The student will be able to administer aerosol and humidity
therapy J. Humidity supplied to inspired gas by safely. The student will: nasopharyngeal and oropharyngeal passages: 1) Demonstrate proper set-up of humidifiers with high and low ● If not supplied by the nose, moisture will 2) flow oxygen delivery devices be taken from tracheal mucosal blanket 3) Given situations, discuss humidity deficit and prevention which dries and thickens secretions 4) Give indications for humidity 5) Discuss factors influencing the efficiency of humidifiers 6) Given situation, calculate R.H. K. Inadequate humidification can cause: 7) Discuss problems of humidity deficit 1. Decreased cilia activity 8) Discuss hazards of humidityI 2. Decreased movement of mucous 9) Demonstrate bronchial hygiene methods 3. Inflammation and necrosis of pulmonary 10) Discuss indications for use 11) Discuss sputum indication epithelium The student will be able to assemble and apply humidifiers. 4. Retention of secretions 5. Bacterial culture media 6. Atelectasis -------------------------------------------------------- 7. Pneumonia I. HUMIDITY L. Indications for humidification: A. Water in gaseous state 1. To prevent dry gas from drying mucosa 2. To provide near body humidity when B. Water vapor upper airway function is impaired or bypassed C. Molecular water in gas M. Humidity adds moisture to the respiratory D. Potential humidity tract 1. The amount of water vapor a gas can hold 2. Determined by temperature of gas N. Clinical application: 3. Sometimes referred to as capacity 1. If a humidifier puts out a R.H. of 100% at any given temperature, and then the E. Saturated temperature of a gas increases, the ● When the gas has reached its potential R.H. decreases at that temperature ○ example: if at 30° C a cascade puts out 100% R.H., and then F. Absolute humidity the temperature increases to 1. Amount of water weight held in the gas 37° C, less than 100% R.H. is 2. Expressed in mg/L delivered to the patient 2. If the temperature of a gas, that has a G. Relative humidity RH of 100%, decreases, the RH will 1. R.H. = AH/PH x 100 = is the '%' in 100% remain the same but the potential and RH actual humidity will decrease which will 2. Expressed as a % result in rain out and a decrease in delivered humidity H. Alveolar gas ● example: a humidifier puts out a 1. 100% relative humidity gas that is 37° C and has a RH of 2. At 37° C alveolar gas holds 100%. The gas is delivered to the patient through large bore tubing. approximately 44 mg/L As the gas travels through the 3. At 37° C and 100% R.H. The pressure tubing it is cooled because the exerted by water vapor is 47mmHg average room temperature is 24° C. This causes the delivered humidity I. Humidity deficit to drop from 44 mg/L to 22 mg/L ● Amount of humidity in alveolar gas and causes the water vapor to rain minus the out and form condensation. amount of humidity inspired -------------------------------------------------------- II. AEROSOL A. Water particles suspended in air B. Particulate water in a gas H. Clearance: C. Mist 1. Aerosol adds liquid water to lung D. Fog ○ must be cleared to avoid E. Stability of an aerosol accumulation ● The ability of particles to remain stable 2. Clearance methods suspended in a gas a. mobilization of the mucous blanket F. Factors affecting stability b. cough 1. Concentration c. lymphatic uptake a. number of particles d. phagocytes 2. more particles bump together e. mechanical suctioning a. Size b. large particles rain out I. Indications: 3. Relative humidity a. To thin secretions 4. low relative humidity of the gas causes b. To improve cough particles to evaporate c. To deliver medications d. Humidification of artificial airways G. Penetration and deposition 1. Penetration J. Hazards: a. depth of tracheobronchial tree 1. Swelling of dried secretions that a particle reaches a. causes airway obstruction can 2. Deposition be fatal usually patients with a a. particles rain out at a particular weak cough area. Deeper into the smaller 2. Causes bronchospasm, particularly in airways a. reactive airways 3. Factors influencing penetration and b. asthma deposition 3. Fluid overload a. Gravity a. usually use of high output i. the larger the particle systems with infants the more likely to b. Congestive Heart Failure (CHF) deposit or rain out 4. Nosocomial infection can be caused by b. kinetic motion cross-contamination i. the more particles move, the more likely to bump together, coalesce and rain out c. Inertial impaction i. when airways narrow and alter direction, aerosol particle may continue on their same path and deposit by bumping into airway walls.
d. ventilatory pattern i. alterable factor influencing deposition and retention ii. tt ideal pattern is slow, deep breath with an up inspiratory hold
