Tx with medication

Pulse, RR, Brth Snds-Befor,During,After

How administered?

Inflation hold

Position of Pt.?

Any changes from Administering Therapy?

Cough/Sputum

Lenght of tx

any pt. comments

How therapy is being delivered (MP, aerosol mask,trach mask, in-line with ventilator,etc.)

Continuous Aerosol

Service Q4 or Q2

Pulse, RR, Brth Snds

FIO2

Functioning of Equipment

Service of equipment

How therapy is being delivered (trach mask, aerosol mask, blow-by, etc.)

Large vol.

Principle-Bernoulli

a.FIO2 controlled

b. High flow system

Large reservoir of water -up to 500ml

Heated produces up to 100%

unheated 40-50% B.H

Particle range .5-30u

Output 1-2 ml/min

High flow Nebs

Small Vol. Nebulizer

Principle-bernoulli

Small reservoir of Liquid-3ml-5ml

used for medication delivery

produces 17-45% B.H

particle range .2-20u

Principle-Piezoelectric- convert alternating current (a.c.) to high freq. sound waves (1.35megacycles)

Particle size 1 to 10u, 3u is the mean

determined by the freq. of the sound wave

output (density) .5 to 6 ml/min

determined by the amplitude of the sound wave

Bronchospasm

Fluid overload

contamination

is a device driven by a compressed air machine. it allows you to take asthma medicine in the form of a mist (wet aerosol). It consists of a cup, a mouthpiece attached to a T-shaped part or a mask. and thin, plastic tubing to connect to the compressed air machine. it is used mostly by three types of patients:

Young children under age 5

Patients who have problems using metered dose inhalers

patients with severse asthma

a nebulizer helps make sure they get the right amount of medicine.

a routine for cleaning the nebulizer is important because an unclean nebulizer may cause an infection. A good cleaning rountine keeps the nebulizer from clogging up and helps it last longer.

1. Measure the correct amount of normal saline solution using a clean dropper and put it into the cup. If you medicine is premixed, go to step 3

2.Draw up the correct amount of medicine using a clean eyedropper or syringe and put it into the cup with the saline solution. Once you know your number of drops, you can count them as a check on yourself

3. Fasten the mouthpiece to the t-shaped part and then fasten this unit to the cup or fasten the mask to the cup. For a child over the age of 2, use a mouthpiece unti because it will deliver more medicine than a mask.

4. Put the mouthpiece in you mouth. Seal you lips tightly around it or place the mask on you face.

5.Turn on the air compressor machine.

6.Take slow, deep breaths in through the mouth.

7. Hold each breath 1 to 2 seconds before breathing out.

8.continue until the medicine is gone from the cup (approximately 10 minutes).

9. Store the medicine as directed after each use.

1. Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. Rinse the mask or mouthpiece and T-shaped part-as well as the eyedropper or syringe-in warm running water for 30 seconds. Use distilled or sterile water for rinsing, if possible.

2. Shake off excess water. Air dry on a clean cloth or paper towel.

3. Put the mask or the mouthpiece and T-shaped part, cup and tubing back together and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer.

High Output extended Aerosol Respiratory Therapy

240 ml reservoir

Continuous Nebulization Therapy

a. Increased efficacy

b. faster patient improvement

c.fewer patient admissions

d. Increased labor efficiency

e. decreased costs

f. shorter hospital days

high output neb

high flow 10-15Lpm

up to 8hrs. of neb. of meds

mean particle size of 2.5um

output up to 50ml/hr

Considerations of this type of therapy:

close patient monitoring

pulse

rr

brth sounds

spo2

side effects of drug

1. connect heart neb to the flowmeter either by using Flowmeter adaptor or oxygen supply tubing

2. pour prescribed medication into reservor

3.connect one end of corrugated tubing to aerosol outlet port of heart neb. and the other end to aerosol mask.

4.place heart neb. into pole clamp if not using flowmeter adaptor.

5.adjust flowmeter to 10 L/min for 30ml/hr (20%) output. note. heart neb. output at 15L/min is 56mL/hr (20%)

6.Adjust oxygen concentration per physician order if using blender.

7.check liquid consumption Q1hr and adjust flowmeter to obtain 30mL/hr output.

9. Replace Heart neb. every 24 hours. For single patient use only. Do not reuse.

Oxygen Blender(FIO2)-oxygen tubing-source gas inlet

aerosol outlet port-

Corrugated tubing-aerosol mask-face

Body of heart neb(medication reservoir)

10LPM

1. In what devices is the desired drug available

2. what device is the patient likely to be able to use properly, given the patient's age and the clinical setting

3. for which device and drug combination is reimbursement available?

4. which devices are the least costly?

5. which devices are the most convient for the patient, family (outpatient use) or medical staff (acute care setting) to use, given the time required for drug adminstration and device cleaning, and the portability of the device?

7. How durable is the device?

8. Does the patient or clinician have any specific device preferences?

a. Each actuation -70 mph "hit"

b. Proper administration

i. Remember to rinse mouth

ii. priming of the valve is necessary (loss of dose)

iii. shake canister before use (typically, but see drug insert)

iv. Timing of actuation intervals (puffs)

v. Open mouth method-best

vi. inflation hold-best for deposition

C. Use of spacers (aerochambers)

inability to follow direction

poor inspiratory capacity

incapable of breath hold

tachypneic or unstable RR (>25bpm)

need to aerosolize drugs not in MDI preparation

ability to follow directions

adequate inspiratory capacity

capable of breath hold

stable RR

availability of drug in MDI preparation

Fluorocarbons

technique

side effects of meds

1. assemble medihaler for use

2. exhale completely through pursed lips.

