Inhalations

How various lung pathology are treated using inhalation therapy is explained properly all the procedures drugs etc has been given in details

1. INHALATION: Dry and moist and related care

2. INTRODUCTION Inhalation is the process of entry of air into the alveoli through the airway from the external environment. Today, inhalation represents the route of choice for the delivery of drugs to treat various respiratory disorders. With this therapy, drugs are delivered directly to the site of action of the lungs for localized effect at lower doses for getting a rapid response with fewer adverse effects compared to systemic administration of the same agent.

3. DEFINITION Inhalation therapies are a group of respiratory treatments designed to help restore or improve breathing function in patients with a variety of disease.

4. Anatomy of Respiratory System

5. TYPES OF INHALATIONS 1.Moist/ wet inhalation- Steam inhalation Nebulization 2.Metered dose inhaler 3.Dry inhalation-Aerosol inhalers

6. PARTICLE SIZE <1 micrometer reach upto the alveoli 0.5-5 micrometer beyond the 10 th generation of bronchi >5 micrometer oropharynx

7. INHALANT DRUGS Antiallergic agents- budesonide ( glucocorticoids ) Bronchodilaters - Salbutamol (beta-2 agonist) Anaesthetics- opioids Mucolytic agents- Acetylcysteine Antimicrobials- tobramycin (antibacterial) pentamidine (antifungal)

8. STEAM INHALATION Deep breathing of warm and moist air(vapour) into the lungs for local effect on the air passage or for a systemic effect .

9. PURPOSE- To relieve inflammation and congestion of the mucous membranes of respiratory tract and paranasal sinuses. To soften thick tenacious mucous To prevent dryness of the mucous membrane following tracheostomy . To relieve spastic conditions of larynx and bronchi. To provide antiseptic action on the respiratory tract .

10. INDICATIONS- Sinusitis Edema of larynx Thick mucous in the chest Whooping cough Acute bronchitis After tracheostomy Spasm of mucous membrane of larynx

11. CONTRAINDICATIONS - Carcinoma of lungs Very young and very old patients High fever patients Patients with severe headache

12. DRUGS USED Eucalyptus 2 ml per 500 ml of boiling water Methyl salicylate few drops per 500ml of boiling water Menthol few crystals per 500 ml of boiling water

13. ARTICLES TRAY containing- Towel Nelson’s inhaler Sputum cup with antiseptic solution Inhaler mouthpiece gauze piece Cotton balls Ounce glass Face towel Kidney tray Cardiac table Pillows Medication if ordered Boiling water (160 F)

14. PROCEDURE Explain procedure Screen the patient Auscultate patients lung fields Place him in a sitting position Cover the patient with a blanket to avoid chills or drought Bring the prepared inhaler to bed side Place the inhaler on the cardiac table Instruct the patient to inhale by mouth & exhale through the nose for 15-20 minutes

15. Keep a sputum cup & face towel near patient Remove the inhaler, keep the patient in a comfortable position & well covered for an hour Wash the mouth piece of the inhaler with a swab & running water Replace all the articles & record it.

16. POINTS TO REMEMBER Avoid spilling & prevent scalding the patient Never leave babies or a helpless patient along with inhaler Check the inhaler & mouth piece for cracks & leakages before use Give treatment regularly as ordered

17. NEBULIZATION Means of administering drugs by inhalation. The equalizer breaks the solution to be inhaled into fine droplets which are then suspended in a steam of gas and the patient actively inhales this gas steam containing the drug.

18. FOR TRACHEOSTOMY PATIENT

19. SWIVEL CONNECTOR

20. T - PIECE CONNECTOR

21. FOR VENTILATOR PATIENT

22. Respules Levolin - levosalbutamol inhalation solution Budecort-Budesonide Asthalin - salbutamol Ipravent - ipratropium bromide Duolin/Iprazest-Levosalbutamol and ipratropium bromide respirator solution

23. PURPOSE Delivery of bronchodilators in patients with acute asthma attack and dyspnoea. Administration of antibiotics and antifungal agents. To aid in expectoration Local analgesia to relieve dyspnoea in terminally ill pts .

