..
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Program: Respiratory
Therapy
Course: Introduction to
Respiratory Therapy
Lesson: Aerosol/Humidity
Therapy and CPT
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance
Objective -Lecture
The student will be able to Administer
aerosol and humidity therapy safely.
Supporting Student Performance
Objectives:
• Demonstrate proper set-up of humidifiers
with high and low flow oxygen delivery
devices.
• Given situations, discuss humidity deficit
and prevention.
• Give indications for humidity.
• Discuss factors influencing the efficiency of
humidifiers.
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance
Objective -Lecture
The student will be able to Administer
aerosol and humidity therapy safely.
Supporting Student Performance
Objectives Continued:
•
•
•
•
•
Given a situation, calculate R.H.
Discuss problems of humidity deficit.
Discuss hazards of humidity.
Demonstrate bronchial hygiene methods.
Discuss indications for bronchial hygiene
use.
• Discuss indications for sputum inductions.
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Assemble and apply humidifiers.
Supporting
Student Performance Objectives
• Correctly assemble, test for function, safely
apply, and troubleshoot the following
humidifiers:
–
–
–
–
Pass-over humidifier
Bubble humidifier
Cascade humidifier
Wick humidifier
• Demonstrate the use of humidifiers using
appropriate delivery devices.
• Correctly monitor the following as
appropriate:
– Oxygen concentration
– Temperature
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Position the patient and apply chest
physiotherapy.
Supporting Student Performance Objectives:
• Demonstrate proper body alignment and
stance when performing patient care skills.
• Demonstrate the usage of good body
alignment and body mechanics when
positioning or assisting a lab partner.
• Demonstrate how to properly position a
patient in the following positions:
–
–
–
–
–
Fowler’s
Supine
Prone
¼ turn from supine
Semi-Fowler’s
– Trendelenberg
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Position the patient and apply chest
physiotherapy.
Supporting Student Performance
Objectives Continued:
• Demonstrate how to assist a patient from
the bed into a chair and back to bed.
• Demonstrate how to properly secure the
following restraints:
– Chest
– Waist
– Wrist and ankle
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Position the patient and apply chest
physiotherapy.
Supporting Student Performance
Objectives Continued:
• Demonstrate correct use of bed rails and
other safety devices.
• Using a lab partner, properly perform
postural drainage and chest percussion on
any specified segment(s) of the lung
including:
– Proper positioning
– Identification of anatomical landmarks
– Proper manual percussion and vibration
techniques
– Proper use of a mechanical percussor
Lesson: Aerosol/Humidity Therapy and CPT
Humidity
A. Water in a gaseous state
B. Water vapor
C. Molecular water in gas
D. Potential Humidity
E. Saturated
F. Absolute Humidity - A.H.
G. Relative Humidity - R.H.
Lesson: Aerosol/Humidity Therapy and CPT
Humidity
Alveolar gas
At 37oC alveolar gas holds
approximately 44 mg/L of
humidity
At 37oC and 100% R.H. the
pressure exerted by water
vapor is 47 mmHg
Humidity deficit
Lesson: Aerosol/Humidity Therapy and CPT
Humidity
Normally supplied to inspired
gas by nasal or oropharynx
passages.
Humidity adds moisture to the
respiratory tract
Lesson: Aerosol/Humidity Therapy and CPT
Aerosol
• Water particles suspended
in air
• Particulate water in a gas
• Mist
• Fog
Lesson: Aerosol/Humidity Therapy and CPT
Aerosol
• Factors affect stability
• Penetration and deposition
affected by breathing pattern
and size of particles
Lesson: Aerosol/Humidity Therapy and CPT
Particle Size, Deposition, and Location
Particle Size (mm)
% Deposited
Deposition Location
100
100
Mouth, nose, equipment
100 - 40
100
Upper airways
40-15
40-100
Upper airways
15-8
30-40
Bronchi
5-2
55+
Bronchioles
2.0-1
50
Alveoli
1.0
10
Exhaled
Lesson: Aerosol/Humidity Therapy and CPT
Aerosol
Airway Clearance
Indications for Aerosol
Hazards of Aerosol Therapy
Lesson: Aerosol/Humidity Therapy and CPT
Passover Humidifier: Wick Type
Lesson: Aerosol/Humidity Therapy and CPT
Passover Humidifier: Membrane Type
Lesson: Aerosol/Humidity Therapy and CPT
General Considerations for
Nebulizers
• 44 mg/L is the target volume for a 100%
effective large volume Nebulizer.
