DOCSLIB.ORG

Development and Implementation of Respiratory Care Plans

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Development and Implementation of Respiratory Care Plans CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 2NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC DevelopmentNOT FOR SALE OR DISTRIBUTIONand ImplementationNOT FOR SALE OR DISTRIBUTION of Respiratory Care Plans © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DavidDISTRIBUTION C. Shelledy, Jay I.NOT Peters FOR SALE OR DISTRIBUTION © Toria/Shutterstock © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OUTLINE 11. Design a respiratory care plan to mobilize secretions. 12. Propose a respiratory care plan for the treatment and/or Overview © Jones & Bartlett Learning, LLC prevention of atelectasis and© pneumonia. Jones & Bartlett Learning, LLC Introduction to RespiratoryNOT Care Plans FOR SALE OR DISTRIBUTION13. Give examples of types of respiratoryNOT FOR care plans SALE used inOR the DISTRIBUTION Common Conditions Requiring Care Plan Development intensive care unit. Respiratory Care Plan Development 14. Explain the role of diagnostic testing in the development of a Maintain Adequate Tissue Oxygenation respiratory care plan. Treat and/or Prevent Bronchospasm and Mucosal Edema Assessment and Treatment of COPD KEY TERMS Mobilize© Jones and Remove & SecretionsBartlett Learning, LLC © Jones & Bartlett Learning, LLC ProvideNOT Lung FOR Expansion SALE Therapy OR DISTRIBUTION acute respiratoryNOT distress FOR SALEhistory OR DISTRIBUTION Critical Care and Mechanical Ventilation syndrome (ARDS) hypoxemia Diagnostic Testing acute respiratory incentive spirometry (IS) Respiratory Care Plan Format failure (ARF) inhaled corticosteroid acute ventilatory (ICS) CHAPTER OBJECTIVES failure (AVF) intermittent positive © Jones & Bartlett Learning, LLC © Jonesairway &clearance Bartlett Learning,pressure LLC breathing 1. Describe the purpose of a respiratory care plan. techniques (ACT) (IPPB) NOT FOR SALE2. Identify OR the DISTRIBUTION key elements of a respiratory care plan. NOTantiasthmatic FOR SALE medication OR DISTRIBUTIONlung expansion therapy 3. Describe common conditions that may require development anti-inflammatory agent mechanical ventilation of a respiratory care plan. asthma mucosal edema 4. Define respiratory failure, and give examples of several types atelectasis oxygen therapy of respiratory failure. bronchial hygiene physical 5. Define ventilatory ©failure Jones, and contrast & Bartlett acute ventilatory Learning, LLCbronchiectasis ©pneumonia Jones & Bartlett Learning, LLC failure and chronic ventilatory failure. bronchodilator therapy positive airway 6. Give examples of NOTappropriate FOR outcome SALE measures OR for DISTRIBUTION a bronchospasm NOTpressure FOR (PAP) SALE OR DISTRIBUTION respiratory care plan. chest physiotherapy (CPT) protocol 7. Outline the key steps in the development and implementation chronic bronchitis pulmonary edema of a respiratory care plan. chronic obstructive respiratory care plan 8. Develop a respiratory care plan to maintain adequate tissue pulmonary disease retained secretion oxygenation. (COPD) six-minute walk test (6MWT) 9.© JonesCreate a respiratory & Bartlett care plan Learning, for the treatment LLC and/or chronic ventilatory© Jones & BartlettSOAP note Learning, LLC NOTprevention FOR of SALE bronchospasm OR andDISTRIBUTION mucosal edema. failure (CVF)NOT FOR SALEtreatment OR DISTRIBUTION menu 10. Describe the care of patients with asthma and COPD. