Inhaled Aerosol Medication Treatments
Contents
1. 8 If another dose is required wait 30 seconds then pull the cartridge out once and push in once to rotate disk to the next number Repeat steps 5 to 7 CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 8 of 10 TREATMENTS DISKHALER PROCEDURE cont d 9 If treatment includes use of either a corticosteroid or non steroidal instruct client to rinse mouth and gargle with water at completion of treatment to prevent hoarseness throat irritation and oral candidiasis Instruct client to not swallow rinse water 10 Rotate the disk to the next dose ensuring that the blister is not pierced until immediately before inhalation 11 Document medication administration and client response 12 To clean any remaining powder a small brush is provided under the device lid Remove the cartridge and wheel before using brush Do not throw away the wheel when disposing of empty medication disk 13 The Diskhaler is a single client use device Discard on discharge or send home with client if to continue on treatment Turbuhaler GUIDELINE In order to use this device the client must be able to generate a strong breath in and hold their breath for at least four seconds EQUIPMENT I Turning grip Turbuhaler Prescribed medication CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsec2. CS 04 03 11 Page 6 of 10 TREATMENTS Diskhaler GUIDELINE In order to use this device the client must be able to generate a strong breath in and hold their breath for at least four seconds EQUIPMENT Diskhaler Medication Disk mouthpiece DISKHALER PROCEDURE l Remove the colored cover and ensure that the mouthpiece is clean De Pull out the white cartridge until the ribbed sides of the cartridge are visible then squeeze the ribbed sides and pull the entire cartridge out of the Diskhaler device 3 Place the disk on the wheel with the numbers facing up and slide the cartridge back into the device body CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 7 of 10 TREATMENTS DISKHALER PROCEDURE cont d 4 Mechanically rotate the disk by gently pushing in and pulling out the loaded cartridge until the number 8 appears in the side indicator window Indicator 5 Hold the device firmly in a level position Lift the Diskhaler lid into the fully upright position and then close the lid ensuring that the blister has been pierced 6 While keeping the device level exhale completely then place the Diskhaler in mouth ensuring that the air inlet holes on the mouth piece are not covered he Inhale quickly and fully and hold breath for 4 10 seconds after the device is removed from mouth
3. EROSOL MEDICATION CS 04 03 11 Page 4 of 10 TREATMENTS MDI SPACER PROCEDURE cont d 5 Depress the canister 6 Inhale slowly and fully Hold breath for 4 10 seconds 8 If more than one puff is required at each dose wait for at least 30 seconds then shake the spacer inhaler before repeating steps 4 to 7 9 If steps 6 and 7 cannot be completed inhale and exhale normally three or four times through the spacer medication will not be lost 10 Deliver medication in the following order e bronchodilator e anti inflammatory 11 If treatment includes use of a corticosteroid or non steroidal instruct client to rinse mouth and gargle with water at completion of treatment to prevent hoarseness throat irritation and oral candidiasis Instruct client to not swallow rinse water 12 Replace cap on inhaler mouth piece 13 Document procedure and client response 14 Send spacer with client on discharge MDI Spacer with Mask GUIDELINE This device is indicated for a client using an MDI but unable to use a mouthpiece EQUIPMENT Metered dose inhaler Medication as ordered AeroChamber Spacer with Adult Mask CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 5 of 10 TREATMENTS MDI Spacer with Mask PROCEDURE tee Eee VS See SS Oe 10 11 12 13 14 15 AEROCHAMBER Remove i
4. Service Manual WCarewest Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 2 of 10 TREATMENTS e When the client is using a wet nebulizer at home WET NEBULIZER GUIDELINES cont d Indications for using mouth piece e Administration of ipratropium bromide Atrovent could potentially exacerbate glaucoma if given by mask Indications for using mask e When the client is too ill or unable to use a mouthpiece EQUIPMENT Air flowmeter or air compressor Small volume nebulizer set includes mouth piece and oxygen tubing Medication as ordered Aerosol mask optional PROCEDURE l Check the physician s orders 2 Inspect and attach air flowmeter to the wall attachment where available or obtain an air compressor 3 Perform a respiratory assessment Position client in semi fowler s position or upright position 5 Attach small volume nebulizer to tubing and attach tubing to air flowmeter or air compressor 6 Place a piece of masking tape on nebulizer bottle with current date 7 Fill small volume nebulizer with medication Do not exceed 5 mL of medication per treatment 8 Set air flowmeter high enough to get a good mist approximately 5 7 litres minute or turn on air compressor 9 Administer nebulizer therapy by mask or mouth piece 10 Instruct client to e take slow deep breaths e pause at the end of inspiration and e exhale in a normal relaxed manner 11 If treatm
5. WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 1 of 10 TREATMENTS Related terms Date Dates Revised Established September 2010 Authorized by Date For Review Clinical Directors September 2013 RATIONALE To provide guidelines for the administration of aerosol medication treatments APPLICABILITY RN LPN RRT HCA trained in medication delivery DEFINITIONS Aerosol Medication Refers to wet nebulizer metered dose inhaler MDI and dry powder inhaler DPI medication POLICY 1 A physician s order is required for aerosol medication and is to include the name of the drug dosage device and frequency of administration 2 The administration of aerosol medication treatments and associated assessments is the responsibility of the RN LPN or RRT Trained HCAs who are assisting with medication delivery at selected sites may deliver aerosol medications by MDI and DPI Wet Nebulizer GUIDELINES Indications for wet nebulization of medications e When large doses of drug must be administered i e initial therapy for acute severe asthma e When the client is too ill or unable to use an MDI or DPI Physical limitations of extremities weakness pain or lack of coordination Mental limitations disoriented confused or insufficient cognitive ability e When the drug is unavailable for delivery by MDI or DPI CAREWEST Care and
6. ent includes use of a corticosteroid or non steroidal instruct client to rinse mouth and gargle with water at completion of treatment to prevent hoarseness throat irritation and oral candidiasis Instruct client to not swallow rinse water 12 Perform a respiratory assessment CAREWEST Care and Service Manual WCarewest Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 3 of 10 TREATMENTS WET NEBULIZER PROCEDURE cont d 13 Document medication administration and client s response 14 Rinse the small volume nebulizer daily with sterile water and change wet nebulizer equipment weekly Discard wet nebulizer equipment on client discharge Remove air flowmeter from the wall disinfect and return to the clean holding room in a bag Remove portable air compressor disinfect and return to storage area MDI Spacer POINTS OF EMPHASIS This is the preferred method of delivery of inhaled medication EQUIPMENT Metered dose inhaler Medication as ordered Spacer MDI SPACER PROCEDURE 1 Remove cap from inhaler and spacer mouthpiece 2 Shake inhaler well A ERN 3 Place inhaler mouth piece in large hole in spacer 4 Place spacer mouthpiece in mouth closing lips around it while making sure that the small slots are uncovered exhale slowly and fully CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED A
7. ler is a single client use device Discard on discharge or send home with client if to continue on treatment REFERENCES Calgary Regional Health Authority 1999 Medication Inhaled Aerosol Treatments Adult M 2 Acute Care Nursing Policy and Procedure Manual CAREWEST Care and Service Manual
8. nhaler mouthpiece cap Shake inhaler well Place inhaler mouthpiece in large hole in rubber ring of spacer with mask Place mask over nose and mouth check that the seal is complete by watching for movement of top membrane during practice breath Exhale slowly and fully Depress canister Inhale slowly and fully If inhaling too quickly an audible whistle will be heard Hold breath for 4 10 seconds If steps 6 8 cannot be completed hold mask in place for at least six breaths The membrane on mask moves with each breath this is the easiest way to indicate the number of breaths taken Wait for at least 30 seconds and shake the spacer inhaler before repeating steps 3 to 9 Deliver medications in the following order e bronchodilator e anti inflammatory If treatment includes use of a corticosteroid or non steroidal instruct client to rinse mouth and gargle with water at completion of treatment to prevent hoarseness throat irritation and oral candidiasis Instruct client to not swallow rinse water Replace cap on inhaler mouth piece Document medication administration and client response The MDI spacer with mask is a single client use device If visibly soiled clean with soap and water and allow to air dry Discard on discharge or send home with client if to continue on treatment CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION
9. tion Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 9 of 10 TREATMENTS TURBUHALER PROCEDURE 1 Unscrew and remove the cover If the client accidentally drops or exhales into the Turbuhaler the dose will be lost therefore a second dose will have to be loaded vA When the red mark just appears at the top in the window the inhaler has about 20 doses left When the red mark reaches the bottom of the window the inhaler is empty oe 2 Hold the inhaler upright and turn the colored grip to the right as far as it will go then back to the left until it clicks CAREWEST Care and Service Manual WCarewest INNOVATIVE HEALTH CARE Section CCL Subsection Respiratory Care INHALED AEROSOL MEDICATION CS 04 03 11 Page 10 of 10 TREATMENTS TURBUHALER PROCEDURE cont d 3 Exhale quickly but fully away from the device Place the inhaler mouthpiece in mouth Inhale quickly and fully remove the inhaler and hold breath for 4 to 10 seconds If a second dose is required wait at least 30 seconds then repeat steps 2 to 4 Replace the cover when finished a R If treatment includes use of either a corticosteroid or non steroidal instruct client to rinse mouth and gargle with water after inhalation of corticosteroid to prevent hoarseness throat irritation and oral candidiasis Instruct client to not swallow rinse water 8 Document medication administration and client response 9 The Turbuha
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