A 2 yo child is seen in the ER of a local hospital and diagnosed with croup. The physician orders a dose of racemic epinephrine via SVN to help with the subglottic swelling. What size aerosol particle is most likely to deposit in this region, providing the greatest therapeutic benefit to the patient?
C. particles 5-10 micrograms
The 3 main uses of aerosol therapy in resp care include the following:
I. Humidification of dry gases
II. Improved mobilization and clearance of secretions
III. Delivery of aerosol drugs to the resp tract
IV. Deliver of nutrients for patients unable to masticate.
B. I, II, and III only
For pulmonary diagnostic and therapeutic applications, the particle size range of interest is what?
A. 1-10 micrograms
Two hypothetical SVNs, A & B, have the following specs from the manufacturer:
Count median diameter
(A)1.7 um (B) 1.5 um
Mass median aerodynamic
(A) 3.2 um (B) 7.7 um
Geometric standard deviation
(A) 1.1 um (B) 1.5 um
*Which neb would be best to treat the lower resp tract?
Neb A
67 yo male patient w/ chronic bronchitis present in ER with acute distress. Vital signs: HR 123, RR 28. You note faint exp wheezing. Which of the following would be least appropriate to deliver an aerosolized drug to this patient?
C. DPI
An aerosol is best defined as:
B. a suspension of solid or liquid particles in a carrier gas
Traditionally, what percentage of a given dose of aerosolized medication reaches the lower respiratory tract, regardless of the type of delivery device being used?
D. 10-15%
What is the purpose of the end-inspiratory breath-hold used in conjunction with aerosole delivery?
B. allows better deposition through gravitational settling
You are treating a patient who has a confirmed diagnosis of Pneumocystis pneumonia. Which type of delivery device should you choose to administer the dose of pentamidine ordered by the attending physician? (Hint: P may irritate the larger airways, and is most effective when intraalveolar deposition occurs.)
B. ultrasonic nebulizer
A 7 mo old presents to the hospital w/ a diagnosis of resp syncytial virus. The attending physician agrees w/ your recommendation of ribavirin to treat the disease. Because ribavirin is delivered as an aerosol, you must decide which method of delivery to use. Which of the following devices should you choose?
A. Small particle aerosol generator (SPAG)
After delivering an aerosol treatment, you notice that approx 0.5 cc of medicine remains in the SVN. Which of the following actions do you take?
Take no action and deliver the following dose with the SVN.
Which of the following statements are true concerning the recommended volume of solution when delivering an aerosol treatment via SVN?
I. A volume between 3-5 ml of solution is recommended.
II. Incr. the volume results in a decr. in the concentration of drug remaining in the dead volume when nebulization ceases.
III. Patient compliance is directly proportional to convenience.
IV. Incr the volume of solution results in a net incr in the amount of active drug in the nebulizer.
C. I, II, and III only
You are administering an aerosol treatment to a patient via a gas-powered SVN when you realize that the output appears to be much less than normal. On checking the flowmeter, you see that it is set to 4 L/min. Your next action is to:
C. > flow rate to 10 L/min.
The Dr. has ordered your patient to receive continuous administration of heliox w/ racemic epinephrine secondary to postextubation stridor. As you approach the bedside to deliver the ordered dose of racemic epi via SVN, what outcomes should you expect w/ a gas flow of 10 L/min w/ heliox?
B. You should expect a twofold incr in neb time (when compared with that of just oxygen).
Your patient is receiving gentamicin (high-viscosity antibiotic solution) via gas-powered SVN. To compensate for the incr viscosity of the aerosol solution, you should:
A. set the flow to 12 L/min
You are instructing the parents of a 4 yo child w/ asthma on how to deliver aerosolized medication at home via a traditional SV jet neb. When asked how much of the medication actually reaches the child's lungs, you answer:
C. 10-15% of the total drug dose
By the year 2008, all MDIs must be powered by
Hydrofluoroalkanes (HFAs)
Which of the following are problems associated with patient use of a MDI?
I. Failure to coordinate inhalation and actuation of the inhaler
II. A too-rapid inspiratory flow rate
III. Failure to shake and mix canister contents
IV. Cessation of inspiration as the aerosol strikes the throat
B. I, II, III, and IV
Your patient carries an albuterold MDI, which she claims to use every few weeks. She complains that the first dose actuated from the device seems to have no effect on her bronchospasm. What suggestion would you make to correct the problem?
B. discharge a waste dose before using the MDI
When teaching proper MDI technique to a patient, you should explain that failure to shake the device before actuation may result in:
C. either A or B
Your patient asks how long to wait between the 1st and 2nd dose from her alubterol MDI. You suggest that she:
A. pause 1-5 minutes between actuations
Barring any issues regarding patient coordination or ability to correctly use the device, how should you suggest that a patient administer a drug with an MDI if no spacer is available?
C. hold the MDI several cm in from of the open mouth
Your patient informs you that she keeps her albuterol MDI stored in her regrigerator, for she feels that this may keep the medication "fresher" for a longer period of time. What is your response?
Request that she no longer regrigerate the canister, but shore it at rm temp
Your are teaching proper use of an MDI to an elderly man who's having trouble coordinating actuation of the device w/ an inspiratory effort. What suggestion(s) would you make to help him w/ his problem?
A. suggest Autohaler
The physician has requested that you provide a patient w/ a reservoir device to use in conjunction w/ an MDI. Given a choice, which type would you give the patient?
B. antistatic valved holding chamber
The greatest limitation to patient use of a dry powder inhaler is:
C. patient ablity to provide an insp flow rate of 30-90 L/min
The physician has granted your request to change a patient from an SVN to an MDI for administration of albuterol. The dose via SVN was 2.5 mg of drug. What is the quipvalent dose via MDI to your patient?
B. 2 puffs
You have been asked to administer albuterol to a nonintubated neonate. Which of the following aerosol devices would be age appropriate?
D. Both B and C
Which device releases aerosol only during insp, allowing all released aerosol to be available for patient inhalation?
C. dosimetric nebulizer
Which device allows greater aerosol release during insp, while decreasing output during exhalation or breath-hold?
c. SVN using vibrating plate technology
C. breath-enhanced nebulizer
Which device produces aerosol constantly during both inspiration and exhalation, allowing the greatest loss of aerosol into the environment?
c. SVN using vibrating plate technology
C. constant-output nebulizer
Which device requires no gas source and leaves very little dead volume?