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 25 © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284217155_CH02_025_068.indd 25 28/11/20 5:25 PM 26 CHAPTER 2 Development and Implementation of Respiratory Care Plans © Jones &Overview Bartlett Learning, LLC © JonesO (Objective). & Bartlett Refers Learning, to what the LLC clinician observes or objective test results. This chapter provides a guide to the development, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION A (Assessment). Refers to the clinician’s assessment. implementation, and evaluation of respiratory care P (Plan). Refers to the plan of care. plans. The respiratory care plan provides a detailed description of the care to be provided based on the in- A modification known as SOAPIER adds care plan dividual needs of the patient. Care plans often include documentation of the following: assessment, diagnosis,© orJones problem & list;Bartlett goals and/or Learning, ob- LLC © Jones & Bartlett Learning, LLC I (Intervention). What was done. jectives; specific activitiesNOT FORor interventions SALE OR to be DISTRIBUTION taken; NOT FOR SALE OR DISTRIBUTION E (Evaluation). The clinician’s evaluation of the care outcomes of care provided; and evaluation. In order to provided. develop an appropriate respiratory care plan, the clini- R (Revision). Any changes in care provided based on cian must first perform a thorough patient assessment, the clinician’s evaluation. including a review of the patient’s existing medical re- cord,© aJones patient interview,& Bartlett and Learning, a physical assessment. LLC The Further details© Jones of SOAPIER & Bartlett can be Learning, found in LLC bedsideNOT measurement FOR SALE of clinicalOR DISTRIBUTION parameters related to Chapter 3. TheNOT respiratory FOR SALE care planOR mayDISTRIBUTION also include oxygenation, ventilation, and pulmonary function may a statement of how the intensity and/or duration of be performed. Pulse oximetry (Spo2) is routinely used therapy will be adjusted and when the therapy will be to assess oxygenation status. Arterial blood gases should discontinued. Assessment of the outcomes of therapy be obtained if there is concern regarding the patient’s may also be included, as well as measurable objectives © Jones & ventilatoryBartlett status,Learning, acid–base LLC balance, or the reliability of© Jonesof the &care Bartlett delivered. Learning, LLC NOT FOR SALESpo2 values. OR Laboratory,DISTRIBUTION imaging, and other diagnostic NOT FOR SALE OR DISTRIBUTION studies may be needed to further define and clarify the RC Insight patient’s problem and diagnosis. Following establish- ment and clarification of the patient’s diagnosis and/or The respiratory care plan provides a written de- problem list (see Chapter 1), a respiratory care plan is scription of the care the patient is to receive, based developed, implemented,© Jones and evaluated. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONon a thorough assessmentNOT and determination FOR SALE of OR DISTRIBUTION Introduction to Respiratory the care needed. Care Plans In summary, the respiratory care plan provides the Therespiratory care plan provides a written descrip- © Jones & Bartlett Learning, LLC written plan© of Jones treatment & thatBartlett the patient Learning, will receive. LLC tion of the care the patient is to receive. The plan is based The plan may include goals, objectives, rationale, sig- on NOTa careful FOR patient SALE interview OR and DISTRIBUTION physical assessment, nificance, andNOT a description FOR SALE of how OR care DISTRIBUTION will be assessed. review of diagnostic test results, and consideration of Following a careful patient assessment, the respiratory the treatment modalities available, sometimes known care plan is developed, implemented, and evaluated. A treatment menu as the . The respiratory care plan may take summary of the types of care often included in the res- the form of physician’s orders, a detailed progress note piratory care plan is provided in Table 2-1. © Jones & in theBartlett medical Learning, record, an established LLC protocol, completion© Jones & Bartlett Learning, LLC NOT FOR SALEof a standardized OR DISTRIBUTION respiratory care consultation and treat- NOTCommon FOR SALE Conditions OR DISTRIBUTION Requiring ment plan template, or the use of problem-oriented medi- cal records (e.g., SOAP notes). The respiratory care plan Respiratory Care Plan can be viewed as an individualized protocol for the patient. Development A basic respiratory care plan