Inhaled and nebulizaed medication

Question 1

What does MDI standfor and what is it?

Answer 1

Metered-dose in halers

• Medications administered with handheld inhalers are dispersed through an aerosol spray, mist, or powder that penetrates the airways.
• An MDI is a small, handheld device that disperses medication into the airways through an aerosol spray or mist by activation of a propellant.

Question 2

What are pMDIs, BAIs,

Answer 2

Pressurized metered-dose inhalers (pMDIs):

Breath-actuated metered dose inhalers (BAIs): o A patient with poor coordination may need to use a spacer device or a BAI to administer medication properly.

Question 3

What would a patient frequently suffer from if they use a broncho dialitor?

Answer 3

Asthma and chronic resp. disease

Question 4

Why are bronchodialtors used?

Answer 4

o Drugs administered by inhalation provide control of airway hyperactivity or bronchial constriction.

Question 5

What is the usual dosing of an MDI?

Answer 5

1-2puffs

Question 6

If a patient is using aerosol what might be needed if their condition is poor?

Answer 6

a spacer or a BAI to administer the medication properly

Question 7

What are the expected outcomes for adminstering MDI’s?

Answer 7

Expected outcomes:

a. Patient correctly administers a metered dose
b. Patient describes proper time during respiratory cycle to inhale and spray and number of inhalations for each administration
c. Patient’s breathing pattern improves, and lung sounds indicate that airways are less restrictive

Question 8

What are the steps for administering MDI without spacer?

Answer 8

a. Remove mouthpiece cover from inhaler after inserting MDI canister into holder.
b. Shake inhaler well for 2-5 seconds (five or six times).
c. Hold inhaler in dominant hand.
d. Have patient stand or sit and instruct him or her to position inhaler in one of two ways:
i. Have patient place the mouthpiece in the mouth between the teeth and over the tongue, aimed toward the back of throat, with lips closed tightly around it. Do not block the mouthpiece with the teeth or tongue.
ii. Position mouthpiece 2-4 cm (1-2 inches) in front of widely opened mouth with opening of inhaler toward back of throat. Lips should not touch inhaler.
e. While holding the mouthpiece away from the mouth, have patient take deep breath and exhale completely.
f. With inhaler positioned, have patient hold it with thumb at mouthpiece and index and middle fingers at top. This is a three-point or bilateral hand position.
g. Instruct patient to tilt head back slightly and inhale slowly and deep through mouth for 3 to 5 seconds while depressing canister fully.
h. Have patient hold breath for about 10 seconds.
i. Remove MDI from mouth before exhaling and exhale slowly through nose or pursed lips.

Question 9

Explain and demonstrate steps to administer MDI using space device.

Answer 9

a. Remove mouthpiece cover from MDIA and mouthpiece of spacer device.
b. Shake inhaler well for 2-5 seconds (5 or 6 shakes).
c. Insert MDI into end of spacer device.
d. Instruct patient to place spacer device mouthpiece in mouth and close lips. Do not insert beyond raised lip on mouthpiece. Avoid covering small exhalation slots with lips.
e. Have patient breathe normally though spacer device mouthpiece.
f. Instruct patient to depress medication canister, spraying one puff into spacer device.
g. Patient breathe in slowly and fully (for 5 seconds).
h. Instruct patient to hold full breath for 10 seconds.

Question 10

How long should a patient wait between inhalations of the same medications vs different medications?

Answer 10

• 20 to 30 seconds between inhalations if same medication)

- 2 to 5 minutes between inhalations if different medications).

Question 11

What is a normal reaction to droplets of medication on tongue or pharynx?

Answer 11

gagging sensation

Question 12

How would you instruct a patient to clean the MDI?

Answer 12

a. For daily cleaning, instruct patient to remove medication canister, rinse inhaler and cap with warm running water, and be sure that inhaler is completely dry before reuse. Do not get valve mechanism of canister wet.
b. Instruct patient to clean mouthpiece twice a week with a mild dishwashing soap, rinse thoroughly, and dry completely before storage.

Question 13

What would you include in your assessment after the patient has used an MDI?

Answer 13

1. Auscultate patient lungs, listen for abnormal breath sounds, and obtain peak flow measures if ordered.
2. Have patient explain and demonstrate steps in use and cleaning of inhaler.
3. Ask patient to explain drug schedule and dose of medication.
4. Ask patient to describe side effects of medication and criteria for calling health care provider.
5. Use teach back.

Question 14

What should you teach the patient to make note of when tracking doses?

Answer 14

o Note first day of use on calendar.
o Note number of inhalations in the canister.
o Note number of inhalations used per day.
o Divide total number of inhalations in the canister by the number of inhalations needed per day to determine the number of days that the inhaler should last.
o Mark on a calendar the date the inhaler will be empty and obtain a refill of the inhaler a few days before this target date.

Question 15

How would you use a peak flowmeter?

Answer 15

o Move the marker to the bottom of the numbered scale and connect the mouthpiece to the peak flowmeter.
o Have patient stand up if able.
o Have patient take a deep breath, filling the lungs completely.
o Have the patient place the lips tightly around the mouthpiece of the flowmeter and then blow as hard and as fast as possible with a single breath.
o Note the final position of the marker. This is the patient’s peak flow rate.
o Have the patient repeat the steps blowing into the peak flowmeter two more times. Record the highest reading of the three.

