1. Program: Respiratory Therapy.. .
Program: Respiratory Therapy
Course: Introduction to Respiratory Therapy
Lesson: Aerosol/Humidity Therapy and CPT

2. 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.

3. 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.

4. Student Performance Objectives
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

5. 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

6. Supporting Student Performance Objectives Continued:
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

7. Supporting Student Performance Objectives Continued:
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

8. Lesson: Aerosol/Humidity Therapy and CPT
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.

9. Lesson: Aerosol/Humidity Therapy and CPT
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

10. Lesson: Aerosol/Humidity Therapy and CPT
Normally supplied to inspired
gas by nasal or oropharynx
passages.
Humidity adds moisture to the
respiratory tract

11. Lesson: Aerosol/Humidity Therapy and CPT
Water particles suspended
in air
Particulate water in a gas
Mist
Fog

12. Lesson: Aerosol/Humidity Therapy and CPT
Factors affect stability
Penetration and deposition affected by breathing pattern and size of particles

13. Lesson: Aerosol/Humidity Therapy and CPT
Particle Size, Deposition, and Location
Particle Size (mm) % Deposited Deposition Location
100
40-15
15-8
5-2
2.0-1
1.0
100
40-100
30-40
55+ 50 10
Mouth, nose, equipment
Upper airways
Bronchi
Bronchioles
Alveoli
Exhaled

14. Lesson: Aerosol/Humidity Therapy and CPT
Airway Clearance
Indications for Aerosol
Hazards of Aerosol Therapy

15. Passover Humidifier: Wick Type
Lesson: Aerosol/Humidity Therapy and CPT
Passover Humidifier: Wick Type

16. Passover Humidifier: Membrane Type
Lesson: Aerosol/Humidity Therapy and CPT
Passover Humidifier: Membrane Type

17. General Considerations for Nebulizers
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 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.

18. Lesson: Aerosol/Humidity Therapy and CPT
Postural Drainage
Indications:
Mobilize accumulated secretions due to:
COPD
Dehydration
Acute pulmonary disease
Prophylactically - history of pulmonary problems

19. Positions for Each Lung Segment
Lesson: Aerosol/Humidity Therapy and CPT
Positions for Each Lung Segment
Lobe/Area
Position
Right Upper Lobe
apical
anterior
posterior
Right Middle Lobe
medial
lateral
Right Lower Lobe
superior
anterior basal
lateral basal
posterior basal

20. Positions for Each Lung Segment
Lesson: Aerosol/Humidity Therapy and CPT
Positions for Each Lung Segment
Lobe/Area
Position
Left Upper Lobe
anterior
apical - posterior
superior lingula
inferior lingula
Left Lower Lobe
superior
anterior medial
lateral basal
posterior basal

21. Postural Drainage - Relative Contraindications
Lesson: Aerosol/Humidity Therapy and CPT
Postural Drainage - Relative Contraindications
Empyema
Flail Chest
Wounds
Spinal Injuries
Pneumothorax
Head Injuries
Unstable cardiac status
COPD
Obesity
Pregnancy
Recent meals or tube feeding

22. Lesson: Aerosol/Humidity Therapy and CPT
Percussion
Clapping chest wall
Indications:
When difficult to mobilize secretions
When postural drainage alone may not be effective

23. Percussion - Relative Contraindications
Lesson: Aerosol/Humidity Therapy and CPT
Percussion - Relative Contraindications
Empyema
Flail Chest
Wounds
Frank hemoptysis
Anticoagulant therapy
Pain or patient intolerance TB
Metastasized cancer

24. 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.

25. 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

26. Mechanical Percussors and Vibrators
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.

27. Patient 1: Winnie Kirkwood
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 Findings:
Pulse 108, regular, BP 102/70, temperature C, 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?

28. 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 Findings:
Pulse 110, regular, BP 158/90, temperature C, respiration 24, shallow. Breath sounds are decreased with rhonchi on exhalation throughout. Chest expansion is decreased in the bases. Patient has occasional weak, non-productive 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?

29. Patient 3 - Jonathan Harker
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 Findings:
Pulse 98, regular, BP 134/92, temperature C, 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?

30. 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 Findings:
Pulse 104, thready, BP 96/42, temperature C, 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 T-tube 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?

31. 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 Findings:
Pulse 96, thready, BP 134/90, temperature 380 C, respiration 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?

32. 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 Findings:
Pulse 110, regular, BP 146/82, temperature C, 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, non-productive 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?

33. 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 Findings:
Pulse 88, regular, BP 110/70, temperature C, 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?

34. 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 Findings:
Pulse 132, bounding, BP 178/96, temperature C, 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%, FiO
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?

35. 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.

36. 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.

37. Supporting Student Performance Objectives
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

38. 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

39. Supporting Student Performance Objectives Continued:
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

40. Supporting Student Performance Objectives Continued:
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