Preparing and Administering Inhaled Medications
Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Inhaled medications are prescribed for condi…
1. General medication administration considerations (review in the room, with the patient).
Upon first entering the patient's room, wash hands with soap and warm water, applying vigorous friction for at least 20 s. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
At the bedside computer, log into the patient's electronic health record and review the patient's medical history and previous administration times. Verify with the patient any medication allergies and discuss his/her physical allergic responses and reactions.
At the bedside computer, pull up the Medication Administration Record (MAR).
Review the inhaled medications that are due to be administered, and clarify with the patient whether he/she has a preference or concerns prior to acquiring and preparing the medication.
Assess the patient's respiratory rate and auscultate breath sounds in all respiratory fields to determine medication appropriateness and to serve as a reference for evaluating medication effectiveness. If the patient demonstrates shallow respirations or increased work of breathing, this delivery method may be inappropriate, and the care provider should be notified.
Review the medication administration process with the patient and ensure that the patient has sufficient knowledge, understanding, and ability to follow the instructions and effectively carry out the procedure. Provide additional education as needed.
Leave the patient's room, washing hands as described above (step 1.1)
2. Go to the medication preparation area and complete the first safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video. Upon acquiring the medication from the medication dispensing device, verify the expiration date. Verifying expiration supports the Right medication and the Right dose.
3. In the medication preparation area, complete the second safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video. Reconfirm the initial ten rights as applicable.
4. Gather the necessary supplies, including a cup of water, a basin, and a spacer (if required). Take the supplies into the patient's room.
Administration
5. Wash hands when entering the patient's room.
6. In the patient's room, complete the third and final medication safety check, adhering to the ten "rights" of medication administration.
7. As with any medication administration, remind the patient of the medication's purpose, any adverse reactions, and the administration procedure. Reinforces the Right reason, Right education, and supports the Right to refuse.
8. Assist the patient into an upright position to facilitate lung expansion.
9. Administer the inhaled medication using the mouthpiece.
Shake the inhaler vigorously and then remove the mouthpiece cover.
Ask the patient to hold the lower portion of the inhaler between his/her thumb and middle finger, with the index finger at the top of the canister, and place the mouthpiece of the inhaler between the upper and lower lips.
Instruct the patient to take a deep breath and to exhale fully.
Ask the patient to close his/her lips tightly around the mouthpiece and to inhale deeply and fully while depressing the canister with his/her index finger to release the medication.
At the top of the patient's inhalation, ask him/her to hold his/her breath for 10 s, or as long as it is comfortable, and to release his/her index finger from the top of the canister.
If a second inhaled dose is ordered, have the patient wait for approximately 1 min prior to administering the second dose. For the second inhaled dose, instruct the patient to repeat steps 9.1-9.5.
10. Variation: Administer the inhaled medication using a spacer.
11. If the patient received an inhaled corticosteroid, or if he/she requests it, hand the patient the cup of water and ask him/her to swish the water in his/her mouth and spit it in the basin. This step helps prevent oral candidiasis, reinforcing the Right response.
12. As with any medication, document the medication administration date, time, and location of administration in the electronic MAR. Ensure documentation of the Right medication, Right dose, Right route, Right time, and patient response, supporting the Right documentation.
13. Prior to leaving the room, remind the patient about any side effects/adverse effects or considerations for which he/she should notify the nurse. Reinforces the Right education and the Right response.
14. Leave the patient's room and wash hands with soap and water for at least 20 seconds, applying vigorous friction.
1. General medication administration considerations (review in the room, with the patient).
Upon first entering the patient's room, wash hands with soap and warm water, applying vigorous friction for at least 20 s. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
At the bedside computer, log into the patient's electronic health record and review the patient's medical history and previous administration times. Verify with the patient any medication allergies and discuss his/her physical allergic responses and reactions.
At the bedside computer, pull up the Medication Administration Record (MAR).
Review the inhaled medications that are due to be administered, and clarify with the patient whether he/she has a preference or concerns prior to acquiring and preparing the medication.
Assess the patient's respiratory rate and auscultate breath sounds in all respiratory fields to determine medication appropriateness and to serve as a reference for evaluating medication effectiveness. If the patient demonstrates shallow respirations or increased work of breathing, this delivery method may be inappropriate, and the care provider should be notified.
Review the medication administration process with the patient and ensure that the patient has sufficient knowledge, understanding, and ability to follow the instructions and effectively carry out the procedure. Provide additional education as needed.
