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Verify that the patient has sufficient strength to depress the canister to discharge the medication and adequate coordination during the breathing cycle.
Notify the practitioner if no improvement, a deterioration from baseline, a significant increase in heart rate, or a cardiac arrhythmia occurs after medication administration. These changes may require changes in medication dosing.
Take steps to eliminate interruptions and distractions during medication preparation.
A pressurized metered-dose inhaler (pMDI) is a device used to administer a medication through the inhalation route.undefined#ref1">1,2 It is a hand-held device that disperses medications through an aerosol spray or mist that penetrates the lung airways (Figure 1). The deeper passages of the respiratory tract provide a large surface area for medication absorption, and the alveolar capillary network absorbs medication rapidly.
Inhaled medications are usually designed to produce local effects; for example, bronchodilators open narrowed bronchioles. However, because these medications are absorbed rapidly through pulmonary circulation, some have the potential for producing systemic side effects (e.g., albuterol may cause palpitations, tremors, and tachycardia).
Many patients with a chronic respiratory disease receive medications by inhalation. Inhaled medications provide control of airway hyperactivity or constriction. Because patients depend on these medications, they must learn about them and learn how to self-administer them safely.
A pMDI delivers a measured dose of the medication with each push of a canister. This is a problem for some older adult patients because hand strength diminishes with age. Because using a pMDI requires coordination during the breathing cycle, many patients are able to spray only the back of their throat and fail to receive a full dose (Box 1). To ensure that the medication reaches the lower airways, the inhaler must be depressed to discharge the medication just as the patient inhales.
A spacer or breath-activated inhaler helps resolve administration issues caused by poor coordination. A spacer traps medication released from the pMDI, and the patient then inhales the medication from the device. These devices improve delivery of the correct dose of inhaled medication by increasing pulmonary deposition. Use of a spacer and mask is best for a small child.1
If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.
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Rationale: Placing the patient in a sitting or semi-Fowler position or raising the head of the patient’s bed improves medication delivery to the lower airways.
When administering an anticholinergic medication, the patient should use the closed-mouth technique or a spacer device to prevent the medication from spraying into the eyes because this can increase intraocular pressure.
Explain that the patient may feel a gagging sensation when droplets of the medication hit the pharynx or tongue.
Rationale: Holding the breath allows the medication to reach deep into the lungs.
Rationale: Waiting between puffs permits the second puff to penetrate the lungs better.
Caution the patient not to repeat inhalations before the next scheduled dose (Box 1).
Rationale: The spacer device contains the fine spray and allows the patient to inhale more of the medication.
Rationale: Holding the breath ensures distribution of the medication particles into the deeper airways.
Schmitz, D.C. and others. (2019). Imperative instruction for pressurized metered-dose inhalers: Provider perspectives. Respiratory Care, 64(3), 292-298. doi:10.4187/respcare.06302
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills and techniques (10th ed.). St. Louis: Elsevier.
Clinical Review: Suzanne M. Casey, MSN-Ed, RN
Published: October 2023
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