inhalation

1. Teaching Self-administration with a Metered-
dose Inhaler
Presented By
Mrs.Usha Rani Kandula, MSc(N),
Assistant professor in Adult health nursing, Department of Clinical nursing,
Arsi University, College of health sciences, Asella, Ethiopia, Institutional email:
usharani2020@arsiun.edu.et.

2. Equipment
 Medication administration record (MAR)
 Inhaler
 Non sterile gloves
 Wash basin or sink to rinse mouth
 Tissue (optional)

5. Sl.No Action Rationale
1 Check with the client and the chart for
known allergies or medical conditions
that would contraindicate the use of the
drug.
Prevents occurrence of adverse reactions.
2 Gather necessary equipment. Promotes efficiency.
3 Check the MAR against written health
care
practitioner orders.
Ensures accuracy in identification of
medication.
4 Wash your hands. Reduces the transmission of
microorganisms.
5 -Follow the five rights of medication
administration.
-Check the client’s identification band.
Ensures correct client.

6. Sl.No Action Rationale
6 Review with the client the purpose of
each prescribed medication.
Some clients have several inhalants
ordered and need to be taught the correct
sequence. For example, fast-acting
bronchodilators (albuteral sulfate) are
taken before slower acting bronchodilators
(iprotropium bromide).
7 -Allow the client to hold and manipulate
the canister.
-Explain how the canister fits into the
inhaler.
-Have the client demonstrate insertion
of the canister.
Nurse can assess client’s ability to
manipulate
inhaler, and client can become more
comfortable with task.
8 Explain metered-dose concept to client,
and discuss frequency of prescribed
medications.
Client needs to understand dangers of
overuse related to adverse reactions.
9 Explain that the inhaler must be shaken
before each use.
Medication must be mixed with aerosol
propellant to ensure correct dosage of

7. Sl.No Action Rationale
10 Remove the mouthpiece and cap from
the bottle and insert the stem into the
small hole on the flattened portion of
the mouthpiece.
Client should grasp the inhaler with
thumb
and first two fingers.
Proper hand position facilitates use of the
inhaler.
11 Instruct the client to exhale, place the
mouthpiece into the mouth, and ensure
that the lips form a tight seal around
the mouthpiece (Figure 29-37A).
Tight seal prevents escape of medication.
12 Instruct the client to firmly push the
cylinder down against the mouthpiece
only once (Figure 29-37B), while slowly
inhaling until the lungs feel full.
Releases the medication; as client inhales
medication is distributed into the airway.

8. Sl.No Action Rationale
13 Ask the client to remove the
mouthpiece while holding breath for
about 10 seconds and then to exhale
slowly through pursed lips.
Allows the medication to reach the alveoli.
If the client had difficulty coordinating
the
inhalation and medication dispensing,
an
aerochanber may be added (Figure 29-
37C).
An aerochamber provides dead space for
the medicated mist while the client inhales
slowly and deeply.
14 Repeat doses as ordered, waiting 1
minute
between puffs.
Allows for maximal absorption and effect
of first dose before another is taken.
15 Inform client that a mouthwash can be
used to remove the taste of the
medication.
Promotes client comfort.

9. Thanking you
Sl.No Action Rationale
17 If two or more metered-dose
medications are ordered, wait 5–10
minutes between inhalations or as
specifically ordered by the health care
practitioner.
Drugs must be inhaled sequentially to
maximize therapeutic effect.
18 Record on the MAR the drug’s name,
dose,
date, and time of medication.
Provides documentation that medication
was
given.
19 Observe for effectiveness of the
medication and relief of client
symptoms.
Evaluates effectiveness of medication.