Leave the patient's room, washing hands as described above (step 1.1)
2. Go to the medication preparation area and complete the first safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video. Upon acquiring the medication from the medication dispensing device, verify the expiration date. Verifying expiration supports the Right medication and the Right dose.
3. In the medication preparation area, complete the second safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video. Reconfirm the initial ten rights as applicable.
4. Gather the necessary supplies, including a cup of water, a basin, and a spacer (if required). Take the supplies into the patient's room.
Administration
5. Wash hands when entering the patient's room.
6. In the patient's room, complete the third and final medication safety check, adhering to the ten "rights" of medication administration.
7. As with any medication administration, remind the patient of the medication's purpose, any adverse reactions, and the administration procedure. Reinforces the Right reason, Right education, and supports the Right to refuse.
8. Assist the patient into an upright position to facilitate lung expansion.
9. Administer the inhaled medication using the mouthpiece.
Shake the inhaler vigorously and then remove the mouthpiece cover.
Ask the patient to hold the lower portion of the inhaler between his/her thumb and middle finger, with the index finger at the top of the canister, and place the mouthpiece of the inhaler between the upper and lower lips.
Instruct the patient to take a deep breath and to exhale fully.
Ask the patient to close his/her lips tightly around the mouthpiece and to inhale deeply and fully while depressing the canister with his/her index finger to release the medication.
At the top of the patient's inhalation, ask him/her to hold his/her breath for 10 s, or as long as it is comfortable, and to release his/her index finger from the top of the canister.
If a second inhaled dose is ordered, have the patient wait for approximately 1 min prior to administering the second dose. For the second inhaled dose, instruct the patient to repeat steps 9.1-9.5.
10. Variation: Administer the inhaled medication using a spacer.
11. If the patient received an inhaled corticosteroid, or if he/she requests it, hand the patient the cup of water and ask him/her to swish the water in his/her mouth and spit it in the basin. This step helps prevent oral candidiasis, reinforcing the Right response.
12. As with any medication, document the medication administration date, time, and location of administration in the electronic MAR. Ensure documentation of the Right medication, Right dose, Right route, Right time, and patient response, supporting the Right documentation.
13. Prior to leaving the room, remind the patient about any side effects/adverse effects or considerations for which he/she should notify the nurse. Reinforces the Right education and the Right response.
14. Leave the patient's room and wash hands with soap and water for at least 20 seconds, applying vigorous friction.
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Q1: What conditions require inhaled medication therapy?
Inhaled medications treat acute conditions like bronchitis, pneumonia, and pulmonary edema, as well as chronic conditions including asthma, chronic bronchitis, emphysema, cystic fibrosis, and lung cancer. These medications target the bronchi and bronchioles to open airways, decrease inflammation, and promote airflow throughout the respiratory system.
Q2: Why is direct airway delivery preferred for inhaled medications?
Delivering medications directly into the airways produces a faster therapeutic response compared to systemically administered medications. This targeted approach also significantly decreases the impact of systemic side effects, making inhaled administration more efficient and safer for patients requiring respiratory treatment.
Q3: What are the main types of inhaled medication delivery devices?
Common inhaled delivery devices include metered-dose inhalers, dry-powder inhalers, and breath-activated inhalers. These devices use chemical propellants, deep inhalation, or fine mist to deliver short- and long-acting bronchodilators and corticosteroids directly to the lower bronchi and bronchioles for optimal therapeutic effect.
Q4: How does a spacer device improve metered-dose inhaler use?
A spacer is a device that helps patients coordinate breathing with medication release from a metered-dose inhaler. It is particularly useful for patients who have difficulty inhaling medications into the lower airways, ensuring more effective delivery of the medication to the target respiratory structures.
Q5: What assessments should be completed before administering inhaled medications?
A thorough respiratory assessment must be completed prior to inhaled medication administration to ensure the medication and delivery device are appropriate for the patient's condition and that the patient can comply with the administration procedure. Patient education about the inhalation process is also essential before beginning treatment.
Q6: What is the difference between acute and chronic respiratory conditions treated with inhaled medications?
Acute respiratory conditions have quick onset and temporary symptoms, including bronchitis, pneumonia, and pulmonary edema. Chronic conditions persist with recurrent symptoms lasting months to years, such as asthma, emphysema, and cystic fibrosis. Both require inhaled medications but differ in duration and treatment approach.
Q7: Why is patient education important before administering inhaled medications?
Inhaled medications require administration coordinated with the breathing cycle, making patient education critical for successful treatment. Patients must have a working understanding of the inhalation procedure before beginning medication administration to ensure proper technique and optimal medication delivery to the airways.