often includes the fol- Problems that affect oxygenation and/or ventila- lowing elements: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tion often require the development of a respiratory ■ Goals of therapyNOT FOR SALE OR DISTRIBUTIONcare plan. Other common respiratoryNOT FOR problems SALE in- OR DISTRIBUTION ■ Device or procedure to be used or medications to clude bronchospasm and mucosal edema, retained be given secretions, airway plugging, infection, consolidation, ■ Method or appliance to be used inadequate lung expansion, atelectasis, and pulmonary ■ Gas source or oxygen concentration edema. Common disease states or conditions en- © ■ Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTDevice FOR pressure, SALE volume, OR DISTRIBUTION and/or flow countered inNOT the physician’s FOR SALE office, OR clinic, DISTRIBUTION or acute ■ Frequency of administration and duration of care setting that may require respiratory care include therapy upper respiratory tract infection, pneumonia, acute bronchitis, asthma, chronic obstructive pulmonary SOAP notes are sometimes used to document patient disease (COPD) (including emphysema and chronic care plans: bronchitis © Jones & Bartlett Learning, LLC © Jones & Bartlett), pulmonary Learning, hypertension, LLC heart failure, lung NOT FOR SALES (Subjective). OR
Load more

Recommended publications
  • Drug Administration Routes - Summary
    Only Use L6. DrugCourse Administration & Transport 207 by Fluid Motion 243/CENG April 19, 2018 NANO Only Use Course 207 243/CENG Part I: Drug Administration NANO Routes of Drug Administration Only Topical: local effect, substanceUse is applied directly where its action is desired. EnteralCourse: systemic effect, substance is 207given via the gastrointestinal (GI) tract. Parenteral: systemic effect, substance is given by routes other than the gastrointestinal (GI) tract. 243/CENG NANO Topical Drug Delivery Epicutaneous – directly onto the surface of the skin Only allergy testing local anesthesia… Use Eye drops antibiotics for conjunctivitis … Course Inhalational207 asthma medications acute infection in upper airway … 243/CENG Intranasal route decongestant nasal sprays … NANO Enteral Drug Delivery Any form of administration that involves any part of the gastrointestinalOnly tract Use Course 207 Oral: Rectal: Gastric feeding tube: many drugs as tablets, various drugs in many drugs, enteral capsules, drops… suppository or enema nutrition… form… 243/CENG NANO Parenteral Drug Delivery Intravenous: into a vein (many drugs, total parenteral nutrition…) Only Intramuscular: into a muscle (many vaccines, antibiotics…) Use Subcutaneous: under the skin (insulin…) Intraarterial: into an artery (vasodilator drugs in the treatment of vasospasm…) Course Intradermal: into the skin itself (skin testing some allergens, tattoos…) 207 Transdermal: diffusion through the intact skin (transdermal opioid patches in pain management, nicotine patches for treatment
    [Show full text]
  • Effects of Intraoperative Insufflation with Warmed, Humidified CO2 During Abdominal Surgery: a Review
    Annals of Original Article Coloproctology Ann Coloproctol 2018;34(3):125-137 pISSN 2287-9714 eISSN 2287-9722 https://doi.org/10.3393/ac.2017.09.26 www.coloproctol.org Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review Ju Yong Cheong1,2, Anil Keshava1, Paul Witting2, Christopher John Young1 1Colorectal Surgical Department, Concord Repatriation General Hospital, Sydney Medical School, The University of Sydney, Sydney; 2Discipline of Pathology, Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, Australia Purpose: During a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20°C, 0%– 5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO2 in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes. Methods: A review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain. Results: The literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO2, cold, dry CO2 resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation.
