Respiratory Potpourri - HBO, Aerosols, Humidity, ETC.
Material for test 3 in my class. Covers 891-894 (hyperbaric treatment), Ch. 35, and Ch. 36 of Egan's Fundamentals of Respiratory Care (9th ed. )
Questions and Answers
- 1.
1. LouAnn-Sue-Lyn has been brought to the ER because when her friend Anita Ride came over to see if she could borrow Louann’s car, she found her friend with her bad foot (it had become badly ulcerated over the last few months) up on the table and it was looking really bad and stinking. The physician ordered HBO therapy, and after figuring out that it would not entail watching television Louann began treatments. Which of the following below could apply to Louann’s wound and ensuing therapy.A. HBO would not be good because of vasoconstrictionB. HBO would lead to neovascularization.C. HBO would lead to hyperoxygenation of blood and tissueD. HBO would help enhance immune function
- A.
A only
- B.
A & B
- C.
B & C
- D.
B, C, & D
- E.
All of the above
Correct Answer
D. B, C, & DExplanation
Although vasoconstriction is another effect of the hyperbaric effects it is more than made up for by the increased oxygenation (p.891-892) and in some injuries the dissipation of edema caused by the vasoconstriction can be an additional benefit. (p.892)Rate this question:
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- 2.
2. All of the following are possible complications of HBO EXCEPT:A. CNS oxygen toxicityB. Ear or sinus barotraumasC. Catch an old Sopranos episode and watch it instead of studyingD. Claustrophobia
- A.
A only
- B.
C only
- C.
C and D
- D.
D only
- E.
All of the above
Correct Answer
B. C onlyExplanation
All of the following except the stupid TV reference are possible. (sorry that I don't have any idea what's on that channel anymore).Rate this question:
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- 3.
True or False: The physiological nose is an example of a superior HME.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
They don't refer to HMEs as "artificial noses" because the nose is horrible at retaining heat and moisture.Rate this question:
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- 4.
What is the relative humidity at BTPS?
- A.
44%
- B.
47%
- C.
60%
- D.
100%
- E.
None of the above
Correct Answer
D. 100%Explanation
The relative humidity at BTPS is 100%. This means that the air at BTPS is holding the maximum amount of moisture it can hold at its current temperature. This indicates a high level of humidity, suggesting that the air is saturated with moisture.Rate this question:
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- 5.
Where is the isothermic saturation boundary located (approximately)?
- A.
Hypopharynx
- B.
Oropharynx
- C.
5 cm above the carina
- D.
5 cm below the carina
- E.
None of the above
Correct Answer
D. 5 cm below the carinaExplanation
The isothermic saturation boundary refers to the point in the respiratory tract where inspired air is fully saturated with water vapor and reaches body temperature. It is located approximately 5 cm below the carina, which is the point where the trachea divides into the left and right main bronchi. This is because as inspired air travels down the trachea and bronchi, it gets progressively warmed and humidified by the respiratory mucosa, reaching the isothermic saturation boundary at this specific location. The other options (hypopharynx, oropharynx, and 5 cm above the carina) are not correct because they do not correspond to the specific location where the isothermic saturation boundary is typically found.Rate this question:
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- 6.
Which of the following would not shift the ISB further down the tracheo-bronchial tree?
- A.
Bypassed upper airway
- B.
Breathing through mouth
- C.
Breathing cold air
- D.
Increased minute ventilation
- E.
All of the above would distally shift the ISB
Correct Answer
E. All of the above would distally shift the ISBExplanation
All of the given options would distally shift the ISB (inspiratory stridor boundary) further down the tracheo-bronchial tree. A bypassed upper airway would allow air to flow directly into the lower airways, bypassing the upper respiratory tract. Breathing through the mouth would also bypass the nasal cavity and upper airway, causing the air to go directly into the lower airways. Breathing cold air can cause bronchoconstriction, narrowing the airways and pushing the ISB further down. Increased minute ventilation refers to an increase in the amount of air breathed in per minute, which can also push the ISB further down.Rate this question:
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- 7.
Your patient Luke Warm is being treated with O2 by nasal cannula to keep SaO2 above 92%. Sometime during the last hour the nurse increased the flow from 3LPM to 5LPM. You have just received a call that Mr. Warm’s work of breathing has increased and his secretions are becoming inspissated. What is a likely problem you can determine even before taking a step into the room?
- A.
5LPM is too much for a cannula, the patient should be on a mask.
- B.
FiO2 of the nasal cannula is too high
- C.
Luke Warm is getting colder (CTD)
- D.
Humidity is needed at flows above 4LPM, bring a bubble humidifier.
- E.
The patient needs HBO (or at least Cinemax)
Correct Answer
D. Humidity is needed at flows above 4LPM, bring a bubble humidifier.Explanation
It would probably be wise to ask whoever was calling if they bothered to put humidity on the gases. The patient will be experiencing a humidity deficit at this flow rate without humidity support.Rate this question:
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- 8.
The doctor has ordered cool humidified gas for a patient on your floor. This is most likely :
- A.
Due to the doctor being crazy
- B.
Due to the patient having an artificial airway
- C.
Due to the patient having upper airway inflammation
- D.
To decrease the amount of humidity in the delivered gas
- E.
All but the doctor being crazy are likely
Correct Answer
C. Due to the patient having upper airway inflammationExplanation
More stupid question options, but the point was to emphasize that there IS a purpose for such a thing as cool humidity even though you read 2 or 3 paragraphs somewhere else about how bad breathing cold air is.Rate this question:
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- 9.
What is the most efficient (returns the most humidity) of the HMEs?
- A.
Simple condenser
- B.
Hygroscopic condenser
- C.
Hydrophobic condenser
- D.
A & B
- E.
