Program: Respiratory Therapy Course: Introduction to Respiratory Therapy Lesson: Aerosol/Humidity Therapy and CPT

Program: Respiratory Therapy

Course: Introduction to Respiratory Therapy

Lesson: Aerosol/Humidity Therapy and CPT

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• Demonstrate proper set-up of humidifiers with high and low flow oxygen delivery devices.

• Given situations, discuss humidity deficit and prevention.

• Give indications for humidity.

• Discuss factors influencing the efficiency of humidifiers.

Major Student PerformanceObjective -Lecture

The student will be able to Administeraerosol and humidity therapy safely.

Supporting Student Performance Objectives:

• Given a situation, calculate R.H.

• Discuss problems of humidity deficit.

• Discuss hazards of humidity.

• Demonstrate bronchial hygiene methods.

• Discuss indications for bronchial hygiene use.

• Discuss indications for sputum inductions.

Supporting Student Performance Objectives Continued:





• Correctly assemble, test for function, safely apply, and troubleshoot the following humidifiers:– Pass-over humidifier

– Bubble humidifier

– Cascade humidifier

– Wick humidifier

• Demonstrate the use of humidifiers using appropriate delivery devices.

• Correctly monitor the following as appropriate:– Oxygen concentration

– Temperature

Major Student Performance Objective -Laboratory

Assemble and apply humidifiers.

SupportingStudent Performance Objectives


• Demonstrate proper body alignment and stance when performing patient care skills.

• Demonstrate the usage of good body alignment and body mechanics when positioning or assisting a lab partner.

• Demonstrate how to properly position a patient in the following positions:– Fowler’s

– Supine

– Prone

– ¼ turn from supine

– Semi-Fowler’s

– Trendelenberg


Position the patient and apply chest physiotherapy.



• Demonstrate how to assist a patient from the bed into a chair and back to bed.

• Demonstrate how to properly secure the following restraints:

– Chest

– Waist

– Wrist and ankle





• Demonstrate correct use of bed rails and other safety devices.

• Using a lab partner, properly perform postural drainage and chest percussion on any specified segment(s) of the lung including:– Proper positioning

– Identification of anatomical landmarks

– Proper manual percussion and vibration techniques

– Proper use of a mechanical percussor




Humidity

A. Water in a gaseous state

B. Water vapor

C. Molecular water in gas

D. Potential Humidity

E. Saturated

F. Absolute Humidity - A.H.

G. Relative Humidity - R.H.


Humidity

Alveolar gas

At 37oC alveolar gas holds approximately 44 mg/L of humidity

At 37oC and 100% R.H. the pressure exerted by water vapor is 47 mmHg

Humidity deficit


Humidity

Normally supplied to inspired

gas by nasal or oropharynx

passages.

Humidity adds moisture to the

respiratory tract


Aerosol

• Water particles suspended

in air

• Particulate water in a gas

• Mist

• Fog


Aerosol

• Factors affect stability

• Penetration and deposition affected by breathing pattern and size of particles



Particle Size, Deposition, and Location

Particle Size m) % Deposited Deposition Location

100

100 - 40

40-15

15-8

5-2

2.0-1

1.0

100

100

40-100

30-40

55+

50

10

Mouth, nose, equipment

Upper airways

Upper airways

Bronchi

Bronchioles

Alveoli

Exhaled

Aerosol

Airway Clearance

Indications for Aerosol

Hazards of Aerosol Therapy


Lesson: Aerosol/Humidity Therapy and CPTPassover Humidifier: Wick Type


Passover Humidifier: Membrane Type

General Considerations for Nebulizers


• 44 mg/L is the target volume for a 100% effective large volume Nebulizer.

• Therapeutic range of an aerosol particle is between 1.0-3.0 microns.

• Nebulizers are a potential source of nosocomial infections.

• Electrical nebulizers are potential shock hazards.

• Nebulizers add fluid to the body.

• Monitor patients carefully for fluid overload.

