2. General objective
At the end of this session all the PCL
Nursing First year students will be
able to explain about inhalation.
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3. Contents
Definition of inhalation
Types of inhalation
Definition of steam inhalation
Purpose of steam inhalation
Articles required for steam inhalation
Procedure of steam inhalation ( jug
and bowl method).
Definition of nebulization therapy
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4. Contents…
Purposes of nebulization therapy
Articles required for nebulization
therapy.
Procedure for nebulization therapy.
Definition of drug inhalation.
Definition of inhaler.
Types of inhaler
Procedure for using metered dose
inhaler
Procedure for using rotahaler.
Summary and post test. 4
5. Inhalation
Inhalation does refer to the breathing
of vapor, air or gas into the lungs by
the oral or nasal respiratory route.
It is used to introduce steam or certain
drugs for a rapid therapeutic localized
effects or systemic effects. E.g. relief
of bronchial spasm.
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6. Types of Inhalation
1. Dry Inhalation:
It means inhaling dry gases to
produce generalized anesthesia or
hypnosis.
E.g. Ether, chloroform, nitrous oxide,
halothane etc.
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7. 2.Wet inhalation:
It means inhaling warm or moist air as
it is mixed with water.
Vapors may be plain or medicated.
For e.g. Plain steam inhalation, O2
inhalation, nebulization
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8. Steam Inhalation
Steam inhalation is deep breathing of
warm and moist air through the oral or
nasal respiratory route.
Drugs like bronchodilators and
decongestant are frequently used by
this route in the form of steam.
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9. Purposes
To relieve the inflammation and
congestion of the mucous membranes
of the respiratory tract.
To soften the thick, tenacious mucous
which helps in its expulsion.
To relieve coughing.
To prevent post- operative
complication.
To improve breathing.
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10. Articles required
A tray containing
Medication cardex
Towel
Inhaler in a bowl
Sputum cup
Inhaler mouth piece( if needed)
Gauze piece
Cotton ball
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11. Face towel
Kidney tray or paper bag
Cardiac table/ back rest/ extra pillows
Boiling water ( 160 °F)
Articles required
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12. Procedure
Check physician prescription and
nursing care plan.
Explain the procedure to the patient
and ensure that patient has emptied
his / her bowel and bladder
Collect the required articles.
Wash hands
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13. Procedure..
Position the patient in a comfortable
position either sitting up with a back
rest and pillow, cardiac table in front or
lying down with slide with pillows.
Take vital signs.
Screen the patient.
Putt off fans, windows and doors
which are near the patient.
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14. Jug Method
Pour the boiling water ¾ in a
container.
Wrap the inhaler in its cover or towel
and place it in a bowl with the inhaler
in small tray.
Place the tray on the table nearly in
the bed or on the cardiac
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16. Ask the patient to breath in steam
through the small hole made in the
top of the cone.
Cover the patient’s head and inhaler
with the bath sheet or bath blanket.
Let the patient inhaler for 15- 20
minutes.
Remove the inhaler from the patient
after the stated time; wipe off
perspiration from the patient’s face 16
17. Give the chest physiotherapy and
encourage patient to bring out sputum by
coughing.
Note the colour, consistency, amount,
odour and any abnormalities of the
sputum.
Instruct patient to remain in the bed for 1
to 2 hours. It helps to reduces chances
of dizziness and effects of sudden
temperature variations.
Clean and replace the articles 17
18. Wash hands.
Record the procedure in nurse’s
record with date, time, purpose and
patient’s response to the treatment.
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19. Bowl or Pot Method
Fill wide pot with water, bring it to boil.
Then remove the pot from heat source
then place it on heat proof pad or
cutting board at convenient height for
the inhalation treatment.
Instruct patient to hold head over the
pot and breathe the steam.
Capture the steam by draping with
large towel creating a tent
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21. Keep face far enough from the water
so that steam does not irritate or burn
the skin.
Be careful about bowl, basin or pots of
hot water. Steam burn can occur
(scalding).
Do not leave patient alone during the
treatment.
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22. Nebulization Therapy
The process of dispersing liquid
medication into the microscopic
particles (Aerosol) and delivering it to
the lungs as patient inhales is known
as nebulization.
Nebulizer is the machine that
transforms the medication into the fine
mist which can be breathing in by
normal breathing usually, via face
mask.
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24. Purposes
To administer medication directly in
the respiratory tract for sputum
expectoration
To liquefy and remove the retained
thick secretion from the lower
respiratory tract.
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25. Purposes..
To increase the vital capacity.
To relieve the dyspnea.
To reduce the inflammatory and
allergic response of upper respiratory
tract.
To prevent post- operative
complications.
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26. Articles
Nebulizer machine
Medicine and saline solution
Connecting tube
Face mask
Sputum cup with disinfectant
Cotton balls
Disposable syringe
Kidney tray
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27. Procedure
Check the physician’s instructions and
nursing care plan.
Monitor vital signs before and after the
treatment.
Explain the procedure to the patient.
Assemble all the necessary articles at
patient’s bed side.
Place the patient in sitting or semi
fowler’s position
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28. Procedure..
Wash hands.
Add the prescribed amount of
medication and saline or sterile water
to the nebulizer.
Connect the tubing to the compressor.
Place mask on the patient’s face to
cover his mouth and the nose instruct
him to inhale deeply and slowly
through the mouth, hold breath and
exhale. 28
29. Procedure..
Instruct the patient to breath slowly
and deeply until all medication is
nebulized. Medication usually is
nebulized within 15 minutes.
