Administering inhaled drugs:
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Metered dose inhalers:
 A spacer is always used with a pressurized metered-dose inhaler (MDI) that delivers
inhaled corticosteroids. Spacers can make it easier for medication to reach the lungs,
and also mean that less medication gets deposited in the mouth and throat, where it
can lead to irritation and mild infections.
 Shake the MDI gently before using.
 Remove the cap; hold the inhaler upright, and grasp with the thumb and first
two fingers.
 Tilt the patient’s head back slightly.
 If the MDI is used without a spacer, do the following: Remove the inhaler
cap; hold the inhaler upright and grasp with the thumb and first two fingers.
 1. Have the patient open his mouth; position the inhaler 3 to 5 cm
away from the mouth (Figure 10.92). For self-ad- administration,
some patients may measure this distance as 1 to 2 finger-widths.
 2. Have the patient exhale, then press down once on the inhaler to
release the medication; have the patient breathe in slowly and deeply
for 5 seconds.
 3. Have the patient hold his breath for approximately 10 sec- onds and
then exhale slowly through pursed lips.
 With a spacer:
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Remove the inhaler cap and then attach the spacer to the mouthpiece
of the inhaler.
 Place The Mouthpiece Of The Spacer In The Patient's Mouth
 Have the patient exhale
 Press down on the inhaler to release the medication and have the
patient inhale deeply and slowly through the spacer. The patient then
breathes in and out slowly for 2 to 3 seconds and then holds her
breath for 10 seconds
 Clean the spacer. Take the spacer apart and gently move the parts
back and forth in warm, soapy water. Avoid the use of high-pressure
or boiling hot water, rubbing alcohol, or disinfectant. Rinse the parts
well in clean water. Do not dry the inside of the spacer with a towel as
it will create static; rather, air dry.
 If a second puff of the same meds is order wait 1-2 minutes
 If ordered for diff med, wait 2-5 mins
 If both a bronchodilator and a corticosteroid inhaled medication are
ordered, the bronchodilator should be adminis- tered first so that the
air passages will be more open for the second medication
 Instruct the patient to rinse the mouth with water after inhal- ing a steroid
medication to prevent the development of an oral fungal infection.
 Educate the pt how many puffs are left in the inhaler, see pg 161
Small volume nebulizer
 Nebulizer: changes medication from a liquid to a mist so you can inhale it into
your lungs.
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In some facilities, nebulizer treatments may be performed by a respiratory
therapist. However, closely monitor the patient before, during, and after the
drug administration.
Be sure to take the patient’s baseline heart rate, especially if a beta-adrenergic
drug is used. Some drugs may increase the heart rate.
After gathering the equipment, add the prescribed medica- tion to the
nebulizer cup (Figure 10.94). Some medications will require a diluent; others
are premixed with a diluent. Be sure to verify before adding a diluent.
Before starting the nebulizer treatment, have the patient take a slow, deep
breath, hold it briefly, then exhale slowly. Patients who are short of breath
should be instructed to hold their breath every fourth or fifth breath.
Turn on the small-volume nebulizer machine (or turn on the wall unit), and
make sure that a sufficient mist is forming.
Instruct the patient to repeat the breathing pattern mentioned previously
during the treatment.
Occasionally tap the nebulizer cup, during the treatment and toward the end,
to move the fluid droplets back to the bottom of the cup.
Monitor the patient’s heart rate during and after the treatment.
If inhaled steroids are given, instruct the patient to rinse his mouth afterward.