This document outlines procedures for administering medications to patients with respiratory issues, including sputum collection and examination, metered-dose inhalers (MDIs), and nebulization therapy. It describes how to properly collect sputum samples, the use of MDIs to deliver bronchodilators and other drugs to the lungs, and nebulization which uses a compressor to deliver medications as an aerosol mist. The document discusses indications, contraindications, equipment, potential effects, and the nurse's role when administering nebulization therapy to patients.

1. ADMINISTERING
MEDICATIONS FOR
PATIENTS WITH
PROBLEMS RELATED TO
RESPIRATORY SYSTEM

2. OUTLINE
• SPUTUM COLLECTION AND
EXAMINATION
• USE OF MDI
• NEBULIZATION THERAPY

3. COLLECTION OF SPUTUM
1. EARLY MORNING, DEEP COUGH SAMPLE IS PREFERRED
2. SAMPLES SHOULD BE IMMEDIATELY TRANSPORTED TO LABORATORY
THE SPUTUM SAMPLE IS OBTAINED BY HAVING THE PATIENT:
(1) RINSE THE MOUTH WITH WATER TO MINIMIZE CONTAMINATION BY NORMAL
ORAL flORA
(2) BREATHE DEEPLY SEVERAL TIMES
(3) COUGH DEEPLY
(4) EXPECTORATE THE RAISED SPUTUM INTO A STERILE CONTAINER.

4. INVASIVE PROCEDURES USED TO COLLECT
SPECIMENS
SPUTUM MAY BE OBTAINED BY :
• NASOTRACHEAL OR OROTRACHEAL SUCTIONING WITH A SPUTUM TRAP OR BY
fiBEROPTIC BRONCHOSCOPY
• BRONCHOSCOPY FOR PATIENTS WITH ACUTE SEVERE INFECTION, PATIENTS
WITH CHRONIC OR REFRACTORY INFECTION, OR IMMUNOCOMPROMISED
PATIENTS WHEN A DIAGNOSIS CANNOT BE MADE FROM AN EXPECTORATED OR
INDUCED SPECIMEN.

5. METERED-DOSE INHALER (MDI)
• A DEVICE THAT DELIVERS A SPECIFIC AMOUNT OF MEDICATION TO
THE LUNGS, IN THE FORM OF A SHORT BURST OF AEROSOLIZED
MEDICINE THAT IS USUALLY SELF-ADMINISTERED BY THE PATIENT VIA
INHALATION.
• IT IS THE MOST COMMONLY USED DELIVERY SYSTEM FOR TREATING
ASTHMA, CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND
OTHER RESPIRATORY DISEASES.
• THE MEDICATION IN A METERED DOSE INHALER IS MOST COMMONLY A
BRONCHODILATOR, CORTICOSTEROID OR A COMBINATION OF BOTH
FOR THE TREATMENT OF ASTHMAAND COPD.

7. NEBULIZATION THERAPY
DEFINITION
• IS THE PROCESS OF MEDICATION ADMINISTRATION VIA
INHALATION. IT UTILIZES A NEBULIZER WHICH TRANSPORTS
MEDICATIONS TO THE LUNGS BY MEANS OF MIST INHALATION.
• A NEBULIZER IS A SMALL DEVICE THAT CAN CONVERT A DRUG
FROM A SOLUTION INTO AN AEROSOL FORM BY MEANS OF A
COMPRESSOR/COMPRESSED GAS SOURCE.
• NEBULIZATION CREATES A MIST OF DRUG PARTICLES THAT CAN
BE INHALED VIA A FACE MASK OR MOUTHPIECE SOOTHING THE
INFLAMED AIRWAYS
• BRONCHODILATORS ARE THE MOST COMMON NEBULIZED DRUGS
BUT MANY OTHERS CAN BE NEBULIZED, INCLUDING STEROIDS
AND ANTIBIOTICS.
•

8. NEBULIZATION THERAPY
PURPOSE
• TO ADD MOISTURE TO OXYGEN DELIVERY
SYSTEM
• TO HYRDATE THICK SPUTUM AND PREVENT
MUCUS PLUGGING
• TO ADMINISTER VARIOUS DRUGS TO THE
AIRWAYS

9. MEDICATIONS ADMINISTERED
VIA NEBULIZER
• BRONCHODILATORS (FOR EXAMPLE, SALBUTAMOL),
• ANTICHOLINERGICS (FOR EXAMPLE, IPRATROPIUM BROMIDE),
• CORTICOSTEROIDS (FOR EXAMPLE, BECLOMETASONE)
• NORMAL SALINE.

