The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [551]
5 Assemble the nebulizer equipment as per manufacturer’s instructions. To ensure correct administration (manufacturer’s instructions, C).
6 Measure any liquid medication with a syringe. Add the prescribed medication and diluent (if needed) to the nebulizer. To ensure the correct dose (DH 2007, C).
7 Ask the patient to hold the mouthpiece between the lips or apply the facemask and take a slow deep breath. To promote greater deposition of medication in the airways (Snyder 2007, E).
8 After inspiration, the patient should pause briefly and then exhale. To ensure correct administration.
9 Turn on the O2 and ensure sufficient mist is formed. A minimum flow rate of 6 litres per minute is required. This will deliver 65% of the medication. To ensure at least 65% of the droplets are of a size which enables drug penetration into the distal airways (Downie et al. 2003, E).
10 The patient should continue to breathe as above until all the nebulized medication is completed (0.5 mL will remain in chamber). To ensure all medication has been received. E
11 Optimal nebulization of 4 mL takes approximately 10 minutes. To ensure it is effective. E
Postprocedure
12 Clean any equipment used and/or discard all single use disposable equipment in appropriate containers. To minimize the risk of infection (DH 2007, 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; NMC 2009, C).
Postprocedural considerations
If the nebulizer is marked as single use then it must be discarded after each use. However, nebulizers should not be used for single patient use unless clearly indicated by the manufacturer. If it can be reused, then the nebulizer chamber and mask should be washed in hot soapy water, rinsed thoroughly and dried with paper towels to reduce bacterial contamination and also to prevent any build-up of crystallized medication in the nebulizer (Downie et al. 2003). Spacer devices should be washed, rinsed and allowed to dry naturally on a weekly basis and replaced after 6–12 months (Downie et al. 2003).
Complications
There is a risk of patients developing oral candidiasis when using a MDI. This can be reduced by using a spacer device. Overuse of some inhalers can result in cardiac dysrhythmias and patients may suffer from tachycardia, palpitations, headache, restlessness and insomnia. The doctor should be informed and observations commenced (Snyder 2007).
Ophthalmic administration
Definition
Dosage forms introduced into the eye for local effects, for example, to treat infections, to dilate or constrict the pupil, or to treat eye conditions such as glaucoma (Snyder 2007).
Related theory
The topical route is the most popular way to introduce drugs into the eye in the form of eye drops or eye ointment. Most types of drops are instilled into the inferior fornix, the pocket formed by gently pulling on the lower eyelid as the conjunctiva in this area is less sensitive than that overlying the cornea. Administering medications in this area prevents immediate loss of the drops into the nasolacrimal drainage system.
There are many factors that affect how much of this drug will have an effect on the eye. The eye has a highly selective corneal barrier which can prevent absorption of drug. It also has a tear film which provides an effective clearance mechanism. When an excess volume of fluid is present in the eye, this fluid will either be spilled onto the cheeks and eyelashes or will enter the nasolacrimal drainage system with a potential for systemic absorption of drug. Drugs also need to be introduced to the eye at a neutral pH, as acidic or alkaline preparations will result in reflex lacrimation which will remove the drug from the eye.
Evidence-based approaches
In order