Postural Drainage


• Indications:– Mobilize accumulated secretions

due to:

• COPD

• Dehydration

• Acute pulmonary disease

– Prophylactically - history of pulmonary problems

• Right Upper Lobe– apical

– anterior

– posterior

• Right Middle Lobe– medial

– lateral

• Right Lower Lobe– superior

– anterior basal

– lateral basal

– posterior basal

Positions for Each Lung Segment


Lobe/Area Position

• Left Upper Lobe– anterior

– apical - posterior

– superior lingula

– inferior lingula

• Left Lower Lobe– superior

– anterior medial

– lateral basal

– posterior basal

Positions for Each Lung Segment


Lobe/Area Position

• Empyema

• Flail Chest

• Wounds

• Spinal Injuries

• Pneumothorax

• Head Injuries

• Unstable cardiac status

• COPD

• Obesity

• Pregnancy

• Recent meals or tube feeding

Postural Drainage - Relative Contraindications


Percussion


• Clapping chest wall

• Indications:

– When difficult to mobilize secretions

– When postural drainage alone may not be effective

• Empyema

• Flail Chest

• Wounds

• Frank hemoptysis

• Anticoagulant therapy

• Pain or patient intolerance

• TB

• Metastasized cancer

Percussion - Relative Contraindications


• Avoid sternum, spine, and bony structures.

• May use sheet or towel to avoid slapping.

• Examine skin for any effect.

• Each segment for 3-5 minutes.

Percussion Technique


• Used with percussion or alone.

• Tensing arms - keep them straight - shake from shoulder during patient exhalation only.

• Indications:– After each segment with

percussion to move secretions in large airways.

– Alone when percussion is not tolerated

Vibrations


• Use only to lung area - avoid kidneys, etc.

• Avoid bony structures.

• Avoid breast tissue in females.

• Use towel or sheet to prevent slapping.

• Use electrical precautions - avoid water and hazardous gas environments.

Mechanical Percussors and Vibrators


Patient Cases

Patient 1: Winnie Kirkwood

Patient:

Physical Findings:

Lab Data:

Order:

Winnie Kirkwood, a seventy-six year-old female. Admitted this morning with shortness of breath progressing over the last 24 hours. Patient has a history of COPD. Patient is alert and possibly confused. She is in a regular room.

Pulse 108, regular, BP 102/70, temperature 38.40 C, respiration 22, shallow. Breath sounds are decreased rhonchi in bases. Patient has an occasional cough which appears to be productive - patient is swallowing mucous. Patient is in semi-Fowler’s position, she is slightly overweight.

pH 7.37, PaCO2 60, HCO3 -34, PaO2 46, SaO2 78%, FiO2 nasal cannula at 1 Lpm, Hgb 15.8, WBC 13,100.

Increase oxygen to 5 Lpm. Administer 2 puffs ventolin via metered dose inhaler (MDI) Q. 4h.

Would you implement this order as it is written?What would you recommend in its place?Would you add or delete anything from this order?


Patient Cases

Patient 2 - Kip Kiester

Patient:

Physical Findings:

Lab Data:

Order:

Kip Kiester, a fifty-two year-old male. Patient had a colon resection two days ago. Patient is alert and oriented. He is in a regular room on the surgical floor. Patient had a thirty pack-year smoking history.

Pulse 110, regular, BP 158/90, temperature 38.80 C, respiration 24, shallow. Breath sounds are decreased with rhonchi on exhalation throughout. Chest expansion is decreased in the bases. Patient has occasional weak, non-productive cough. Skin is warm and moist.

SpO2 94% on room air.

Incentive spirometry Q. 2h. Administer 0.5cc isoetharine in 2.5cc normal saline via aerosol q. i. d.



Patient Cases

Patient 3 - Jonathan Harker

Patient:

Physical Findings:

Lab Data:

Order:

Jonathan Harker, a seventy-year-old male. Admitted this morning with an exacerbation of ulcerative colitis. Paatient has a long history of COPD. Patient is alert and oriented. He is in a regular room and has an IV.

Pulse 98, regular, BP 134/92, temperature 37.60 C, respiration 22. Breath sounds clear in apices, scattered rhonchi in the bases, occasional productive cough of white sputum. Patient is resting comfortably in bed.

SpO2 92% on 2 Lpm via nasal cannula, Hgb 12.8, WBC 12,300.

Increase oxygen to 4 Lpm. 0.5cc isoetharine in 2.5cc normal saline via aerosol Q. 4h.



Patient Cases

Patient 4 - Mina Seward

Patient:

Physical Findings:

Lab Data:

Order:

Mina Seward, a sixty-year-old female. Admitted last night from a nursing home with increasing shortness of breath and increased temperature. Patient is minimally responsive. She is in a regular room with an IV.

Pulse 104, thready, BP 96/42, temperature 38.80 C, respiration 30, shallow. Breath sounds are decreased throughout with rhonchi on exhalation. Patient has occasional weak, non-productive cough. Patient’s skin is warm and dry.

pH 7.52, PaCO2 28, HCO3 -23, PaO2 44, SaO2 83%, FiO2 0.21, Hgb 10.2, WBC 11,200.

Oral intubation, place on 60% oxygen via aerosol T-tube to an ET (endotracheal) tube.