10. INDICATION OF NEBULIZATION
NEBULIZATION THERAPY IS USED TO DELIVER MEDICATIONS ALONG THE
RESPIRATORY TRACT AND IS INDICATED TO VARIOUS RESPIRATORY PROBLEMS
AND DISEASES SUCH AS:
• BRONCHOSPASMS
• CHEST TIGHTNESS
• EXCESSIVE AND THICK MUCUS SECRETIONS
• RESPIRATORY CONGESTIONS
• PNEUMONIA
• ATELECTASIS
• ASTHMA

11. CONTRAINDICATIONS
IN SOME CASES, NEBULIZATION IS RESTRICTED OR AVOIDED DUE TO POSSIBLE
UNTOWARD RESULTS OR RATHER DECREASED EFFECTIVENESS SUCH AS:
• PATIENTS WITH UNSTABLE AND INCREASED BLOOD PRESSURE
• INDIVIDUALS WITH CARDIAC IRRITABILITY (MAY RESULT TO DYSRHYTHMIAS)
• PERSONS WITH INCREASED PULSES
• UNCONSCIOUS PATIENTS (INHALATION MAY BE DONE VIA MASK BUT THE
THERAPEUTIC EFFECT MAY BE SIGNIFICANTLY LOW)

12. EQUIPMENT
• NEBULIZER AND NEBULIZER CONNECTING TUBES
• COMPRESSOR OXYGEN TANK
• MOUTHPIECE/MASK
• RESPIRATORY MEDICATION TO BE ADMINISTERED
• NORMAL SALINE SOLUTION

13. POSSIBLE EFFECTS AND REACTIONS AFTER
NEBULIZATION THERAPY
• PALPITATIONS
• TREMORS
• TACHYCARDIA
• HEADACHE
• NAUSEA
• BRONCHOSPASMS (TOO MUCH VENTILATION MAY RESULT OR EXACERBATE
BRONCHOSPASMS)

14. CAUTION
• PATIENTS WITH COPD SHOULD HAVE NEBULIZERS DRIVEN BY AIR (BMA/RPSGB,
2007).
• PATIENTS WITH ACUTE ASTHMA SHOULD HAVE NEBULIZERS DRIVEN BY OXYGEN
(USUALLY 6-8L/MIN
• IF A PATIENT WITH GLAUCOMA IS TO RECEIVE AN ANTICHOLINERGIC DRUG SUCH
AS IPRATROPIUM BROMIDE, A MOUTHPIECE IS PREFERRED AS THIS REDUCES THE
LEAKAGE OF NEBULISED SOLUTION INTO THE EYES (PORTER-JONES, 2000).
• COMPRESSORS SHOULD BE SERVICED ON A REGULAR BASIS ACCORDING TO
LOCAL POLICY.
• LOCAL INFECTION CONTROL PROCEDURES SHOULD BE FOLLOWED TO MINIMIZE
THE RISK OF CROSS INFECTION.
•

15. NURSE’S ROLES
1. CLOSELY MONITOR ALL CLIENTS RECEIVING
BRONCHODILATORS FOR SIGNS OF INCREASED HEART RATE,
NERVOUS AGITATION AND RESTLESSNESS
2. PATIENT TEACHING
• PROPER WAY OF DOING THE THERAPY TO FACILITATE
EFFECTIVE RESULTS AND PREVENT COMPLICATIONS
(DEMONSTRATION IS VERY USEFUL
• EMPHASIZE COMPLIANCE TO THERAPY
• REPORT UNTOWARD SYMPTOMS IMMEDIATELY FOR
APPOSITE INTERVENTION.

16. REFERENCES
• KOZIER & ERBS FUNDAMENTALS OF NURSING. EIGHTH ED.
• CRAVEN & HIRNLE. FUNDAMENTALS OF NURSING. HUMAN HEALTH AND
FUNCTION. LIPPINCOTT & WILLIAMS. FOURTH ED.
• NURSING CRIB