3.place open end of the mouthpiece 2-3 fingers in front of mouth.

4. Do not close lips-this pulls in more air to aide in carrying the medication deeper into the lungs.

5. while taking a slow deep breath, press down firmly on the cartridge to release medication

6. Hold your breath a few seconds to allow good distribution of the medication on the airways.( this will help prevent you from exhaling the medication.)

7. exhale slowly using pursed lips.

8. Repeat as directed. Rest 5 minutes before using again. Rinse mouth to help prevent holder (using the vinger solution) every 24 hours when in daily use.

9. keep your medihaler clean, free from lint and dirt, by keep it in a plastic bag.

10. if you are using more than one inhaler, use your bronchodialtor first. if you are still uncertain ask your DR or pharmacist. Note. periodically check the amount of medication in you medi-haler so you may obtain refills ahead of time. To do this, place the cartridge in a container of water and observe its position as it floats.

apical segments

anterior segment

posterior segment

left upper lobe lingula

anterior segment

posterior segment

superior segments(apical)

right middle lobe

anterior segments

lateral segment

posterior segments

lateral segment RLL cardiac (medial)

Cystic Fibrosis

Bronchietasis

bronchitis

pneumonia

to aid in the mobilization of retained secretions

to reduce air trapping in asthma and copd

Procedure:

Stage 1: Mucus loosening and Mucus Mobilization

i. Set subject up and instruct to relax performing diaphragmatic breathing and slowly inhale a volume of air larger than normal tidal volume(but not to total lung capacity)

ii. Hold breath fo r2 to 3 seconds

iii. place futter in mouth, adjust tilt, keep cheek's stiff.

iv. exhale though flutter to functional residual capacity (FRC) actively but not forcefully. (place hands on chest to check for resonance)

v. adjust tilt angle to achieve good resonance.

vi. attempt to suppress cough.

Vii. repeat steps 1 through 5 for 5 to 10 breaths.

Begin Stage 2 : Mucus elimination

viii. slowly inhale filling lungs completely.

ix. Hold breath 2 to 3 seconds.

x. place flutter in mouth, adjust tilt, keep cheeks stiff.

xi.exhale forcefully through the Flutter as completely as possible.

xii. Repeat steps 7 through 10 for 1 to 2 breaths.

xiii. Direct coughing( or huff maneuver). Return to step 1 and repeat full sequence until lungs are clear or therapy is over.

Active expiration against a resistance

Move secretions into the larger airways by filling underaerated or nonaerated segments via controlled ventilation

prevent airway collapse

a. cystic fibrosis

b. COPD

c.Post-op Atelectasis

a. by itself

b. in conjunction with svn or MDI attached to a one-way valve.

1. Breath in.

2. Hold your breath (1-2 secs.)

3. Exhale through mouthpiece (keep indicator between the two arrows)

4. Rest

5. Repeat 10-15 times over one hour, then huff cough 3 times

procedure:

1. Adjust the Expiratory resistor selector dial to the setting prescribed by RT

2. Have patient sit with elbows resting comfortably on the table. Put the PEP device on table in front of patient.

3. Have pt. place mouth piece in mouth. Be sure to have them maintain a tight seal during exhalation.

4. Instruct the pt. to breathe from their diaphragm taking in a larger than normal breath, but not filling the lungs to capacity. Have patient hold their breathe for 2-3 secs.

5. Have the pt. exhale actively but not forcefully maintaining a pressure of 10-20 cm which means the blue piston is between the 2 lines. Exhalation should last 3 times longer than inhalation.

6. Perform 10-20 PEP breaths, then remove mouthpiece and perform 2-3 "huff" coughs. A "huff" cough requires the pt. to place arms in a slightly flexed position (like a chicken flapping their wings) and as they forceably exhale the patient brings their arms to their side. This helps to raise secretions.

the new generation of vibratory PEP therapy.

combines the benefits of both PEP therapy and airway vibrations to mobilize pulmonary secretion.

pt. is free to  sit, stand or recline.

color coded units.

 Dial for adjustable frequency and flow resistance-reproducible settings.

can be connected to the TheraPEP pressure port and gauge for monitoring exact expiratory pressure feedback.

easy to self-administer

pt. can inhale through acapella without removing from mouth.

no assembly required.

Who gets Green acepella?

detachable mouthpiece

patient end-accommodates a mouthpiece, 3 mask options, or theraPEP pressure port

One-way inspiratory valve- with 22mm male fittings) allows inhalation without removing from mouth

Expiatory resistance/frequency adjustment dial-lets you customize therapy based on patient's clinical needs

1. Turn on machine

2. in Pause phase (5secs) place mask over patients nose &mouth or attach to Ett or trach.

let patient adjust to cycles of inhalation (2-3 secs) & exhalation 1-2 secs by adjusting pressure knobs up with each cycle.

cough cycles should be performed as tolerated by patient. Usually 4 cycles (4 breaths per cycle), up to 4-5 cycles resting patient for 20-30 seconds in between.

3. Turn off machine.

Muscle weakness

paralysis

4-5 cycles, resting patient 20-30 seconds in between cycles to avoid hyperventilation