Inhalation therapy

Inhalation

1. INHALATION THERAPY Prepared by: Ganga Tiwari BSC Nursing 4 th Year

2. General objective At the end of this session all the PCL N ursing First year students will be able to explain about inhalation. 2

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 3

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. 5

6. Types of Inhalation 1. D ry Inhalation : It means inhaling dry gases to produce generalized anesthesia or hypnosis . E.g. Ether, chloroform, nitrous oxide, halothane etc. 6

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 7

8. Steam I nhalation 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. 8

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. 9

10. Articles required A tray containing M edication cardex Towel Inhaler in a bowl Sputum cup Inhaler mouth piece( if needed) Gauze piece Cotton ball 10

11. Face towel Kidney tray or paper bag Cardiac table/ back rest/ extra pillows Boiling water ( 160 °F) Articles required 11

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 12

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 . 13

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 14

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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. 18

19. Bowl or P ot M ethod 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 19

20. Steam inhalation through bowl 20

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. 21

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. 22

23. Nebulizer 23

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. 24

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. 25

26. Articles Nebulizer machine Medicine and saline solution Connecting tube Face mask Sputum cup with disinfectant Cotton balls Disposable syringe Kidney tray 26

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 27

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 29

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. 30

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 31

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) 32

33. Rotahaler 33

34. Medicine for rotahaler 34

35. Metered dose inhaler with spacer 35

36. Meter dose inhaler 36

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. 38

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. 39

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. 40

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 . 41

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. 42

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 . 43

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. 44

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. 45

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 46

47. Cleaning of R otahaler 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. 47

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. 48

49. ANY QUERIES???? 49

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? 50

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 52

53. THANK YOU! 53