    [Show full text]
  • West Virginia Nerve Injury Slides
    Anesthesia for Robotic Surgery: Is it a Different Ball Game? Michael A. Olympio, M.D. Professor of Anesthesiology Wake Forest University School of Medicine YES, it is… Access to, and monitoring the patient Combined Pneumoperitoneum and Trendelenburg – Type and amount of inflation gas – Pulmonary impairments – Hydrostatic gradients – Cardiovascular derangements – Circulation to the lower limb – Confounding obesity Anesthetic adjuncts and outcomes – Routine general anesthesia – General and regional? – Multimodal, narcotic-sparing, “ideal” anesthetic Olympio, MA. “Anesthetic Considerations for Robotic Urologic Surgery” In, Hemal AK, Menon M (eds.) Robotic Urologic Surgery. New York: Springer-Verlag, 2011. Photo of RALRP At the end of this lecture, the learner will explain or understand: – the physiological derangements associated with combined pneumoperitoneum and Trendelenburg posture – the relationships between, and significance of hydrostatic pressure, blood pressure measurement and the risks of organ hypo/hyper-perfusion – the reasons for choosing specific anesthetic management techniques and drugs. No disclosures. What you should know about your own surgical outcomes: operative time nausea and vomiting rates blood loss use of intermittent morbidity types and rates pneumatic serial compression (IPSC) length of stay and criteria for discharge desired extremes of TP mortality (if any and its desired intra-abdominal cause) inflation pressures (IAP) postoperative pain and and, type of inflation gas analgesic regimens Pre-Anesthetic
    [Show full text]
  • I-Gel User Guide
    User Guide i-gel® single use supraglottic airway Adult and paediatric sizes www.i-gel.com Contents 1.0 Introduction .................................................................................................................... 2 1.1 The i-gel design ..................................................................................................................................................2 1.2 Key components and their function .........................................................................................................3 1.2.1 Soft non-inflatable cuff ................................................................................................................4 1.2.2 Gastric channel .............................................................................................................................4 1.2.3 Epiglottic rest ................................................................................................................................4 1.2.4 Buccal cavity stabiliser ................................................................................................................4 1.2.5 15mm connector ..........................................................................................................................5 1.2.6 Important key points.....................................................................................................................5 2.0 Indications .....................................................................................................................
    [Show full text]
  • Download the Evonik for More Information!
    ADVANCED APPROACHES THE PRESCRIPTION CAN WE ACHIEVE FOR DELAYED-RELEASE ABUSE EPIDEMIC: EFFECTIVE ORAL P04 FORMULATIONS P18 DESIGNING A SOLUTION P32 DELIVERY OF VACCINES? NOVEL ORAL DELIVERY SYSTEMS 77 O 2017 • ISSUE N 2017 TH JULY 17 JULY Contents o TH ONdrugDelivery Issue N 77, July 17 , 2017 Advanced Approaches for Delayed-Release Formulations Maria Montero Mirabet, Senior Project Manager, NOVEL ORAL DELIVERY SYSTEMS Drug Delivery Services, Business Line Health Care, and 4 - 9 Brigitte Skalsky, Senior Director, Scientific Communication, This edition is one in the ONdrugDelivery series Business Line Health Care of publications from Frederick Furness Publishing. Evonik Nutrition & Care Each issue focuses on a specific topic within the field of drug delivery, and is supported by industry Technologies & Clinical Studies for the Oral Delivery of Calcitonin Nozer Mehta, Principal leaders in that field. Peptide Technologies James P Gilligan, Chief Scientific Officer 12 MONTH EDITORIAL CALENDAR 10 - 16 Tarsa Therapeutics Sep Wearable Injectors William Stern, Consultant Peptide Drug Development Oct Prefilled Syringes Nov Pulmonary & Nasal Delivery The Prescription Abuse Epidemic: Designing a Solution Dec Connecting Drug Delivery Aia Malik, Healthcare Product Manager, and 18 - 20 Gemma Budd, Director of Technologies and Strategy Jan ‘18 Ophthalmic Delivery Lucideon Feb Prefilled Syringes Mar Skin Drug Delivery: Targeting the End Goal: Opportunities & Innovations in Colonic Drug Delivery Dermal, Transdermal & Microneedles Sejal R Ranmal, Director
