ADMINISTERING NEBULIZER ADMINISTERING NEBULIZER MEDICATIONMEDICATION

PURPOSE:PURPOSE: - delivers an inhaled dose of medication into the mucosa and - delivers an inhaled dose of medication into the mucosa and

bloodstream to ease respiratory distressbloodstream to ease respiratory distress

EQUIPMENTEQUIPMENTHand-held nebulizerHand-held nebulizer- nebulizer set (cup, tubing, cap, mouthpiece or mask)- nebulizer set (cup, tubing, cap, mouthpiece or mask)- medication (s)- medication (s)- saline- saline- air compressor, wall oxygen- air compressor, wall oxygenMetered-dose inhalerMetered-dose inhaler

PROCEDURE:PROCEDURE:Using a hand-held nebulizerUsing a hand-held nebulizer1. Explain to the client the process of using the 1. Explain to the client the process of using the nebulizernebulizer

- promotes compliance- promotes compliance2. Check the physician’s orders2. Check the physician’s orders

- ensures that the right dose is administered to the - ensures that the right dose is administered to the right clientright client

3. Perform hand hygiene3. Perform hand hygiene- Decreases spread of microorganisms- Decreases spread of microorganisms4. Pour the entire dose of the drug into the nebulizer 4. Pour the entire dose of the drug into the nebulizer

cupcup- Ensures accurate dosing of drug- Ensures accurate dosing of drug

5. Cover the cup with cap and fasten the mouthpiece 5. Cover the cup with cap and fasten the mouthpiece to the cap. Do not touch the interior parts of the masks to the cap. Do not touch the interior parts of the masks or mouthpieceor mouthpiece

- Provides dead space to prevent room air from - Provides dead space to prevent room air from entering system and medicated aerosol from entering system and medicated aerosol from escaping; escaping; prevents introduction of organismsprevents introduction of organisms

6. Attach tubing to the bottom of the nebulizer cup 6. Attach tubing to the bottom of the nebulizer cup and attach the other end to the compressed air sourceand attach the other end to the compressed air source

- Provides conduit for compressed air- Provides conduit for compressed air

7. Adjust wall oxygen to 6 L/min or less as ordered and turn 7. Adjust wall oxygen to 6 L/min or less as ordered and turn air on until medication begins to mist. Leave the air on for air on until medication begins to mist. Leave the air on for about 6 or 7 minutes, until all of the medication is inhaledabout 6 or 7 minutes, until all of the medication is inhaled- Delivers a low dose of oxygen with treatment; air flows - Delivers a low dose of oxygen with treatment; air flows drives medication into aerosolized formdrives medication into aerosolized form

8. Instruct the client to breathe with lips tightly sealed around 8. Instruct the client to breathe with lips tightly sealed around the mouthpiece; if a mask is used, ensure that the mask is the mouthpiece; if a mask is used, ensure that the mask is properly applied to the client’s face and encourage the properly applied to the client’s face and encourage the

client to take slow, deep breaths in through the mouth and client to take slow, deep breaths in through the mouth and out out through the nosethrough the nose

- Promotes efficacy of medication; increases delivery of - Promotes efficacy of medication; increases delivery of medication into lungsmedication into lungs9. When medication is complete, perform hand hygiene and 9. When medication is complete, perform hand hygiene and

don glovesdon gloves- Reduces transmission of microorganisms- Reduces transmission of microorganisms

10. Detach tubing from compressed air source and 10. Detach tubing from compressed air source and nebulizer cup. If nebulizer is disposable, dispose nebulizer cup. If nebulizer is disposable, dispose of of nebulizer in appropriate container. If nebulizer nebulizer in appropriate container. If nebulizer is is to be reused, carefully wash with soapy water, to be reused, carefully wash with soapy water, rinse, and dry nebulizer componentsrinse, and dry nebulizer components

- Reduces transmission of microorganisms- Reduces transmission of microorganisms11. Observe client for several minutes to assess 11. Observe client for several minutes to assess response to medicationresponse to medication

- notes possible adverse reactions- notes possible adverse reactions12. Remove gloves and perform hand hygiene12. Remove gloves and perform hand hygiene

- reduces microorganism transfer- reduces microorganism transfer13. Document procedure appropriately13. Document procedure appropriately

- Serves as a legal record of medication - Serves as a legal record of medication administrationadministration

Administering Metered-dose inhalationAdministering Metered-dose inhalation1. Remove cap and hold inhaler upright1. Remove cap and hold inhaler upright

- allows proper administration of drug- allows proper administration of drug2. Shake inhaler2. Shake inhaler

- mixes medication well- mixes medication well3. Instruct client to tilt head back slightly and 3. Instruct client to tilt head back slightly and breathe outbreathe out

- Allows proper medication administration- Allows proper medication administration4. Position inhaler in client’s mouth with lips 4. Position inhaler in client’s mouth with lips sealed around mouthpiecesealed around mouthpiece

- Allows proper medication administration- Allows proper medication administration

5. Press down on the inhaler to release medication as 5. Press down on the inhaler to release medication as client starts to breathe in. Instruct client to breathe client starts to breathe in. Instruct client to breathe in slowlyin slowly- delivers medication to lungs- delivers medication to lungs

6. Instruct client to breathe in slowly over 3 to 5 6. Instruct client to breathe in slowly over 3 to 5 seconds. If a second puff is ordered, repeat seconds. If a second puff is ordered, repeat administration after client fully exhales with the administration after client fully exhales with the first first administration. If the medication is a dry administration. If the medication is a dry powder powder capsule, have the client close the mouth capsule, have the client close the mouth tightly tightly around the mouthpiece and inhale rapidlyaround the mouthpiece and inhale rapidly

- Promotes medication distribution to lungs; - Promotes medication distribution to lungs; administers full treatment; prevents loss of administers full treatment; prevents loss of medicationmedication

7. Recap medication and store appropriately7. Recap medication and store appropriately

- Allows for future use- Allows for future use

8. Observe client for several minutes to assess 8. Observe client for several minutes to assess response to medicationresponse to medication

- Notes possible adverse reactions- Notes possible adverse reactions

9. Remove gloves and perform hand hygiene9. Remove gloves and perform hand hygiene

- Reduces microorganism transfer- Reduces microorganism transfer

10. Document procedure appropriately10. Document procedure appropriately

- Serves as legal record of medication - Serves as legal record of medication administrationadministration