Question 16

What are DPI’s?

Answer 16

Dry powder inhalers (DPIs) deliver medications that produce local effects such as bronchodilation:
- DPIs deliver inhaled medication in a fine powder formulation to the respiratory tract

Dry powder inhalers (DPIs) hold dry powder medication and create and aerosol when the patient inhales through a reservoir that contains the medication

Question 17

How do MDIs and PDIs contrast in difference?

Answer 17

o with the metered-dose inhaler (MDI), a DPI has no propellant.

Question 18

How are DPIs useful for elderly and children?

Answer 18

o DPIs require less manual dexterity; and, because the device is breath activated, there is no need to coordinate puffs with inhalation.

Question 19

does a DPI require a spacer?

Answer 19

no

Question 20

What is a downside to DPIs?

Answer 20

o Medication inside a DPI can clump if the patient lives in a humid climate.
o Some patients cannot inhale fast enough to administer the entire dose of medication.

Question 21

How would you teach a patient to use a DPI?

Answer 21

1. Have patient exhale fully and then place lips over mouthpiece of DPI and inhale quickly and as deeply as possible. Remove inhaler from mouth as soon as inhalation is complete.
2. Have patient hold breath for 10 seconds or as long as possible and then exhale. Do not exhale into DPI.
3. Instruct patients that, unlike with other inhaled medications, they may not taste or feel the dry powder or there may be a slight sweet taste.
4. After using DPI, have patient rinse mouth with warm water and spit it out to reduce throat irritation and prevent oral candidiasis.
5. Return DPI to closed position or remove loaded capsule or disk if necessary. If an external counter is present, note number, which should be one less than the number in step 14.
6. Have patient demonstrate use of DPI at next scheduled dose. Ask him or her to discuss purpose, action, and side effects of medications.
7. Auscultate breath sounds, evaluate respiratory rate, and ask patient about his or her ease of breathing.
8. Record drug, dose, or strength, route, number of inhalations, and time administered on MAR immediately after administration, not before. Include initials or signature.
9. Record patient teaching and validation of patient’s understanding to nurses’ notes in electronic health records (EHR) or chart.
10. Use teach back: “I want to be sure I explained how often you need to use this DPI medication. Tell me when you will use this medication.”

Question 22

What is nebulization?

Answer 22

• Nebulization is a process of adding medications or moisture to inspired air by mixing particles of various sizes with air.
• nebulizers convert a drug solution into a mist that is then inhaled by a patient into his or her tracheobronchial tree.

Question 23

How are nebulizers useful?

Answer 23

o Adding moisture to the respiratory system through nebulization improves clearance of pulmonary secretions.

Question 24

What kind of medications are often used in nebulizers?

Answer 24

o Medications such as bronchodilators, mucolytics, and corticosteroids are often administered by nebulization.

Question 25

How do nebulizers and MDIs/DPIs differ?

Answer 25

o The droplets in the mist are much finer than those created by metered-dose inhalers (MDIs) or dry powder inhalers (DPIs).

Question 26

What downside is there to using a nebulizer?

Answer 26

o A nebulized medication is designed to create a local effect, but it can be absorbed into the bloodstream through the alveoli. As a result, systemic effects from the medication may occur.
• Equipment:

Question 27

What are the expected patient outcomes when using a nebulizers?

Answer 27

a. Patient’s breathing pattern is effective
b. Patient’s oxygen saturation level is adequate
c. Patient describes side effects of medication and criteria for calling health care provider (e.g. low peak flow rate).
d. Patient demonstrates self-administration of nebulized dose of medication correctly.

Question 28

What would the 3 checks involve?

Answer 28

1) compare two identifiers with information on patients MAR or medical record
2) compare the MAR with names on medication label and patient name
3) Ask if the patient has any allergies

Question 29

What would you explain before giving the medication to the patient?

Answer 29

• Explain procedure to patient.
• Discuss purpose of each medication, action, and possible adverse effects.
• Warn about overuse of inhaler and side effects.

Question 30

what would you instruct the patient to do once the face mask or mouth piece was in place?

Answer 30

1Instruct patient to take deep breath, slowly, to a volume slightly greater than normal. Encourage brief, end-inspiratory pause for about 2 to 3 seconds; then have patient exhale passively. If needed use a nose clip.

Question 31

What would you do if the patient is dyspneic?

Answer 31

encourage him or her to hold every fourth or fifth breath for 5 to 10 seconds.

Question 32

How long does the nebulization usually occur?

Answer 32

10-15min

Question 33

What should you constantly be monitoring while using a nebulizer?

Answer 33

pulse

Question 34

What should you instruct the patient to do if steroid medication was used?

Answer 34

, instruct patient to rinse mouth and gargle with warm water after nebulizer treatment. Have patient spit out solution.

Question 35

what should you tell the patient to do after the nebulization?

Answer 35

1. After nebulizer treatment is complete, have patient take several deep breaths and cough to expectorate mucus.