they are good for sputum induction. 5. Hypertonics are usually preferred over hypotonics. r. Hazards xxiii. Infection xxiv. Airway Reactivity -- can cause bronchospasms xxv. Systemic Effects xxvi. Drug Reconcentration xxvii. Over-hydration -- can cause inspissated pulmonary sections due to "swelling" cause by high-density aerosols. 4. SVN -- Small Volume Nebulizers s. Used to administer many medications xxviii. SABA xxix. LABA xxx. Antibiotics xxxi. Steroids xxxii. Mucolytics (May cause bronchospasms) t. Powered by DISS gas sources -- Air or O2 u. Pulmo-Aide -- Home use and where gas sources are not available. v. Delivery Methods xxxiii. Mouthpiece xxxiv. Snug-fitting mask xxxv. Blow-by w. Needs flows of \~ 7 to 8 L/min. 5. USN - Ultrasonic Nebulizers x. Electrically powered. y. Creates high-frequency vibrations via a piezoelectric crystal. z. Vibrations are then transmitted to a liquid to create aerosol droplets. 6. Other Aerosol Delivery Devices a. SPAG -- Small Particle Aerosol Generator xxxvi. Specifically for administration of ribavirin (Virazole). xxxvii. Used for infants with RSV/Bronchiolitis. b. Respirgard Nebulizer xxxviii. Specifically for administration of pentamidine. xxxix. Used for treatment of the fungus Pneumocystic carinii, which causes a type of pneumonia. c. Continuous Nebulization xl. Very similar to SVN but are designed for long-term nebs -- 1 hour or more. xli. Used for refractory bronchospasms. 7. MDIs/DPIs d. Used to administer many medications xlii. SABA xliii. LABA xliv. Antibiotics xlv. Steroids e. Requires hand-breath coordination. f. Cold Freon Effect g. Spaces / Holding Chambers 8. Administration of Steroids h. Patient should rinse mouth xlvi. May cause hyperplastic candidiasis (Thrush) 9. BTPS -- Body Temperature, Pressure, & Saturation i. 37^0^ C. j. Pressure = 760 mmHg @ sea level k. Saturated (water vapor) = 47 mmHg (pressure) @ 44 mg/L (water vapor content) l. ISB -- Isothermic Saturation Boundary xlvii. \~ 5 to 6 cm below carina. xlviii. Point where inspired gas achieves BTPS conditions. xlix. Above the ISB, temperature & humidity decrease during inspiration & increase during expiration. l. Below the ISB, temperature & relative humidity remain fairly constant. 10. Five Patient Rights m. Patient Identification li. Full Name lii. DOB liii. Medical ID \# liv. NOT room number n. Drug -- Is it the correct medication? o. Dose -- Right dose? p. Route -- How should the medication be delivered q. Time -- For schedule treatment, usually 1 hour before or 1 hour after the scheduled time