Nebulization Checklist

Preparatory Phase
1. Check doctor’s order
2. Knock
3. Wash hands
4. Identify patient
5. Gather all equipment
6. Assess HR, breath sounds, and pulse oximetry

Performance Phase
1. Explain the use of the nebulizer equipment to the mother and warn
about possible side effects.
a) A nebulizer is a piece of medical equipment that a person with
asthma or another respiratory condition can use to administer
medication directly and quickly to the lungs. A nebulizer turns liquid
medicine into a very fine mist that a person can inhale through a face
mask or mouthpiece.
2. Place patient in a comfortable position or semi fowlers position.
3. Teach proper way of inhalation (so medicine will be taken effectively)
a) Slow inhalation via mouthpiece
b) Short pause after inspiration
c) Slow and complete exhalation
d) Some resting breaths before deep inhalation
4. Assemble nebulizer
5. Add medication
6. Turn on nebulizer
7. Let patient hold the mask
8. Instruct patient to take in deep breaths slowly and greater as normal.
Encourage brief end respiratory pause
9. Hold every 4th or 5th breath if dyspneic for 5 to 10 seconds
10. Tap nebulizer cup
11. Check HR during the procedure
12. Encourage patient to cough after several deep breaths

Follow-up Phase
1. Perform hand hygiene and assist patient to a comfortable position
2. Record medications used, response to medication and description of
secretions.
3. Disassemble and store tubing per hospital policy.
 Chest Physiotherapy Checklist
Purpose
 To perform chest physiotherapy (PT) according to the standard of care.

Assessment
 Assess the client's medical record for orders regarding activity and
position restrictions, tolerance of physiotherapy, and position changes.
 Assess bilateral breath sounds, noting rate and character.
 Assess the time of last oral intake. Avoid initiating therapy until 2 hours
after solid food and 1 hour after liquids.

Equipment
 Stethoscope
 Pillows or folded towels for positioning
 Tilt or postural drainage table (if available) or adjustable hospital bed
 Gloves, face shield, and gown
 Emesis basin
 Facial tissues
 Suction equipment
 Equipment for oral care
 Trash bag
 Optional: sterile specimen container, mechanical ventilator, and
supplemental oxygen

Procedure
1. Verify the order. Rationale: Verification of order prevents potential errors.
2. Confirm the client's ID. Compare the name with the name on the client's ID
bracelet using two client identifiers according to your facility's policy. Do not
start the treatment if the client is not wearing an ID bracelet.
Rationale: Checking identification ensures client safety through concept of
correct procedure for correct client.
3. Provide privacy and explain the procedure to the client.
Rationale: Explanation protects client's rights and encourages participation
in care.
4. Wash your hands, don gloves, a face shield, and a gown, and follow standard
precautions. Rationale: Handwashing and protective equipment reduce
transfer of microorganisms and protect nurse.
5. Auscultate the client's lungs. Rationale: Auscultation determines baseline
respiratory status.
6. Position the client as ordered. In generalized disease, drainage usually
begins with the lower lobes, continues with the middle lobes, and ends with
the upper lobes. In localized disease, drainage begins with the affected lobes
and then proceeds to the other lobes to avoid spreading the disease to
uninvolved areas
a) (Fig. 1). Rationale: Gloves and equipment protect you from secretions.
Fig. 1: Various postural drainage positions are used to mobilize
secretions from specific lobes and segments of the lungs.
7. Instruct the client to remain in each position for 10 to 15 minutes. During
this time, perform percussion and vibration, as ordered.
Rationale: Percussion and vibration loosen secretions in target areas.
a) To perform percussion, instruct the client to breathe slowly and deeply,
using the diaphragm, to promote relaxation. Hold your hands in a
cupped shape, with fingers flexed and thumbs pressed tightly against
your index fingers. Percuss each segment for 1 to 2 minutes by
alternating your hands against the client in a rhythmic manner. Listen
for a hollow sound on percussion to verify correct performance of the
technique (Fig. 2).
b) To perform vibration, ask the client to inhale deeply and then exhale
slowly through pursed lips. During exhalation, firmly press your fingers
and the palms of your hands against the chest wall. Tense the muscles of
your arms and shoulders in an isometric contraction to send fine
vibrations through the chest wall. Vibrate during five exhalations over
each chest segment (Fig. 3).
c) Fig. 2: With your hands held in a rigid cup position, strike the area
over the lung lobes to be drained in a rhythmic pattern
d) Fig. 3: Use manual compression and tremor to help loosen the
respiratory secretions

8. After postural drainage, percussion, or vibration, instruct the client to cough

to remove loosened secretions. First, tell the client to inhale deeply through
the nose and then exhale in three short huffs. Then, have the client inhale
deeply again and cough through a slightly open mouth. Three consecutive
coughs are highly effective. An effective cough sounds deep, low, and hollow;
an ineffective one sounds high pitched. Rationale: Coughing removes
secretions that have accumulated in trachea.
9. Have the client perform coughing exercises for about 1 minute and then rest
for 2 minutes. Gradually progress to a 10-minute exercise period four times
daily. Try to schedule the last session just before bedtime.
Rationale: Scheduling chest physiotherapy before bed will help maximize
client's oxygenation while sleeping.

10. If the client's cough is ineffective, suction the client. Rationale: Suction

removes secretions that have accumulated in trachea.

11. Monitor the client's response to the treatment. Be alert for significant color
changes, particularly if the client becomes dusky. Rationale: A dusky color
may indicate poor oxygenation.
12. Dispose of secretions appropriately.
13. Provide oral hygiene. Rationale: Secretions may have a foul taste or a stale
odor.
14. Auscultate the client's lungs. Rationale: Auscultation evaluates effectiveness
of therapy.
15. Record the date and time of chest PT; which chest segments were percussed
or vibrated; the color, amount, odor, and viscosity of any secretions
produced and the presence of any blood; any complications and nursing
actions taken; and the client's tolerance of treatment.
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