• Therapeutic range of an aerosol particle is
between 1.0-3.0 microns.
• Nebulizers are a potential source of nosocomial
infections.
• Electrical nebulizers are potential shock
hazards.
• Nebulizers add fluid to the body.
• Monitor patients carefully for fluid overload.
Lesson: Aerosol/Humidity Therapy and CPT
Postural Drainage
• Indications:
– Mobilize accumulated secretions
due to:
• COPD
• Dehydration
• Acute pulmonary disease
– Prophylactically - history of
pulmonary problems
Lesson: Aerosol/Humidity Therapy and CPT
Positions for Each Lung Segment
Lobe/Area
• Right Upper Lobe
– apical
– anterior
– posterior
• Right Middle Lobe
– medial
– lateral
• Right Lower Lobe
–
–
–
–
superior
anterior basal
lateral basal
posterior basal
Position
Lesson: Aerosol/Humidity Therapy and CPT
Positions for Each Lung Segment
Lobe/Area
• Left Upper Lobe
–
–
–
–
anterior
apical - posterior
superior lingula
inferior lingula
• Left Lower Lobe
–
–
–
–
superior
anterior medial
lateral basal
posterior basal
Position
Lesson: Aerosol/Humidity Therapy and CPT
Postural Drainage - Relative
Contraindications
• Empyema
• Unstable cardiac
status
• Flail Chest
• COPD
• Wounds
• Obesity
• Spinal Injuries
• Pregnancy
• Pneumothorax
• Head Injuries
• Recent meals or tube
feeding
Lesson: Aerosol/Humidity Therapy and CPT
Percussion
• Clapping chest wall
• Indications:
– When difficult to mobilize
secretions
– When postural drainage alone
may not be effective
Lesson: Aerosol/Humidity Therapy and CPT
Percussion - Relative
Contraindications
• Empyema
• Anticoagulant
therapy
• Flail Chest
• Pain or patient
intolerance
• Wounds
• TB
• Frank
hemoptysis
• Metastasized
cancer
Lesson: Aerosol/Humidity Therapy and CPT
Percussion Technique
• Avoid sternum, spine, and bony
structures.
• May use sheet or towel to avoid
slapping.
• Examine skin for any effect.
• Each segment for 3-5 minutes.
Lesson: Aerosol/Humidity Therapy and CPT
Vibrations
• Used with percussion or alone.
• Tensing arms - keep them
straight - shake from shoulder
during patient exhalation only.
• Indications:
– After each segment with
percussion to move secretions in
large airways.
– Alone when percussion is not
tolerated
Lesson: Aerosol/Humidity Therapy and CPT
Mechanical Percussors and Vibrators
• Use only to lung area avoid kidneys, etc.
• Avoid bony structures.
• Avoid breast tissue in
females.
• Use towel or sheet to
prevent slapping.
• Use electrical precautions avoid water and hazardous
gas environments.
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 1: Winnie Kirkwood
Patient:
Winnie Kirkwood, a seventy-six year-old female.
Admitted this morning with shortness of breath
progressing over the last 24 hours. Patient has a history
of COPD. Patient is alert and possibly confused. She is in
a regular room.
Physical Pulse 108, regular, BP 102/70, temperature 38.40 C,
Findings: respiration 22, shallow. Breath sounds are decreased rhonchi
in bases. Patient has an occasional cough which appears to
be productive - patient is swallowing mucous. Patient is in
semi-Fowler’s position, she is slightly overweight.
Lab
Data:
pH 7.37, PaCO2 60, HCO3 -34, PaO2 46, SaO2 78%,
FiO2 nasal cannula at 1 Lpm, Hgb 15.8, WBC 13,100.
