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If bronchospasm occurs during nebulized medication administration, discontinue the medication and notify the practitioner.
Take steps to eliminate interruptions and distractions during medication preparation.
At the completion of the procedure, ensure all choking hazards (e.g., syringe caps, twist-off caps from saline bullets) are removed from the infant’s, toddler’s, and preschool-age child’s bed.
Nebulization is the process of aerosolizing a medication.undefined#ref1">1 Nebulized treatments can be given either intermittently or continuously. Nebulizers are the mainstay of medical aerosol therapy in acute and critical care settings. The primary advantage of nebulized medication administration is that it treats the lung directly; however, the medication can be absorbed into the bloodstream via the alveoli.4 In addition, minimal patient cooperation or coordination is required for the treatment. The disadvantage is that lung deposition of the nebulized medication represents a relatively low fraction of the total dose. The lungs of a crying child receive little nebulized medication. Most of the inhaled medication is deposited in the upper airways or pharynx and swallowed. Development of appropriate approaches that minimize distress is essential for administering nebulized medications to a child.
Small-volume nebulizers provide medications in an aerosolized form that the infant or child can inhale into the tracheobronchial tree (Figure 1). These medications bind to the beta-2 receptors in the smooth muscle. Side effects from systemic absorption include tachycardia, arrhythmia, and hypertension.
Selection of the correct nebulizer device is critical for successful administration in infants and children. Young children may not use a mouthpiece reliably. If the child cannot hold a mouthpiece between the lips, a face mask should be used (Figure 2).
Medications such as bronchodilators, mucolytics, corticosteroids, antimicrobials, and antivirals are often administered by nebulization.
Nebulizer sets must be cleaned appropriately; failure to do so leads to a decrease in performance due to clogging of the output orifice on the machine. Child and family education should include effective nebulizer cleaning techniques.
If the child or family 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.
Do not use any medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe; otherwise, this may lead to harmful reactions.
Rationale: A sitting or semi-Fowler position promotes optimal lung expansion and maximal distribution of aerosolized particles to lung fields.
Rationale: Some medications are unit dosed and prediluted; others may require a diluent such as saline to ensure optimal drug delivery.
Check the required fill volume for the device used.
Rationale: The correct flow rate ensures that a sufficient mist forms to indicate nebulization is occurring.
Rationale: A correct fit with a tight seal around the mouthpiece decreases the loss of medication into the air, ensuring delivery of the prescribed dose.
Make sure the face mask fits tightly and instruct the child to breathe through an open mouth.
Rationale: This technique increases optimal delivery of the medication to the lungs. Normal breathing pattern can be used with the child’s mouth open to provide a direct route to the airways for the medication.
Medication deposition to the lungs will vary in young children depending on their respiratory rate and depth of breathing during treatment.
Rationale: Tachycardia is a side effect of bronchodilators; it can lead to hemodynamic instability in small infants and children with cardiac disease.
Be aware that side effects usually subside shortly after treatment.
Rationale: Tapping the sides of the cup releases droplets of medication that may adhere to sides of the medication cup. Some medications have a longer nebulization time due to increased viscosity of the liquid.
Rationale: Nebulized medications or 0.9% sodium chloride solution may worsen bronchospasm.
Reportable conditions: Rash, difficulty breathing, seizures
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