    [Show full text]
  • Ozone in Medicine. the Low-Dose Ozone Concept and Its Basic Biochemical Mechanisms of Action in Chronic Inflammatory Diseases
    International Journal of Molecular Sciences Article Ozone in Medicine. The Low-Dose Ozone Concept and Its Basic Biochemical Mechanisms of Action in Chronic Inflammatory Diseases Renate Viebahn-Haensler 1,*,† and Olga Sonia León Fernández 2,*,† 1 Medical Society for the Use of Ozone in Prevention and Therapy, Iffezheim, D-76473 Baden-Baden, Germany 2 Pharmacy and Food Institute, University of Havana, Coronela, Lisa, Havana 10 400, Cuba * Correspondence: [email protected] (R.V.-H.); [email protected] (O.S.L.F.) † Both authors contributed equally. Abstract: Low-dose ozone acts as a bioregulator in chronic inflammatory diseases, biochemically char- acterized by high oxidative stress and a blocked regulation. During systemic applications, “Ozone peroxides” are able to replace H2O2 in its specific function of regulation, restore redox signaling, and improve the antioxidant capacity. Two different mechanisms have to be understood. Firstly, there is the direct mechanism, used in topical treatments, mostly via radical reactions. In systemic treatments, the indirect, ionic mechanism is to be discussed: “ozone peroxide” will be directly reduced by the glutathione system, informing the nuclear factors to start the regulation. The GSH/GSSG balance outlines the ozone dose and concentration limiting factor. Antioxidants are regulated, and in the case of inflammatory diseases up-regulated; cytokines are modulated, here downregulated. Rheumatoid Citation: Viebahn-Haensler, R.; arthritis RA as a model for chronic inflammation: RA, in preclinical and clinical trials, reflects the León Fernández, O.S. Ozone in pharmacology of ozone in a typical manner: SOD (superoxide dismutase), CAT (catalase) and finally Medicine. The Low-Dose Ozone GSH (reduced glutathione) increase, followed by a significant reduction of oxidative stress.
    [Show full text]
  • Cough Assist Machine" SW3 6NP UK Fax: 44 2073518911 Educational Aims E-Mail: [email protected]
    Breathe review cough.qxd 21/05/2008 16:06 Page 2 Key points k Ineffective cough is a major cause of mortality and morbidity in patients with neuromuscular disease. k A normal cough requires the inspiratory muscles to inspire to up to 85–90% of total lung capacity followed by rapid closure of the glottis for ~0.2 s. Both glottic opening and contraction of abdominal and intercostal (expiratory) muscles, resulting in intrapleural pressures of >190 cmH2O and generating transient peak cough flows (PCF) of 360–1,200 L per min [1] complete the manoeuvre. k Cough assist techniques are used in patients who present with a weak cough. The goal of these techniques is to increase the expiratory airflow that occurs during a cough, by assist- ing inspiration and/or expiration, thus increasing cough efficacy. k When conventional cough assistance techniques become ineffective, a mechanical insufflator–exsufflator should be considered. Breathe review cough.qxd 21/05/2008 16:06 Page 3 The ERS designates this educational activity for a maximum of 1 CME credit. For information on how to earn CME credits, see page 375 How to use a mechanical M. Chatwin Sleep and Ventilation Unit insufflator–exsufflator Royal Brompton Hospital Sydney Street London "cough assist machine" SW3 6NP UK Fax: 44 2073518911 Educational aims E-mail: [email protected] k To raise awareness of how to use mechanical insufflator–exsufflators. k To discuss the use of mechanical insufflation–exsufflation compared with conventional airway clearance techniques. Support statement k To identify an escalation treatment protocol. M. Chatwin was funded by grants from the Jennifer Trust for Spinal Muscular Atrophy (UK) and Breas Summary Medical (Sweden) Effective cough is a protective mechanism against respiratory tract infections.
