N170 Inhaled and Nebulizer Meds

Question 1

Do inhaled meds exert local or systemic effects?

Answer 1

Typically meant for local, but can cause systemic side effects when absorbed through pulmonary vasculature such as tremors and restlessness

Question 2

Purpose of nebulizers?

Answer 2

• relieve resp distress

- maintain gas exchange by: thinning resp secretions, dec inflammation, or causing bronchodilation

Question 3

Form of med in metered-dose inhalers?

Local or systemic effect?

Answer 3

Can be mist, spray, or powder (DPI = dry powder inhalers)

Meant for Local (such as bronchodilation) but can cause system side effects (palpitations, tremors, tachycardia, etc.)

Question 4

Typical dose from inhalers achieved in ___ puffs

Answer 4

1-2

Question 5

Common barrier/problems with using inhalers

Answer 5

• Approx 5-10lb of pressure required to activated aerosol, so must have adequate stength
• need to coordinate with breathing…common to pull into back of throat without proper inhalation so not all med is received
• Not waiting long enough between puffs (may prevent proper dose from being given or drug may not penetrate to lungs)
• Not shaking before (needs to be suspended)
• Failure to clean the valve (occasionally)
• Failure to recognize canister is empty

Question 6

What is the role of a spacer device in inhalers?

Answer 6

• decreases amount of med deposited into oropharyngeal mucosa
• Can be used to solve issue of poor coordination
• Some spacers have one-way value that activates on inhalation, removing need for good hand-breath coordination

Question 7

Procedure for inhaler:

Answer 7

• Shake 3-5 seconds
• Position in mouth or 2-4cm outside widely opened mouth
• Take deep breath + exhale completely
• Tilt head back + inhale for 3-5 seconds while depressing canister fully
• Hold breath for 10 sec
• Remove from mouth + exhale slowly through nose or pursed lips

Question 8

How long to wait between inhalations with puffer?

What if switching meds?

Answer 8

20-30 sec

2-5mins if changing meds

Question 9

What to do after administering last puff from inhaler?

Answer 9

Have rinse mouth 2 mins after last dose

Question 10

Difference between a MDI (Metered-Dose Inhaler) and DPI (Dry Powder Inhalers)

Advantages + disadvantage of DPI?

Answer 10

DPI - powder + has no propellant
- Requires less manual dexterity + doesn’t need hand-breath coordination
- Deliver more med to lungs
- Does not require spacer
Disadvantage: Some patients cannot inhale fast enough to get all med; may clump in humid climate

Question 11

How to inhale with DPI?

Answer 11

Quickly and deeply - remove inhaler before exhalation

–> hold for 10 seconds before exhalation

Question 12

Common classifications of drugs administered by nebulizer

learning outcome

Answer 12

bronchodilators
Mucolytics
Corticosteroids

Question 13

Nebulizer designed for local or systemic effects?

Answer 13

Local, but may cause systemic

Question 14

When to use face mask (vs. mouthpiece) for nebulizer?

Answer 14

If pt is infant, child, or fatigued adult or unable to follow instructions

Question 15

Breathing patterns for nebulizer use?

Answer 15

Have pt take deep, slow breath to volume slightly greater than normal. Encourage brief end-inspiratory pause for 2-3 seconds, then have exhale passively
- If dysneic, enourage to hold 5-10 seconds at end of inhale

Question 16

If giving steroids, pt must ____ after nebulization process?

Answer 16

Rinse mouth and gargle with warm water (removes residue and prevents oral candidiasis)

Question 17

After nebulization process is complete, have patient…

Answer 17

Take several deep breaths + expectorate mucus

Question 18

Technique for ensuring all of med is taken through nebulizer? (done near end of treatment)

Answer 18

Tap side of nebulizer cup to release droplets clinging to side of cup

Question 19

2 kinds of nebulization?

Answer 19

1) Atomization = device called atomizer produces large droplets for inhalation
2) Aerosolization = droplets suspended in gas (such as 02 or compressed air)

–> the smaller the droplets, the farther they can go into resp tract

Question 20

What does “B before C” mean with regard to order of inhalation meds?

Answer 20

“Bronchodilators before corticosteroids”

- B will open airways, should be given first if taking more than one inhaler