On completion of the treatment,
encourage the patient to cough after
several deep breaths. The medication
dilates airway facilitating expectoration
of secretions
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30. Procedure..
Make the patient comfortable.
Observe patient for any adverse
reaction to the treatment.
Record medication used and
description of secretion expectorated.
Disassemble and clean nebulizer after
each use.
Wash hands.
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31. Drug Inhalation
Medication administered with hand
held inhalers are dispersed through
aerosol spray, mist or powder that
penetrates the lung airways.
They are commonly used in
bronchial asthma or chronic
obstructive pulmonary disease
(COPD) patients as bronchodilator.
E.g. asthalin, Ipravent etc
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32. The device which is used to
administer these medicines is known
as inhaler. Inhalers are of various
types:
Spray inhaler ( metered dose inhaler)
Powder inhaler ( also called rotahaler)
Nebulizer ( for giving high dose)
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37. Purposes
Check the medication instructions in
cardex.
Identify the patient.
Explain procedure to the patient and
purpose of medication inhalation.
Shake inhaler thoroughly (5-6) times.
This aerosolizes fine particles.
Tell the patient to sit up straight or stand
and take deep breath and exhale.
Remove the cap from the inhaler mouth
piece.
37
38. Remove the cap from the inhaler mouth
piece.
With the canister up and the mouth
piece down, put the mouth in to the
mouth and close the lips around it.
Instruct patient to tilt head back slightly
and inhale slowly and deeply and
through mouth for 3 to 5 seconds while
fully pressing down on canister.
Inhalation through mouth rather than
nose draws medication better into the
airways.
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39. Have the patient to hold breath as
long as comfortable, up to 10
seconds. Allows medication to settle
into the airways.
Remove MDI from mouth and exhale
slowly through the pursed lip.
Exhalation through pursed lip keeps
small airways open.
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40. If spacer is to be attached in MDI then:
Remove mouth piece cover from both
spacer and MDI. Inspect spacer for
any foreign materials.
Insert MDI into the end of spacer.
Shake the inhaler 5-6 times and
repeat the other steps as above.
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41. If another puff is prescribed, wait 1 to
5 minutes before the next inhalation.
If desired. Gargle with tap water and
blow nose into the tissue to remove
any trace of medication.
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42. Point to remember
If a patient uses a corticosteroids ,
have the patient to rinse the mouth with
water or salt water or brush teeth after
inhalation to reduce risk of fungal
infection.
Also teach the patient inspect oral
cavity daily for redness, sores or white
patches. Report any abnormal findings.
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43. Rotahaler are the devices that deliver
a measured dose of medicine in
powdered form.
The transparent rotahaler breaks a
capsule ( rotacap) in the powder form
and the patient inhales the powder
form in the aerosol form through the
mouth piece of rotahaler.
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44. Purposes
Check the physician instructions on
cardex.
Identify the patient.
Explain the procedure to the patient
and purpose of medication.
Place the patient comfortably either
sitting or standing.
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45. Point to remember..
Hold the rotahaler vertically and put a
capsule in to the square hole. Make
sure top of rotacap is at same level
with top of hole.
Twist barrel forward and backward.
This splits capsule into two.
Breathe out gently.
Keep mouth piece between lips and
teeth breath in powder quickly and
deeply.
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46. Point to remember
Remove rotahaler from mouth and hold
breath about 10 seconds.
If any powder is left, breathe it again.
Instruct patient to wait at least 1 minutes
between inhalation of all devices or as
ordered by physician. (Patient need to
inhale slowly. First inhalation opens
airways and reduces inflammation and
second or third inhalation penetrates the
deeper airways.)
Open the rotahaler and discard the
empty capsule
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47. Cleaning of Rotahaler
Once a day, rinse inhaler and cap in
warm running water .Make sure
inhaler is completely dry before using
it. Accumulation of medication around
mouthpiece interferes with proper
distribution during use.
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48. Cleaning of Rotahaler..
Twice a week, wash the L- shaped
plastic mouthpiece with antibacterial
soap and warm water. Rinse and air
dry before putting canister back into
the mouth piece. This removes
residual medication and decreases
transfer of microorganisms.
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50. Questions??
1. What is inhalation?
2.What is steam inhalation?
3.What are the purposes of steam
inhalation?
4.How can you perform steam
inhalation?
5. What is Nebulization?
6.What are the types of Inhaler?
7. How can you instruct patient using
rotahaler inhaler?
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51. References
Health learning material center. Institute of
medicine of medicine ,Tribhuwan
University.Fundamentals of nursing (
second edition reprint ,2010).
Kathmandu:Heidal Press ,Dillibazar.
Basvanthappa,B.T.(2004). Fundamentals of
Nursing. New Delhi :Jaypee Brothers.
Perry, A.G. and Potter, P.A. (2007).Basic
Nursing Essentials For Practice .(sixth
edition): Mosby
Giri, M. and Sharma,P. (2013). Essential
Fundamental Of Nursing.(first
edition).Kathmandu: Medhavi Publication.
51
52. Pathak ,S.and Devkota ,R.(2011).A
Textbook Of Fundamentals of
Nursing.(second
edition).Kathmandu:Vidyarthi Prakashan.
Taylor,C.R. and Lillis,C.(2008).
Fundamental Of
Nursing.(Volume1):Lippincott William and
Willikins
Skidmere ,L . Nursing Drug
Reference(2009): Mosby
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