B & C
Correct Answer
E. B & CExplanation
The most efficient HMEs for returning humidity are the hygroscopic condenser and the hydrophobic condenser. Hygroscopic condensers have the ability to attract and absorb water vapor, while hydrophobic condensers repel water and allow only vapor to pass through. Using both types of condensers together would maximize the amount of humidity that is retained and returned.Rate this question:
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- 10.
What is the approximate low-end efficiency of the most efficient HMEs?
- A.
50%
- B.
60%
- C.
70%
- D.
80%
- E.
None of the above
Correct Answer
C. 70%Explanation
The approximate low-end efficiency of the most efficient HMEs is 70%. This means that these HMEs are able to convert 70% of the input energy into useful output energy, with the remaining 30% being lost as waste heat.Rate this question:
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- 11.
True or False: A decrease in gas flow will result in an increase in rainout
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The higher the flow, the less should be the condensation. Thus, decreased gas flow would lead to increased rainout.Rate this question:
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- 12.
- True or False: A shorter breathing circuit will tend to have less rainout
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Apparently because the longer the circuit the more heat transfer (and thus condensation) will occur along the circuit.Rate this question:
- 13.
True or False: A good rule of thumb to determine if the gas is properly conditioned is to check for a small amount of condensation at the “Y” patient connection.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Not real scientific, but according to our teacher and similar to Rule of thumb on p.790Rate this question:
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- 14.
True or False: Bland aerosol therapy concerns aerosols containing only water.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Technically the fluid can be hypertonic, hypotonic, or isotonic saline solutions along with the sterile waterRate this question:
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- 15.
Your patient Kenny Breathe (Willy’s older brother) is in need of a bland aerosol treatment. He has a functioning natural upper airway. What is the best device for giving him his treatment?
- A.
T-tube
- B.
Aerosol mask
- C.
Tracheostomy mask
- D.
Nasal cannula
- E.
None of the above
Correct Answer
B. Aerosol maskExplanation
For a natural airway you would use either an aerosol mask or a face tent.Rate this question:
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- 16.
When Kenny Breathe goes back to his nasal cannula @ 6LPM what kind of humidity device is he probably going to be using?
- A.
Aerosol mask
- B.
Hygroscopic condenser humidifier
- C.
Bubble humidifier
- D.
Large volume nebulizer
- E.
None of the above
Correct Answer
C. Bubble humidifierExplanation
The bubble humidifier is basically only used with NC, and the only device with small tubing.Rate this question:
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- 17.
Later in the day you are trying to do some good old-fashioned sputum induction on our pal Kenny Breathe. You are not satisfied with the aerosol output of the ultrasonic nebulizing device (and are not worried about the density). You can do which of the following to help solve your dilemma.A. Turn up the amplitudeB. Turn up the flowC. Turn up the frequencyD. Turn up the fiO2E. All of the above
- A.
A only
- B.
B only
- C.
A & B
- D.
A, B, and C
- E.
All of the above
Correct Answer
C. A & BExplanation
Turning up the flow and amplitude will both increase output (although increasing flow will decrease the density of the mist). The frequency is a fixed property of the piezoelectric circuit and cannot be adjusted.Rate this question:
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- 18.
The good doctor has ordered two drugs to be administered to Mr. Breathe. The first is an aerosol medication delivered by metered-dose inhaler. Which of the following should be part of your patient education.A. Spacers are a waste of pocket spaceB. Stick the opening of the inhaler as far into your mouth as possibleC. Be sure to breathe in hard and fast as you actuate the inhalerD. Holding your breathe is pointlessE. Taking two puffs at once is just as good as anything else
- A.
B only
- B.
C only
- C.
B & C
- D.
B, C, & D
- E.
None of the above
Correct Answer
E. None of the aboveExplanation
Both spacing and breathing slowly (but deeply) reduces inertial impaction and increases amount of deposition in the desired areas of the lungs. Holding your breathe also helps deposition (especially of some of the particles that would normally be exhaled). Taking two puffs at once is a waste.Rate this question:
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- 19.
True or False: The best way to use a dry powder inhaler is to inhale deeply and lightly.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Deeply yes, but you will need to inhale with quite a lot of force (>60 L/min).Rate this question:
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- 20.
True or False: Monodispersed aerosols are very common and this term means that the particle sizes created are not the same.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
They are not very common and means the particles are all the same sized. Heterodispersed is the more common aerosol that is made up of many different sized particles.Rate this question:
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- 21.
An aerosol with a MMAD of 10 micrometers is most likely going to end up where?
- A.
Nose
- B.
Main bronchi
- C.
Lobar bronchi
- D.
Basal parenchyma
- E.
None of the above is reasonable
Correct Answer
A. NoseExplanation
5 microns and up will be deposited in the upper airway is the rule of thumb (p.804). Most particles larger than 5 will end up getting stuck in the mucosa/vibrissae of the nose according to something I read somewhere (can't find it right this minute).Rate this question:
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- 22.
An aerosol with a MMAD of 3 micrometers is most likely going to end up where?
- A.
Nose
- B.
Main bronchi
- C.
Lobar bronchi
- D.
Alveolar parenchyma
- E.
B, C, and D are all possibilities
Correct Answer
E. B, C, and D are all possibilitiesExplanation
According to the rule of thumb (p.804) again a 3 micron particle would most likely make it to the lower airways but could also make it to the alveoli.Rate this question:
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- 23.
True or False: Using a spacer or using an open-mouth technique with a MDI reduces the amount of inertial impaction
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Using a spacer or using an open-mouth technique with a MDI reduces the amount of inertial impaction because it allows the medication particles to slow down and disperse more evenly in the airways. This reduces the likelihood of the particles impacting on the walls of the airways and increases the chances of the medication reaching the intended target areas in the lungs.Rate this question:
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