NUR 111: CARE OF CLIENTS WITH LIFE

THREATENING CONDITIONS/ACUTELY
ILL/MULTI-ORGAN PROBLEMS/HIGH ACUITY
AND EMERGENCY SITUATIONS, ACUTE AND
CHRONIC -RLE
A. Aerosol Delivery Devices and
Therapy
• Nebulizers
• MDIs
AEROSOL DELIVERY
DEVICES
 BENEFITS OF DELIVERING
MEDICATION VIA INHALED
ROUTE
1. Rapid onset of action
2. High local concentration by delivery directly to the
airways
3. Needle-free systemic delivery of drugs with poor
oral bioavailability.
A. NEBULIZER

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

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, and
Asthma.
 TYPES OF NEBULIZER

Jet Nebulizers
• A jet nebulizer delivers compressed gas through a jet (see image below).This causes a region of negative
pressure, in which a solution or suspension is entrained into the gas stream and is sheared into a liquid film. This
film is unstable and breaks into droplets due to surface tension forces. A baffle in the aerosol stream produces
smaller particles, and it is further conditioned by factors such as the relative humidity of the carrier gas.
 Mesh Nebulizers
• Mesh nebulizers use a mesh or plate with multiple apertures
to produce an aerosol (See image below). Mesh nebulizers
have very low residual volume, fast treatment time, and the
ability to nebulize a variety of solutions and suspensions.
These devices are powered by batteries or electricity, and an
external gas flow is not required.
 Ultrasonic Nebulizers
Ultrasonic nebulizers convert electrical energy to high-frequency ultrasonic
waves. The ultrasonic waves are transferred to the surface of a liquid, thus
producing an aerosol (Shown in the image below). Small-volume ultrasonic
nebulizers are commercially available for delivery of inhaled bronchodilators.
Their cost is greater than that of jet nebulizer/compressor systems but
comparable to that of mesh nebulizers. A drug/device combination that uses an
ultrasonic nebulizer is the treprostinil/Tyvaso system.
 ADMINISTERING INHALED
MEDICATIONS BY NEBULIZERS

Purpose:

• To administer medication directly and quickly to the lungs.

• To assist the removal of accumulation of lung secretion.
• To prevent accumulation of secretions in client’s at risk, e.g. Those
patient on mechanical ventilators.
• To relieve dyspnea
Contraindication
s
In some cases, nebulization is restricted or avoided due to possible
untoward results or rather decreased effectiveness such as:

1. Patients with unstable and increased blood pressure

2. Individuals with cardiac irritability (may result to dysrhythmias)
3. Persons with increased pulses
4. Unconscious patients (inhalation may be done via mask but the
therapeutic effect may be significantly low)
EQUIPMENT
S
•Nebulizer and nebulizer connecting tubes
•Compressor oxygen tank or Portable Nebulizer
Machine
•Mouthpiece/mask
•Respiratory medication to be administered
•Normal saline solution
ADMINISTERING INHALED
MEDICATIONS BY NEBULIZERS

1. Introduce self to patient. Identify patient using two

patient-identifiers.
2. Check patient’s vital signs prior to Nebulization
administration.
3. Check MAR (Medication Administration Record)
against doctor’s orders
4. Perform the TEN RIGHTS x 3 (must be done
with each individual medication):

1. Right Drug.
2. Right Patient.
3. Right Dose.
4. Right Route.
5. Right Time and Frequency.
6. Right Documentation.
7. Right History and Assessment.
8. Drug approach and Right to Refuse.
9. Right Drug-Drug Interaction and Evaluation.
10. Right Education and Information
5. Assemble nebulizer as per manufacturer’s
instructions.
6. Add medication as prescribed by pouring
medication into the nebulizer cup.
7. Use a mask if patient is unable to tolerate a
mouthpiece, and an adaptor specific to
tracheostomies if the patient has a
tracheostomy.
8. Perform hand hygiene
9. Position patient sitting up in a chair or in bed
at greater than 45 degrees.
10. Turn on air to nebulizer and ensure that a sufficient mist is
visible exiting nebulizer chamber. A flow rate of 6 to 10 L
should provide sufficient misting.
Ensure that nebulizer chamber containing medication is
securely fastened. Ensure that chamber is connected to face
mask or mouthpiece, and that nebulizer tubing is connected
to compressed air or oxygen flow meter