Order:
Increase oxygen to 5 Lpm. Administer 2 puffs ventolin
via metered dose inhaler (MDI) Q. 4h.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 2 - Kip Kiester
Patient:
Kip Kiester, a fifty-two year-old male. Patient had a colon
resection two days ago. Patient is alert and oriented. He is
in a regular room on the surgical floor. Patient had a
thirty pack-year smoking history.
Physical Pulse 110, regular, BP 158/90, temperature 38.80 C,
Findings: respiration 24, shallow. Breath sounds are decreased with
rhonchi on exhalation throughout. Chest expansion is
decreased in the bases. Patient has occasional weak, nonproductive cough. Skin is warm and moist.
Lab
Data:
SpO2 94% on room air.
Order:
Incentive spirometry Q. 2h. Administer 0.5cc
isoetharine in 2.5cc normal saline via aerosol q. i. d.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 3 - Jonathan Harker
Patient:
Jonathan Harker, a seventy-year-old male. Admitted this
morning with an exacerbation of ulcerative colitis.
Paatient has a long history of COPD. Patient is alert and
oriented. He is in a regular room and has an IV.
Physical Pulse 98, regular, BP 134/92, temperature 37.60 C,
Findings: respiration 22. Breath sounds clear in apices, scattered
rhonchi in the bases, occasional productive cough of white
sputum. Patient is resting comfortably in bed.
Lab
Data:
SpO2 92% on 2 Lpm via nasal cannula, Hgb 12.8, WBC
12,300.
Order:
Increase oxygen to 4 Lpm. 0.5cc isoetharine in 2.5cc
normal saline via aerosol Q. 4h.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 4 - Mina Seward
Patient:
Mina Seward, a sixty-year-old female. Admitted last night
from a nursing home with increasing shortness of breath
and increased temperature. Patient is minimally
responsive. She is in a regular room with an IV.
Physical Pulse 104, thready, BP 96/42, temperature 38.80 C,
Findings: respiration 30, shallow. Breath sounds are decreased
throughout with rhonchi on exhalation. Patient has
occasional weak, non-productive cough. Patient’s skin is
warm and dry.
Lab
Data:
pH 7.52, PaCO2 28, HCO3 -23, PaO2 44, SaO2 83%,
FiO2 0.21, Hgb 10.2, WBC 11,200.
Order:
Oral intubation, place on 60% oxygen via aerosol Ttube to an ET (endotracheal) tube.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 5 - Duke Lukela
Patient:
Duke Lukela, a forty-two year-old male. Admitted this
afternoon with an exacerbation of silicosis. Patient is alert
and oriented. He is in a regular room with an IV in place.
Physical Pulse 96, thready, BP 134/90, temperature 380 C, respiration
Findings: 26, shallow. Breath sounds are very decreased throughout;
chest expansion is very decreased throughout. Patient is not
coughing.
Lab
Data:
pH 7.42, PaCO2 30, HCO3 -19, PaO2 58, SaO2 82%,
FiO2 nasal cannula at 2 Lpm, Hgb 16.4, WBC 10,600.
Order:
Increase oxygen to 5 Lpm. Atrovent 2 puffs Q. 6h.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 6 - Philip Hogan
Patient:
Philip Hogan, a sixty-year-old male. He had a large bowel
resection yesterday. Patient is alert and oriented. He is on
the surgical floor and has an IV in place.
Physical Pulse 110, regular, BP 146/82, temperature 38.40 C,
Findings: respiration 26. Breath sounds decreased with fine crackles in
the right base, chest expansion is decreased on both sides,
less on the right. Patient has occasional weak, nonproductive cough.
Lab
Data:
SpO2 90% on room air.
Order:
Oxygen at 2 Lpm via nasal cannula. IPPB with 0.3cc
metaproterenol in 2.1cc normal saline q.i.d.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 7 - Ann Fan
Patient:
Ann Fan, a fifty-two year-old female. Admitted through
the emergency department with an exacerbation of
emphysema. Patient is oriented but somewhat lethargic.
