VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

SKILLS LABORATORY MODULE NO. 8

NEBULIZATION THROUGH AEROSOL MASK & METERED-DOSE
INHALER

Nebulization refers to the delivery medications to the respiratory tract through inhalation via an aerosol
mask or metered-dose inhaler, producing local and systemic effects. The mucosal lining of the respiratory tract
absorbs the propelled medication almost immediately.

LEARNING OBJECTIVES:
By the end of the module, the student will be able to:
1. Give the indications of nebulization.
2. Enumerate the parts of a nebulizer set.
3. Enumerate the parts of an air compressor.
4. Enumerate the parts of a metered-dose inhaler.
5. Describe the procedure for performing nebulization through aerosol mask & metered-dose inhaler.
6. Explain rationale for each step of the procedure accurately.

 Important Information related to this Module:

A. Indications of Nebulization (depends on type of medication nebulized)
▪ To improve airway patency and facilitate mucous drainage ( bronchodilators)
▪ To liquefy tenacious bronchial secretions ( mucolytics )
▪ To decrease airway inflammation ( corticosteroids ).

B. Parts of a NEBULIZER SET :

(1) Mouthpiece
(2) Nebulizer T-piece
(3) Nebulizer Cap
(4) Nebulizer chamber or cup
(5) Nebulizer Air-inlet Connector
(6) Nebulizer Baffle
(7) Tubing
(8) Aerosol mask (different sizes for adult
& pedia)

C. Parts of an AIR COMPRESSOR :

(1) Storage compartment
(2) Storage compartment door with operating instructions
(3) Power switch
(4) Filter cap
(5) Air-outlet connector
(6) Carrying handle
(7) Power cord storage
(8) Nebulizer holder

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D. Parts of an INHALER
(1) Prepackaged dispenser [containing medication] or medication canister with;
(2) Applicator/actuator
(3) Aerochamber or spacer device
(4) Mouthpiece

 Nursing Skills to Develop in this Module & Materials/Equipment Needed: [materials/items with an
asterisk (*) are the materials the students should bring during skills laboratory period]

▪ Administering Nebulized Medications through an Aerosol Mask:

- Tissue*
- 5-mL Syringe*
- 0.9% Sodium Chloride Solution (vial)*
- Alcohol swab*
- Air compressor
- Nebulizer set (with mouthpiece or mask)
- Nebule containing medication

▪ Administering Nebulized Medications through a Metered-Dose Inhaler:

- Medication on Metered-Dose Inhaler (e.g., Ventolin® inhaler or Seretide® discus) with spacer
device or aerochamber*
- Tissue*

 Procedure Guidelines:
A. Administering Nebulized Medications through an Aerosol Mask
1. Verify doctor’s orders.
2. Check for drug allergies & hypersensitivity.
3. Assess the client’s respiratory status. Auscultate client’s chest for wheezes & crackles.
4. Perform hand hygiene before setting up the nebulizer.
5. Pour prescribed amount of drug into the nebulizer chamber. Avoid touching the drug while pouring into
the nebulizer chamber. If medication is not in a nebule, use a syringe or medication dropper to withdraw
prescribed amount of medication (usually indicated for pediatric & elderly clients). Saline may also be
instilled as prescribed with the medication in the nebulizer chamber using a syringe.
6. Cover the chamber with the cap and fasten.
7. Fasten the face mask or T-shaped tube with mouthpiece to the end of the cap. Avoid touching the
nebulizer mouthpiece or the interior part of the mask.
8. Identify the client prior to administration of medication.
9. Identify the medication to the client and clearly explain the therapeutic purpose of the medication.
10. Advise the client to sit in an upright position.

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11. Attach tubing to the nebulizer air-inlet connector and attach the other end to the air compressor.
12. Instruct the client to breathe in and out slowly and deeply through the mouthpiece/mask. The client’s
lips should be sealed tightly around the mouthpiece.
13. Remain with the client long enough to observe the proper inhalation-exhalation technique.
14. Perform hand hygiene.
15. Do appropriate documentation.
16. When the nebulizer chamber is empty, turn off the compressor.
17. Do aftercare of equipment and carefully clean the nebulizer set, ready for next use.
18. Assess the client (particularly respiratory status) immediately following the treatment for results or
adverse effects from the treatment.
19. Reassess the client 5-10 minutes following the treatment.

B. Administering Nebulized Medications through a Metered-Dose Inhaler

1. Assess the client for ability to use the metered-dose inhaler
2. Verify doctor’s orders.
3. Check for drug allergies and hypersensitivity.
4. Perform hand hygiene.
5. Shake the prepackaged dispenser of the metered-dose inhaler containing the medication.
6. Place the prepackaged dispenser into its applicator (if not yet attached).
7. Place the aerochamber onto the mouthpiece of the applicator if needed. The aerochamber provides
dead space for the medicated mist while the client inhales.
8. Have the client seal his lips around the mouthpiece of the metered-dose inhaler or around the
aerochamber.
9. Instruct client to take two deep breaths through the nose and after last exhalation, have client press
down on the prepackaged dispenser as he simultaneously inhales through the mouthpiece of the
metered-dose inhaler or through the aerochamber. Have client hold his breath for 10-15 seconds
and then breathe out slowly. If second dose is needed, patient should wait 1-2 minutes before taking
another dose. [see illustration below]

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10. If there is an aerochamber or spacer attached to the inhaler, have the client inhale slowly and deeply
from the aerochamber or spacer. [see illustrations below]

11. Wipe clean the mouthpiece of the metered-dose inhaler & aerochamber, ready for next use.
12. Observe client for several minutes to assess for possible adverse effects from the medication.
13. Perform hand hygiene.
14. Do appropriate documentation.

 Special Considerations:
▪ If two different inhaled medications are prescribed and one of the medications contains a glucocorticoid
(corticosteroid), administer the bronchodilator first and the corticosteroid second. Wait 5 minutes
following the bronchodilator before inhaling the corticosteroid.
▪ Client should be instructed to gargle with water after inhaling a corticosteroid.
▪ Dust may accumulate on the nebulizer equipment. Always clean equipment in between use.
▪ Teach client how to perform a
“ float test ” to approximate how much
medication is in the metered-dose inhaler, by
observing its displacement in water [see
illustration]. However, client must be warned
that some medication canisters are not to be
submerged in water; thus, instruct client to
read package insert of inhaler for directions
on use.

 References & Suggested Readings:

▪ Altman, G.B. (2010). Fundamental & advanced nursing skills (3rd ed.). Clifton Park, NY: Delmar Cengage
Learning.
▪ Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008). Kozier & Erb’s fundamentals of nursing: Concepts,
process and practice (8th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
▪ Schilling-McCann, J. (2009). Lippincott’s nursing procedures (5th ed.). Philadelphia, PA: Lippincott,
Williams & Wilkins.

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▪ Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Brunner & Suddarth’s textbook of medical-
surgical nursing (12th ed.). Philadelphia, PA: Wolter Kluwer Health/Lippincott, Williams & Wilkins.