Degree year 1 - Adult Health Nursing - NUR 2366

Lab Skills –2023-2024

Nebulization Therapy

Nebulization:
Is the process of medication administration via inhalation. It utilizes a nebulizer which
transports medications to the lungs by means of mist inhalation.

Purposes:
The goal of nebulization therapy can be briefly summarized as “SHAPE”:
• S (Relief airway Spasm): to relieve bronchospasm, coughing and

wheezing:
• H (Humidify): to humidify airway.

• An (Anti-inflammation): to achieve an anti-inflammatory effect.

• P (Prevent): to prevent respiratory complications such as airway

inflammation, obstruction, atelectasis, infection, and asphyxia.

• E (Expectorant): promote expectoration.

Indication:
Nebulization therapy is used to deliver medications along the respiratory tract and is
indicated to various respiratory problems and diseases such as:
▪ Bronchospasms
▪ Chest tightness
▪ Excessive and thick mucus secretions
▪ Respiratory congestions
▪ Pneumonia
▪ Atelectasis
▪ Asthma

Contraindications:
In some cases, nebulization is restricted or avoided due to possible untoward results or
rather decreased effectiveness such as:
▪ Patients with unstable and increased blood pressure
▪ Individuals with cardiac irritability (may result to dysrhythmias)
▪ Persons with increased pulses
▪ Unconscious patients (inhalation may be done via mask but the therapeutic
effect may be significantly low)
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 Degree year 1 - Adult Health Nursing - NUR 2366
Lab Skills –2023-2024

Equipment:
• Nebulizer and nebulizer connecting tubes.
• Compressor oxygen tank
• Mouthpiece/mask
• T-piece connector.
• Respiratory medication to be administered.
• Normal saline solution
• Hand disinfectant.
• Stethoscope.
• Disposable gloves (PPE as indicated).

Complications:

Possible effects and reactions after nebulization therapy are as follows:

• Palpitations
• Tremors
• Tachycardia
• Headache
• Nausea
• Bronchospasms (too much)

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 Degree year 1 - Adult Health Nursing - NUR 2366
Lab Skills –2023-2024

Nebulizer Parts

Nebulization Procedure

# Steps Rational
Pre-procedure
1. Verify physician prescription. To avoid any mistakes
2. Wash Hands. To maintain infection control
3. Prepare needed equipment. To save time and effort
4. Introduce yourself to the patient. To build trust.
5. Verify the patient by 2 Nurses. To ensure that, right patient receives
intervention.
6. Explain procedure to the patient. To decrease patient's anxiety and
increase patient’s cooperation
7. Keep patient privacy. Patient right( to decrease patient
embarrassment )
8. Position the patient appropriately, allowing To facilitate the administration of the
optimal ventilation. medication.
Sit up straight on a comfortable chair. Using a
mouthpiece is preferred. When using a
mouthpiece, place the mouthpiece between the
teeth and ask the patient to seal his/her lips
around it.
If the patient is using a mask, position it
comfortably and securely on the face.

9. Disinfect your hand. To maintain infection control

10. Wear disposable gloves. To maintain infection control
During procedure
11. Assess and record breath sounds, respiratory To provide a baseline for evaluation the
status, pulse rate and other significant effectiveness of nebulization therapy.
respiratory functions. Ask the patient about
allergies.

12. Check the doctor’s orders for the medication, To avoid any mistakes.
prepare thereafter.
Place the premeasured medication in the To get enough volume to make a fine mist
bottom section of the cup or use a dropper to that can be inhaled.
13. place medication. Add prescribed diluent
(usually Saline) if ordered.

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 Degree year 1 - Adult Health Nursing - NUR 2366
Lab Skills –2023-2024

Screw the top portion of the nebulizer cup Air or oxygen must be forced through the
back in place and attach the cup to the nebulizer to form a fine mist.
nebulizer. Attach one end of the tubing to the To secure the passage of aerosol mist to
stem on the bottom of the nebulizer cuff and the lungs.
the other end to the air compressor or oxygen
source.
14.

