Currently, there are three major types of aerosol generators frequently used in the treatment of airway disease. This includes metered-dose inhalers, dry-powder inhalers and small-volume nebulizers. A variation of the metered-dose inhaler is the breath-actuated MDI (pMDI), designed to synchronize inhalation and actuation. Another category includes holding chambers and spacers, though these are used in combination with metered-dose inhalers to improve effectiveness of the drug being administered. In regards to metered-dose inhalers, there are two propellant systems, both chlorofluorocarbon (CFC) and hydrofluoroalkane (HFA). Chlorofluorocarbon propellants are almost completely phased out at this point due to their detrimental effects on the environment, specifically the ozone layer. A patient with chronic obstructive pulmonary disease (COPD), is likely to have an MDI or SVN with a short-acting bronchodilator in conjunction with a DPI that contains a long-acting bronchodilator. However, studies show the use of several devices may lead to confusion for these patients, resulting in incorrect procedure and inadequate drug dosage. Figure 1 demonstrates the diverse variety of inhalation devices available.
Referencing Table 2 in “Practical problems with aerosol therapy in COPD”, the most prevalent error in MDI use amongst patients is error in technique, specifically failure to coordinate the MDI. Following coordination, other errors include inadequate breath-holding, rapid inspiratory flow and failure to shake the MDI before use. It is estimated that 28-68% of patients do not benefit from their MDIs or DPIs due to their misuse of the apparatus. This misuse results in billions of dollars wasted on a drug that is not being administer...
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...atients are able to use DPIs with minimum inspiratory flow.
Small volume nebulizers are simple to use as they require only normal tidal volume with no breath hold. The challenges with SVNs are related to their design, as they are often large in size and require an external power source. Additionally, a compressor or gas source is needed and the treatment time can be lengthy. SVNs are recommended for patients who cannot coordinate an MDI, or patients that cannot activate a DPI due to dyspnea. Individuals with difficulty using a standard MDI may find a breath-actuated MDI a better option. The Duo-Haler was the first breath-actuated MDI, followed by the Autohaler™. 97% of patients with airflow restriction were able to actuate the Autohaler™ on their first attempt. Breath-actuated MDIs received the highest performance scores and are vastly favored amongst patients.
There are two forms of bronchodilators, a short acting and a long acting form. Short acting relieves or stops asthma symptoms and is very helpful during an attack. They are also called ‘rescue’ medications because they are best for treating sudden or severe asthma symptoms. Long acting bronchodilators are used to control asthma, they take longer to work but they also last longer, up to 12 hours, whereas a short acting would only last for about 4-5 hours. Ventolin is a short acting form, it is the recommended medication to use 15-20 mins before exercising.
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
...f inhaler. Patient must disinfect the parts of the nebulizer by boiling them in water every other day of treatment to stop the spread of germs.
Facilitating spontaneous ventilation during APRV aids in alveolar recruitment, and improves distribution of lung volume to collapsed lung units. In one year retrospective study, APRV was compeered with pressure support ventilation(PSV) in eighteen patients with ALI and ARDS. Pressure support ventilation is a patient triggered, pressure limited, and flow cycled ventilation, it allows the patient to control the rate and depth of each breath. The effectiveness of spontaneous ventilation was investigated by the use of both computed tomography scan and volumetry for a period of three days.6 This study showed superiority of APRV in providing better gas distribution, pulmonary oxygenation, and decreasing lungs atelectasis faster than PSV. The clinicians recorded the main reason for this finding was derived from alveolar recruitment without overdistention during APRV. Airway Pressure Released Ventilation allows spontaneous ventilation while providing an open lung protective strategy. 6 Dr. Varpula and colleagues also compared APRV with other forms of partial mechanical ventilation, SIMV with PS, to study the effect of spontaneous ventilation in improving gas distribution. They observed no differences in clinical outcome between APRV and SIMV in gas distribution. Authors interpreted the finding due to the long study period and the differences
Carone M, D. C. ( 2007). Clinical Challenges In COPD[e-book]. (Oxford: Clinical Pub) Retrieved March 24, 2014, from (EBSCOhost).
HENDERSON, Y (1998) A practical approach to breathing control in primary care. Nursing Standard (JULY) 22 (44) p41
Goodfellow, L. T. (2011). 2015 and Beyond: Usable and Unbiased Data. Respiratory Care, 56(12), 1977-1978. doi: 10.4187/respcare.01619
Ventilation and perfusion, an essential contributing factor to living organisms, can be negatively effected by many different factors. Some diseases that effect ventilation and perfusion include congestive heart failure, coronary artery disease, peripheral vascular disease, pneumonia, asthma, chronic obstructive pulmonary disorder, cystic fibrosis and emphysema to name a few. Each of these diseases negatively effect how our bodies would normally ventilate and perfuse. Ventilation is the body’s way of getting in the oxygen it needs to perfuse throughout your body. Ventilation happens in the respiratory system, mainly focusing on the lungs. Ventilation can be impacted by multiple factors, some including, inflammation of the airway, fluid in the lungs and a foreign body obstructing the airway. Perfusion is the way your body delivers oxygenated blood to tissues. Not only does it deliver oxygenated blood, but it also returns deoxygenated blood to the lungs to be reoxygenated, delivers different nutrients to your tissues and removes waste byproducts that are naturally made in the body.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992). The diagnosis of COPD is predominantly based on the results of a lung function assessment (Larsson, 2007). Chronic bronchitis is differentiated from emphysema by it's presentation of a productive cough present for a minimum of three months in two consecutive years that cannot be attributed to other pulmonary or cardiac causes (Marx, Hockberger & Walls, 2014) (Viegi et al., 2007). Whereas emphysema is defined pathologically as as the irreversible destruction without obvious fibrosis of the lung alveoli (Marx, Hockberger & Walls, 2014) (Veigi et al., 2007).It is common for emphysema and chronic bronchitis to be diagnosed concurrently owing to the similarities between the diseases (Marx, Hockberger & Walls, 2014).
The Ottawa Model of Research Use (OMRU) is an interactive model developed by Logan and Graham (1998). The OMRU views research use as a dynamic process of interconnected decisions and actions by different individuals relating to each of the model elements (Logan & Graham, 1998). The OMRU includes six key elements: (1) evidence-based innovation, (2) potential adopters, (3) the practice environment, (4) implementation of interventions, (5) adoption of the innovation, (6) outcomes resulting from implementation of the innovation (Graham & Logan, 2004).
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.