Name: Jan Louis P.

Lapay Date: 05/15/2022

Evaluator: Assistant Professor Neil M. Martin, MAN, MBE, RN Score: ___________

ADMINISTERING MEDICATION VIA SMALL-VOLUME NEBULIZER

Definition:
Nebulization is a process of adding medications or moisture to inspired air by mixing particles of various sizes with air. Small-Volume Nebulizer is anaerosol generator used to deliver liquid medications,
such as bronchodilators, to the mid-to-lower airways. It converts a drug solution into a mist that isthen inhaled by a patient into their tracheobronchial tree. The droplets in the mist are much finer than those
created by metered-dose inhalers (MDIs) ordry powder inhalers (DPIs).

Purpose:
To administer medications such as bronchodilators, mucolytics, and corticosteroids.
To create local effects

Indication:
BronchospasmsChest tightness
Chest tightness
Excessive and thick mucus secretions
Respiratory congestions Atelectasis
Pneumonia
Asthma

ACTION RATIONALE PERFORMED REMARKS

YES NO

1. Gather equipment. Check each medication order against the This comparison helps to identify errors that may have
original order in the medical record, according to facility policy. occurred when orders were transcribed. The Primary care
Clarify any inconsistencies. Check the patient’s chart for provider’s order is the legal record of medication orders for
allergies. each facility.

2. Know the actions, special nursing considerations, safe dose This knowledge aids the nurse in evaluating the therapeuticeffect of the
ranges, purpose of administration, and adverse effects of the medication in relation to the patient’s disorder
medications to be administered. Consider the appropriateness of and can also be used to educate the patient medications
the medication for this patient.
 3. Perform hand hygiene. Hand hygiene prevents the spread of microorganisms.

4. Move the medication cart to the outside of the patient’s room Organization facilitates error-free administration and savestime.
or prepare for administration in the medication area.

5. Unlock the medication cart or drawer. Enter pass code Locking the cart or drawer safeguards each patient’smedication supply.
and scan employee identification, if required. Hospital accrediting organizationsrequire medication carts to be locked when not
in use.Entering pass code and scanning ID allows only authorizedusers into the
system and identifies user for documentationby the computer.

6. Prepare medications for one patient at a time. This prevents errors in medication administration.

7. Read the CMAR/MAR and select the proper medication from This is the first check of the label.
the patient’s medication drawer or unit stock.

8. Compare the label with the CMAR/MAR. Check expiration This is the second check of the label. Verify calculations withanother nurse to
dates and perform calculations, if necessary. Scan the bar code ensure safety, if necessary.
on the package, if required.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 36

ACTION RATIONALE PERFORMED REMARKS

YES NO

9. When all medications for one patient have been This is a third check to ensure accuracy and to preventerrors. Some facilities
prepared, recheck the label with the CMAR/MAR before require the third check to occur at
taking them to the patient. the bedside, after identifying the patient and beforeadministration.

10. Lock the medication cart before leaving it. Locking the cart or drawer safeguards the patient’s
medication supply. Hospital accrediting organizations
 require medication carts to be locked when not in use.

11. Transport medications to the patient’s bedside carefully, and Careful handling and close observation prevent accidental ordeliberate
keep the medications in sight at all times. disarrangement of medications.

12. Ensure that the patient receives the medications at the Check agency policy, which may allow for administrationwithin a period of 30
correct time. minutes before or 30 minutes after thedesignated time.

13. Perform hand hygiene and put on PPE, if indicated. Hand hygiene and PPE prevent the spread ofmicroorganisms. PPE is
required based on transmissionprecautions.

14. Identify the patient. Usually, the patient should be identified Identifying the patient ensures the right patient receives themedications and helps
using two methods. Compare information with the MAR/CMAR. prevent errors.

15. Check the name and identification number on the patient’s This is the most reliable method. Replace the identificationband if it is missing or
identification band. inaccurate in any way

16. Ask the patient to state his or her name and birth date, based This requires a response from the patient, but illness andstrange surroundings
on facility policy. often cause patients to be confused.

17. If the patient cannot identify him- or herself, verify the This is another way to double-check identity. Do not use thename on the door or
patient’s identification with a staff member who knows the over the bed, because these signs may
patient for the second source. be inaccurate

18. Complete necessary assessments before administering Assessment is a prerequisite to the administration ofmedications.
medications. Check the patient’s allergy bracelet or ask the Explanation relieves anxiety and facilitatescooperation.
patient about allergies. Explain what you are going to do,
and the reason for doing it, to the patient.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 37

ACTION RATIONALE PERFORMED REMARKS

YES NO
19. Scan the patient’s bar code on the identification band, if Scanning provides an additional check to ensure that themedication is given
required. to the right patient.

20. Remove the nebulizer cup from the device and open it. Place To get enough volume to make a fine mist, normal salinemay need to be
premeasured unit dose medication in the bottom section of the added to the concentrated medication.
cup or use a dropper to place a concentrated dose of medication
in the cup (Figure 1) and add prescribed diluent, if required.

21. Screw the top portion of the nebulizer cup back in place and Air or oxygen must be forced through the nebulizer to forma fine mist.
attach the cup to the nebulizer. Attach one end of tubing to the
stem on the bottom of the nebulizer cuff and the other end to
the air compressor or oxygen source.

22. Turn on the air compressor or oxygen (Figure 2). Check If there is no fine mist, make sure that medication hasbeen added to the cup
that a fine medication mist is produced by opening the valve. and that the tubing is connected tothe air compressor or oxygen outlet. Adjust
Have patient place mouthpiece into mouth and grasp securely flow meter if
with teeth and lips. necessary

23. Instruct the patient to inhale slowly and deeply through the While the patient inhales and holds the breath, themedication comes in
mouth. Abe is necessary if the patient is also breathing through contact with the respiratory tissue andis absorbed. The longer the breath is
the nose. Hold each breath for a slight pause, before exhaling. held, the moremedication can be absorbed.

24. Continue this inhalation technique until all medication Once the fine mist stops, the medication is no longer being
in the nebulizer cup has been aerosolized (usually about aerosolized. By gently flicking the cup sides, anymedication that is stuck to
15 minutes). Once the fine mist decreases in amount, the sides is knocked into thebottom of the cup, where it can become aerosolized.
gently flick the sides of the nebulizer cup.

25. Have the patient gargle and rinse with tap water after using Rinsing is necessary when using inhaled steroids, becauseoral fungal
the nebulizer, as necessary. Clean the nebulizer according to the infections can occur. Rinsing removes
manufacturer’s directions. medication residue from the mouth. The buildup ofmedication in the device
can affect how the medication isdelivered, as well as attract bacteria.

26. Remove gloves and additional PPE, if used. Perform hand Removing PPE properly reduces the risk for infectiontransmission and
hygiene. contamination of other items. Handhygiene prevents the spread of
microorganisms.

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 ACTION RATIONALE PERFORMED REMARKS

YES NO

27. Document the administration of the medication Timely documentation helps to ensure patient safety.
immediately after administration. See the documentation
section below.

28. Evaluate patient’s response to medication within appropriate The patient needs to be evaluated for therapeutic andadverse effects from the
time frame. Reassess lung sounds, oxygenation saturation if medication. Lung sounds and
ordered, and respirations. oxygenation saturation may improve after nebulizer use.Respirations may
decrease after nebulizer use.

Learner’s Reflection: (What did you learn most of Instructor’s Comments:

the activity? What is its impact to you?)

Through this return demonstration checklist, i have

learned the proper way in using medicine adminsitration
through a small volume nebulizer. Me as an asthmatic
person, this will be of great help to others as well as on
myself