    [Show full text]
  • Oxygen Policy 2018
    Oxygen Policy Document Control Title Oxygen Policy (Prescribing & Administration of Oxygen to Adults in Hospital Policy) Author Author’s job title Consultant Physician, Respiratory Medicine Clinical Development Facilitator Directorate Department Division of Medicine, A&E and Comm. Respiratory Hospitals Date Version Status Comment / Changes / Approval Issued June 0.1 Draft Draft presented to Medical Gases Committee. 2010 1.0 Jun Final Approved at Clinical Services Executive Committee 2010 (CSEC) in 14th June 2010. Approved by Drugs and Therapeutics Committee on July 1st 2010. 1.1 Dec Revision Minor amendments by Corporate Affairs to document 2010 control report, filename, header and footer, formatting for document map navigation. Hyperlinks to appendices and Trust procedural documents. Update to document control report. Amendments to section 8 and 24.1. 1.2 Dec Revision Appendix F added 2017 Re wording/re-ordering of most sections Minor alteration to section 5.2 Sepsis 6 added to section 5.2 Addition of endoscopy and ED to 5.8 1.3 June Revision Appendix G added 2018 Minor alteration to section 5.4 2.0 June Final Approved by all members of the Medical Gas Committee 2018 Main Contact Consultant Physician Tel: Direct Dial – 01271 349589 Level 5 Tel: Internal – Ext No. 3375 North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB Lead Director Medical Director Superseded Documents Issue Date Review Date Review Cycle June 2018 June 2021 3 years Respiratory Team Oxygen Policy Page 1 of 39 Oxygen Policy Consulted with the following stakeholders:
    [Show full text]
  • An Introduction to Anaesthesia
    What You Need to KNoW about An introduction to anaesthesia Introduction divided into three stages: induction, main- n Central neuraxial block, e.g. spinal or Anaesthetic experience in the undergradu- tenance and emergence. epidural (Figure 1 and Table 1). ate timetable is often very limited so it can In regional anaesthesia, nerve transmis- remain somewhat of a mysterious practice sion is blocked, and the patient may stay Components of a general well into specialist training. This introduc- awake or be sedated or anaesthetized dur- anaesthetic tion to the components of an anaesthetic ing a procedure. Techniques used include: A general anaesthetic always involves an will help readers to get more from clinical n Local anaesthetic field block hypnotic agent, usually an analgesic and attachments in surgery and anaesthetics or n Peripheral nerve block may also include muscle relaxation. The serve as an introduction to the topic for n Nerve plexus block combination is referred to as the ‘triad of novice or non-anaesthetists. anaesthesia’. Figure 1. Schematic vertical longitudinal section The relative importance of each com- Types and sites of anaesthesia of vertebral column and structures encountered ponent depends on surgical and patient The term anaesthesia comes from the when performing central neuraxial blocks. * factors: the intervention planned, site, Greek meaning loss of sensation. negative pressure space filled with fat and surgical access requirement and the Anaesthetic practice has evolved from a venous plexi. † extends to S2, containing degree of pain or stimulation anticipated. need for pain relief and altered conscious- arachnoid mater, CSF, pia mater, spinal cord The technique is tailored to the individu- ness to allow surgery.
    [Show full text]
  • Aerosol Delivery Devices
    Year in Review 2014: Aerosol Delivery Devices Timothy R Myers MBA RRT-NPS FAARC Introduction History and Rationale Patient-Related Variables Pediatrics Patient Interfaces Delivery to Patients Requiring Mechanical Support Emerging Technologies Summary After centuries of discoveries and technological growth, aerosol therapy remains a cornerstone of care in the management of both acute and chronic respiratory conditions. Aerosol therapy em- braces the concept that medicine is both an art and a science, where an explicit understanding of the science of aerosol therapy, the nuances of the different delivery devices, and the ability to provide accurate and reliable education to patients become increasingly important. The purpose of this article is to review recent literature regarding aerosol delivery devices in a style that readers of RESPIRATORY CARE may use as a key topic resource. Key words: aerosol; delivery device; MDI; DPI; nebulizer; valved holding chamber; pediatrics; positive expiratory pressure; aerosol mask; high-flow cannula; noninvasive ventilation; mechanical ventilation. [Respir Care 2015;60(8):1190–1196. © 2015 Daedalus Enterprises] Introduction ications delivered through the inhalational route require specialized delivery systems to ensure delivery, deposi- The prevalence of respiratory conditions continues to tion, and accurate dosage.1 grow with each passing year. Regardless of the specific disease etiology, acute and chronic respiratory conditions History and Rationale require medical treatment either in the short term or on a continual, ongoing basis. One of the therapeutic similari- Aerosol delivery devices consist largely of small-vol- ties for all acute and chronic diseases is the necessity for ume nebulizers, pressurized metered-dose inhalers, and dry treatment/management with medication.