11. If mouthpiece is being used, ensure lips are sealed around

mouthpiece.
13. Have patient repeat this breathing pattern until medication is
complete and there is no visible misting. This process takes
approximately 8 to 10 minutes.
14. Tap nebulizer chamber occasionally and at the end of the
treatment
15. Monitor patient’s pulse rate during treatment, especially if beta-
adrenergic bronchodilators are being used.
16. Once treatment is complete, turn flow meter off and disconnect
nebulizer.
17. Properly clean, rinse, dry, and store nebulizer as per agency policy.
18. If inhaled medication included steroids, have patient rinse mouth
and gargle with water/warm water after treatment.
19. Once treatment is complete, encourage patient to perform deep
breathing and coughing exercises to help remove or expectorate
mucous.
20. Return patient to a comfortable and safe position.
 METERED DOSE INHALER
• Inhaled respiratory medications are often taken by using a device
called a metered dose inhaler, or MDI. The MDI is a pressurized
canister of medicine in a plastic holder with a mouthpiece. When
sprayed, it gives a reliable, consistent dose of medication.
• 2 methods of using MDI : With holding valve holding chamber and
without a chamber
 INHALER
DEVICES
Pressurized Metered-Dose Inhalers (pMDI)
• The pMDI was the first widely used
multi-dose portable inhalational device.
Virtually every patient with COPD and
asthma either uses or has used a pMDI,
most often as albuterol and/or
ipratropium. All inhaled drug classes for
obstructive lung diseases are available
in a pMDI as single or combination
products. Yet the pMDI is one of the
most challenging devices for patients to
use correctly
Spacers and Holding Chambers
• VHCs (Valved Holding Chambers) and
spacer devices are used to overcome
some of the limitations of pMDIs. A
spacer is a simple tube or extension
with no valves to contain the aerosol,
whereas a VHC is an extension
device with a 1-way valve that, when
the attached pMDI is actuated, holds
the aerosol until inhalation, although
impaction on the inner walls occurs
shortly after actuation.
Soft Mist Inhalers

Dry Powder Inhalers

 ADMINISTERING INHALED MEDICATIONS USING
METERED DOSE INHALERS PURPOSE

1. To administer medication directly and quickly to the lungs.

2. To assist the removal of accumulation of lung secretion.
3. To prevent accumulation of secretions in client’s at risk, e.g.Those patient
on mechanical ventilators.
4. To relieve dyspnea
ADMINISTERING INHALED MEDICATIONS USING METERED
DOSE INHALERS

1. Introduce self to patient. Identify patient using two patient-

identifiers.
2. Check patient’s vital signs prior to nebulization administration.
3. Review physician’s medication order, including client name, drug
name, dose, no. of inhalations, and time of administration.
4.Perform the TEN RIGHTS x 3 (must be done
with each individual medication):
1. Right Drug.
2. Right Patient.
3. Right Dose.
4. Right Route.
5. Right Time and Frequency.
6. Right Documentation.
7. Right History and Assessment.
8. Drug approach and Right to Refuse.
9. Right Drug-Drug Interaction and Evaluation.
10. Right Education and Information.
5. Wash hands.
6. Assist client’s ability to hold and manipulate inhaler.
7. Assess drug schedule and no. of inhalations prescribed for each
dose.
Have client prepare following equipment and supplies:
a. Metered dose inhaler with medication canister
b. Facial Tissues (optional)
c. Wash basin or sink with warm water.
d. Paper Towel
9. Instruct client in comfortable environment by sitting in chair in
hospital room or kitchen table in home
10. Allow client to manipulate inhaler and canister. Explain and
demonstrate how canister fits into inhaler. Rationale: Client must be
familiar with how to use the equipment
11. Explain metered dose and warn client about over-use of inhaler,
including drug side effects.
12. Explain to client that gagging sensation in throat caused by droplet
of medication on pharynx or tongue may be felt.
13. Explain steps used to administer inhaled dose of medication.
(Demonstrate steps if possible).
a. Remove mouthpiece cover from inhaler.
b. Open lips and place inhaler in mouth with opening toward back of throat.
c. Exhale fully, then grasp mouthpiece with teeth and lips while holding inhaler with
thumb at mouthpiece and index and middle fingers at top.
d. While inhaling slowly and deeply through mouth, fully depress medication
canister once.
e. Hold breath for approximately 10 sec.
f. Remove inhaler.
g. Exhale through pursed lips.
14. Instruct client to wait 5 to 10 minutes between
inhalation or as ordered by the physician.
15. Instruct client against repeating inhalations before
next scheduled dose.
16. Instruct client in removing medication canister and
cleaning inhaler in warm water.
17. Ask client if he/she has any questions.
18. Have client demonstrate use of inhaler and
explain drug scheduled. Provides feedback for
measuring client’s learning.
19. Wash Hands.
20. Describe in nurse’s notes content of skills taught,
client’s ability to perform skill, as well as drug and
dose administered.
THANK YOU !!!