Physical Pulse 88, regular, BP 110/70, temperature 38.20 C,
Findings: respiration 24, shallow. Breath sounds are very decreased
throughout. Chest expansion is decreased especially in the
bases. Patient has an occasional weak, non-productive cough.
Patient is in semi-Fowler’s position and has warm dry skin.
Lab
Data:
pH 7.48, PaCO2 34, HCO3 -23, PaO2 55, SaO2 91%,
FiO2 nasal cannula at 1 Lpm, Hgb 13.8, WBC 9,800.
Order:
Increase oxygen to 3 Lpm. IPPB with 0.5cc albuterol in
2cc 20% mucomyst Q. 4h.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Patient Cases
Patient 8 - Wilbur Post
Patient:
Wilbur Post, a fifty-two year-old male. Admitted through
the emergency department with acute onset of shortness
of breath. Patient has a long history of congestive heart
failure. Patient is alert and very anxious. He is on an
emergency room cart.
Physical Pulse 132, bounding, BP 178/96, temperature 37.20 C,
Findings: respiration 30, shallow and labored. Breath sounds are
decreased throughout with course crackles in all fields. The
patient is not coughing. His skin is warm and moist. He is
sitting up in bed in apparent respiratory distress.
Lab
Data:
pH 7.39, PaCO2 45, HCO3 -26, PaO2 41, SaO2 76%,
FiO2 0.21.
Order:
Oxygen via nasal cannula at 6 Lpm. 0.5cc albuterol in
2.5cc normal saline stat.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance
Objective -Lecture
The student will be able to Administer
aerosol and humidity therapy safely.
Supporting Student
Performance Objectives:
• Demonstrate proper set-up of humidifiers
with high and low flow oxygen delivery
devices.
• Given situations, discuss humidity deficit
and prevention.
• Give indications for humidity.
• Discuss factors influencing the efficiency of
humidifiers.
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance
Objective -Lecture
The student will be able to Administer
aerosol and humidity therapy safely.
Supporting Student Performance
Objectives Continued:
•
•
•
•
•
Given a situation, calculate R.H.
Discuss problems of humidity deficit.
Discuss hazards of humidity.
Demonstrate bronchial hygiene methods.
Discuss indications for bronchial hygiene
use.
• Discuss indications for sputum induction.
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Assemble and apply humidifiers.
Supporting Student
Performance Objectives
• Correctly assemble, test for function, safely
apply, and troubleshoot the following
humidifiers:
–
–
–
–
Pass-over humidifier
Bubble humidifier
Cascade humidifier
Wick humidifier
• Demonstrate the use of humidifiers using
appropriate delivery devices.
• Correctly monitor the following as
appropriate:
– Oxygen concentration
– Temperature
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Position the patient and apply chest
physiotherapy.
Supporting Student Performance Objectives:
• Demonstrate proper body alignment and
stance when performing patient care skills.
• Demonstrate the usage of good body
alignment and body mechanics when
positioning or assisting a lab partner.
• Demonstrate how to properly position a
patient in the following positions:
–
–
–
–
–
Fowler’s
Supine
Prone
¼ turn from supine
Semi-fowler’s
– Trendelenberg
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Position the patient and apply chest
physiotherapy.
Supporting Student Performance
Objectives Continued:
• Demonstrate how to assist a patient from
the bed into a chair and back to bed.
• Demonstrate how to properly secure the
following restraints:
– Chest
– Waist
– Wrist and ankle
Lesson: Aerosol/Humidity Therapy and CPT
Major Student Performance Objective Laboratory
Position the patient and apply chest
physiotherapy.
Supporting Student Performance
Objectives Continued:
• Demonstrate correct use of bed rails and
other safety devices.
• Using a lab partner, properly perform
postural drainage and chest percussion on
any specified segment(s) of the lung
including:
– Proper positioning
– Identification of anatomical landmarks
– Proper manual percussion and vibration
techniques
– Proper use of a mechanical percussor