24. Types of nebulizer Jet nebulizer-

25. Ultrasonic nebulizer

26. Ultrazonic nebulizer is a humidifier using high frequency electricity to power a transducer and divides water up into 0.5-3 mcm particles in its nebulizing chamber used in inhalation therapy The use of this ultrazonic nebulizer benefits the user because the medicated water mist can be deposited deep inside the respiratory tract,which achieves more effective treatment of asthma and other respiratory ailments

27. ARTICLES Air compressor Connecting tube Nebulizer Medication and saline solution Sterile water Cotton balls Sputum cup with disinfectant Kidney tray

28. PROCEDURE Identify the patient Monitor heart rate before & after the treatment for patients using bronchodilator drugs Explain procedure to the patient Place the patient in semi fowlers position Add the prescribed medication or saline or sterile water to the nebulizer Place mask on patients face to cover his mouth & nose & instruct him to inhale deeply & slowly through mouth , hold breath & then exhale several times

29. Continue………….. Observe expansion of chest to ascertain that patient is taking deep breaths Instruct the patient to breathe slowly & deeply until all the medication is nebulized On completion of the treatment encourage the patient to cough after several deep breaths and for facilitating cough chest physiotherapy can be done Observe patient for any adverse reactions

30. Continue…. Record medication used and descriptios of secretions expectorated Disassemble and clear nebulizer after each use,keep the equipment in patients room.the tubing is changed every 24 hours Wash hands Special consideration ; if indicated provide nebulization using oxygen source

31. Care And Maintenance Of Nebulizer Nebulizer should be cleaned using warm water . Soak the device mouthpiece or mask in warm soapy water for minimum 5 mins . Rinse thoroughly (using boiled then cooled water)and allow parts to dry Should be done atleast once daily Nebulizer must be replaced every 6 months to ensure optimum functioning and decrease chances of colonization.

32. METERED – DOSE INHALERS Definition : Process by which the patient inhales a specific or premeasured dose of aerosol medication by means of an inhaler

33. A liquid propellant A metering valve that dispenses a constant volume of a solution in the propellant Dose of inhalation will involve > 1 puff The length of time between inhalation is 15 -20 seconds

34. PURPOSES To relieve inflammation and congestion of mucous membrane To improve clearance of pulmonary secretions To act as a bronchodilator and mucolytic agent

35. ARTICLES MDI (METERED DOSE INHALER Facial tissues

36. PROCEDURE Identify the patient Assess the patients ability to hold and manipulate inhaler Instruct the patient to be in a comfortable environment by sitting in a chair Explain to the patient & demonstrate to the patient how to use this

37. Remove cap & hold inhaler upright, grasping it with thumb and first two fingers Shake inhaler Tilt head back slightly and breath out Position inhaler. hold the inhaler .5-1 inch / attach spacer to mouthpiece of inhaler /place the mouthpiece or spacer in mouth

38. Continue……….. Press down on inhaler to release medication while inhaling slowly Breath in slowly for 2-3 seconds Hold breath for approximately for 10 seconds Repeat puffs as ordered, waiting 1 minute between puffs

39. Procedure continues……… If two inhaled medications are prescribed wait 5- 10minutes between inhalations as ordered by physician Explain patient may feel gagging sensation in throat caused by droplets of medication on pharynx or tongue Instruct patient in removing medication canister and cleaning inhaler in warm water

40. Cleansing and maintenance It is essential to keep plastic mouthpiece clean to ensure proper functioning of inhaler. Clean the inhaler at least once in a week as follows- Gently pull the metal canister out of the plastic body of the inhaler. Remove the mouthpiece cover. Immerse the plastic body and the mouthpiece cover in warm water. Do not put the metal cannister in the water. Next, wash the plastic body and mouthpiece cover in running tape water. Shake well to remove excess water. Leave to dry. Avoid the use of heat to dry the parts. When the plastic body is dry replace the canister an the mouthpiece cover correctly .

41. SPECIAL CONSIDERATIONS Gargle with plain water after steroid inhalations to reduce chances of infections Do not put inhaler in water. The metal cannister is pressurized so do not puncture or burn it even when empty. Keep away from eyes. Keep away from children.

42. DRY INHALATIONS

43. DRY POWDER INHALER No propellant Breath activated and patient coordination is not an important issue The drug is formulated in a filler and contained in a capsule that is placed in the device and punctured to release the powder