For patient on mechanical Ventilator: To deliver medicine by using high-

frequency vibrations to convert the liquid
1. Unhook the ventilator tubing and insert the into an aerosol and do not increase patient
T-piece into the ventilator tubing on the tidal volume during inhalation.
inhalation side.
2. Insert the nebulizer cup into the T-piece
that is now in line with the ventilator
15.
circuit.
3. Connect one end of the tubing to the
bottom of the nebulizer and the other end
to the aerosol/nebulizer machine.
4. Once nebulizer is done, suction the trach to
remove secretions.

16. Turn on the air compressor or oxygen. Check To prevent any leakage while receiving
that a fine medication mist is produced by the medication.
opening the valve. Have the patient place the
mouthpiece (or Mask) into the mouth and
grasp securely with teeth and lips.

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 Degree year 1 - Adult Health Nursing - NUR 2366
Lab Skills –2023-2024

17. Offer the nebulizer to the patient, help until To assess patient ability to receive the
she/he can perform proper inhalation (if medication and to start medication on
unable to hold the nebulizer, replace the time.
mouthpiece with mask)

18. Instruct the patient to inhale slowly and
deeply through the mouth. A nose clip may be
necessary if the patient is also breathing
through the nose. Hold each breath for a slight
pause, before exhaling.
To let the medication come in contact with
respiratory tissues and can be absorbed.
The longer the breath is held, the more
medication can be absorbed.

19. Continue the inhalation technique until the all For optimal delivery of medication to the
medication in the nebulizer cup has been patient.
aerosolized (about 5 to 15 minutes).

20. Observe for any possible side effects or
inhalation reactions.
21. When the medication is completely
aerosolized, the cup will be empty. Have the
patient remove the nebulizer from the mouth
and gargle and rinse with tap water, as
indicated.
22. Reassess patient status from breath sounds,
respiratory status, pulse rate and other
significant respiratory functions needed.
Compare and record significant changes and
improvements. Refer if necessary.
Post procedure
23. Dispose of equipment appropriately.
24. Clean the nebulizer and take it apart and wash To kill bacteria and remove build-up.
all of the parts in warm, soapy water. Store
nebulizer and equipment according to
facility’s policy.
5
To prevent any complications and
reporting it in timely manner.
To avoid oral fungal infections due to
inhaled steroids.
Rinsing removes medication residual
from the mouth.
To ensure the effectiveness of the
medication given and to write down any
changes or differences in the patient’s
condition. Lung sound, Oxygen
saturation level may improve after
nebulizer use. Respiration may decrease
as well.
To reduce risk of transmission of
microorganisms.
 Degree year 1 - Adult Health Nursing - NUR 2366
Lab Skills –2023-2024

25. Remove used gloves and discard in the proper
bag (Red).
26. Wash hands.
27. Record patient's assessment before and after
intervention, medication dosage and name,
date, time, oxygen saturation.
28. Report any abnormalities to the physician
such as allergic reactions or pain.
To maintain infection control.
To maintain infection control.
To maintain patient’s safety and keep-
documented source helps in following
patient’s status.
To take necessary actions.

Procedure Video Links:

https://www.youtube.com/watch?v=V44OI-FjBCk&t=4s
https://youtube.com/watch?v=Z5Lx--xlj28
https://youtube.com/watch?v=afSqRIdwwdM

Prepared by: TA. Gerges Nady

References:
− Lynn, P., 2019. Taylor’s clinical nursing skills: A nursing process approach,
Philadelphia, PA: Wolters Kluwer Health.
− Perry, A.G., Potter, P.A., Ostendorf, W.R. and Laplante, N., 2021. Clinical nursing
skills and techniques-E-Book. Elsevier Health Sciences.
− https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803223/#:~:text=Nebulization%2
0therapy%20can%20be%20used,airway%20management%20in%20other%20diseas
es.
− https://www.urmc.rochester.edu/childrens-hospital/tracheostomy-ventilator-
program/ventilator/nebulizer-
treatments.aspx#:~:text=Place%20the%20medicine%20in%20the,line%20with%20t
he%20ventilator%20circuit.