    [Show full text]
  • Oxygen Therapy and Oxygen Delivery (Pediatric) - CE
    Oxygen Therapy and Oxygen Delivery (Pediatric) - CE ALERT Fire is a significant hazard where oxygen is used. Do not permit flames, sparks, or smoking. OVERVIEW The administration of oxygen to children requires the selection of an oxygen delivery system that suits the child’s age, size, needs, clinical condition, and therapeutic goals. Oxygen delivery systems are categorized as low-flow (variable performance) systems or high-flow (fixed performance) systems. With low-flow systems, 100% oxygen mixes with room air during inspiration, and room air is entrained, making the percentage of delivered oxygen variable. High- flow devices provide such a high flow of premixed gas that the child is not required to inhale room air. Supplemental oxygen therapy is often recommended for children when peripheral oxygen saturation is consistently below 94%.1 A nasal cannula, oxygen mask (e.g., simple face mask, partial rebreathing mask with reservoir, a nonrebreathing mask with reservoir, Venturi mask), face tent, and oxygen hood deliver supplemental oxygen to children to treat hypoxia, respiratory distress, and respiratory failure. Because oxygen can dry the respiratory system, many oxygen delivery systems allow for humidification. Table 1 Nasal Cannula Device Description Indications Considerations Nasal cannula Low-flow Nasal cannulas are Children who need FIO2 inconsistent. nasal lightweight and oxygen Most commonly used oxygen delivery cannula have two soft concentrations device. prongs that fit in 22% to 60%. Child’s size and tidal volume alter the the nares and Allows child to eat, oxygen concentration child receives attach on each talk, and cough despite same flow rate. side to tubing. without Maximum oxygen flow should not Different sizes are interrupting exceed 4 L/min.
    [Show full text]
  • Routes of Opioid Abuse and Its Novel Deterrent Formulations
    evelo f D pin l o g a D Omidian et al., J Develop Drugs 2015, 4:5 n r r u u g o s J Journal of Developing Drugs DOI: 10.4172/2329-6631.1000141 ISSN: 2329-6631 Review Article Open Access Routes of Opioid Abuse and its Novel Deterrent Formulations Omidian A1, Mastropietro DJ2 and Omidian H2* 1The University of Chicago, Chicago, IL, USA 2College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA Abstract This review aimed to investigate the abuse patterns of common prescription opioids currently on the market by collecting large-scale surveys of different abuser populations. Furthermore, we aimed to analyze the efficacy and properties of currently implemented abuse-deterrent formulations (ADF) for these compounds. Our investigation showed that while oxycodone and oxymorphone are primarily abused by oral ingestion and insufflations, respectively, their ADF products (reformulated OxyContin and Opana ER) show some encouraging results to deter their abuse. Tapentadol is not popular amongst abuser populations, its ADF are difficult to tamper with, and it does not produce significantly desirable effects in noncompliant patients when compared to other opioids. Hydromorphone is predominantly abused by injection, and any effective abuse-deterrent strategy must specifically prioritize and target this route. Current formulations have successfully conferred aversive properties onto the drug in the event of preparation for injection, yet overall rates of hydromorphone abuse remain high, suggesting that more innovative steps need to be taken. Despite novel deterrent technologies that collectively offer deterrence by insufflations, injection and co-ingestion with alcohol, more priority needs to be given to deterring the most common and accessible route of abuse, i.e., oral ingestion of multiple doses.
    [Show full text]