Patient Cases

Patient 5 - Duke Lukela

Patient:

Physical Findings:

Lab Data:

Order:

Duke Lukela, a forty-two year-old male. Admitted this afternoon with an exacerbation of silicosis. Patient is alert and oriented. He is in a regular room with an IV in place.

Pulse 96, thready, BP 134/90, temperature 380 C, respiration 26, shallow. Breath sounds are very decreased throughout; chest expansion is very decreased throughout. Patient is not coughing.


Increase oxygen to 5 Lpm. Atrovent 2 puffs Q. 6h.



Patient Cases

Patient 6 - Philip Hogan

Patient:

Physical Findings:

Lab Data:

Order:

Philip Hogan, a sixty-year-old male. He had a large bowel resection yesterday. Patient is alert and oriented. He is on the surgical floor and has an IV in place.

Pulse 110, regular, BP 146/82, temperature 38.40 C, respiration 26. Breath sounds decreased with fine crackles in the right base, chest expansion is decreased on both sides, less on the right. Patient has occasional weak, non-productive cough.

SpO2 90% on room air.

Oxygen at 2 Lpm via nasal cannula. IPPB with 0.3cc metaproterenol in 2.1cc normal saline q.i.d.



Patient Cases

Patient 7 - Ann Fan

Patient:

Physical Findings:

Lab Data:

Order:

Ann Fan, a fifty-two year-old female. Admitted through the emergency department with an exacerbation of emphysema. Patient is oriented but somewhat lethargic.

Pulse 88, regular, BP 110/70, temperature 38.20 C, respiration 24, shallow. Breath sounds are very decreased throughout. Chest expansion is decreased especially in the bases. Patient has an occasional weak, non-productive cough. Patient is in semi-Fowler’s position and has warm dry skin.


Increase oxygen to 3 Lpm. IPPB with 0.5cc albuterol in 2cc 20% mucomyst Q. 4h.



Patient Cases

Patient 8 - Wilbur PostPatient:

Physical Findings:

Lab Data:

Order:

Wilbur Post, a fifty-two year-old male. Admitted through the emergency department with acute onset of shortness of breath. Patient has a long history of congestive heart failure. Patient is alert and very anxious. He is on an emergency room cart.

Pulse 132, bounding, BP 178/96, temperature 37.20 C, respiration 30, shallow and labored. Breath sounds are decreased throughout with course crackles in all fields. The patient is not coughing. His skin is warm and moist. He is sitting up in bed in apparent respiratory distress.

pH 7.39, PaCO2 45, HCO3 -26, PaO2 41, SaO2 76%, FiO2 0.21.

Oxygen via nasal cannula at 6 Lpm. 0.5cc albuterol in 2.5cc normal saline stat.




• Demonstrate proper set-up of humidifiers with high and low flow oxygen delivery devices.

• Given situations, discuss humidity deficit and prevention.

• Give indications for humidity.

• Discuss factors influencing the efficiency of humidifiers.





• Given a situation, calculate R.H.

• Discuss problems of humidity deficit.

• Discuss hazards of humidity.

• Demonstrate bronchial hygiene methods.

• Discuss indications for bronchial hygiene use.

• Discuss indications for sputum induction.





• Correctly assemble, test for function, safely apply, and troubleshoot the following humidifiers:– Pass-over humidifier

– Bubble humidifier

– Cascade humidifier

– Wick humidifier

• Demonstrate the use of humidifiers using appropriate delivery devices.

• Correctly monitor the following as appropriate:– Oxygen concentration

– Temperature


Assemble and apply humidifiers.

Supporting Student Performance Objectives


• Demonstrate proper body alignment and stance when performing patient care skills.

• Demonstrate the usage of good body alignment and body mechanics when positioning or assisting a lab partner.

• Demonstrate how to properly position a patient in the following positions:– Fowler’s

– Supine

– Prone

– ¼ turn from supine

– Semi-fowler’s

– Trendelenberg





• Demonstrate how to assist a patient from the bed into a chair and back to bed.

• Demonstrate how to properly secure the following restraints:

– Chest

– Waist

– Wrist and ankle





• Demonstrate correct use of bed rails and other safety devices.

• Using a lab partner, properly perform postural drainage and chest percussion on any specified segment(s) of the lung including:– Proper positioning

– Identification of anatomical landmarks

– Proper manual percussion and vibration techniques

– Proper use of a mechanical percussor




Documents

Program: Respiratory Therapy Course: Introduction to Respiratory Therapy Lesson: Aerosol/Humidity Therapy and CPT