The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [550]
2 Correct use of inhalers is essential (see manufacturer’s information leaflet) and will be achieved only if this is carefully explained and demonstrated to the patient. If further advice is required, contact the hospital pharmacist. Incorrect use may result in most of the dose remaining in the mouth and/or being expelled almost immediately. This renders treatment ineffective (Watt 2003, E; manufacturer’s instructions, C).
Procedure
3 Sit the patient in an upright position if possible in the bed or a chair. To permit full expansion of the diaphragm. E
4 Consult the patient’s prescription chart, and ascertain the following:
(a) Drug
(b) Dose
(c) Date and time of administration
(d) Route and method of administration
(e) Diluent as appropriate
(f) Validity of prescription
(e) Signature of doctor.
To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (NMC 2006b, C).
5 Remove mouthpiece cover from inhaler. To expose the area for use. E
6 Shake inhaler well for 2–5 seconds. To ensure mixing of medication in canister (Snyder 2007, E).
7 Without a spacer device:
Ask patient to take a deep breath and exhale completely, open lips and place inhaler opening 1–2 cm from mouth but not touching the lips. To avoid rapid influx of inhaled medication and possible irritation of the airway (Snyder 2007, E).
With a spacer device:
Ask the patient to exhale and then grasp spacer mouthpiece with teeth and lips while holding inhaler. To enable the medication to reach the airways instead of hitting the back of the throat (Snyder 2007, E).
8 Ask the patient to tip head back slightly, inhale slowly and deeply through the mouth whilst depressing canister. To allow medication to be distrubted to airways during inhalation (Snyder 2007, E).
9 Instruct the patient to breathe in slowly for 2–3 seconds and hold their breath for approximately 10 seconds, then to exhale slowly through pursed lips. To enable aerosol spray to reach deeper branches of airways (Chernecky et al. 2002, E; Snyder 2007, E).
10 Instruct the patient to wait 2–5 minutes between puffs and if more than one type of inhaled medication is prescribed, to wait 5–10 minutes between inhalations. To ensure that the medication has optimum effect and minimal side-effects (Snyder 2007, E).
11 If steroid medication is administered ask the patient to rinse their mouth after the procedure. To remove any medication residue from oral cavity area to reduce risk of oral yeast infection (Snyder 2007, E).
Postprocedure
12 Clean any equipment used and discard all disposable equipment in appropriate containers. To minimize the risk of infection (DH 2007c, C; Fraise and Bradley 2009, E).
13 Record the administration on appropriate charts. To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC 2008a, C; NPSA 2007c, C; NMC 2009, C).
Procedure guideline 13.8 Medication: administration by inhalation using a nebulizer
Essential equipment Medicinal products
Facemask or mouthpiece
Nebulizer and tubing
Medication required
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (Griffith and Jordan 2003, E; NMC 2008b, C; NMC 2008c, C).
2 Sit the patient in an upright position if possible in the bed or a chair. To permit full expansion of the diaphragm. E
3 Consult the patient’s prescription chart and ascertain the following:
(a) Drug
(b) Dose
(c) Date and time of administration
(d) Route and method of administration
(e) Diluent as appropriate
(f) Validity of prescription
(g) Signature of doctor.
To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (NMC 2006b, C).
Procedure
4