nebulization AND NURSING MANAGEMENT (1).pptx

nebulisation

1. N E B U L I Z A T I ON Presented by - Mrs. Khushnasib Associate Professor Subject – Adult health nursing

2. DEFINITION Process of dispersing a liquid (medication) into microscopic particles and delivering into lungs as patient inhales through the nebulizer. It is used to liquefy and remove retained secretions from the respiratory tract.

3. Most aerosol medication have broncho dilating effects and are administered by respiratory therapy personnel.

4. PURPOSES To relieve respiratory insufficiency due to broncho spasm. To correct the underlying respiratory disorders responsible for broncho spasm. To liquefy and remove retained thick secretions. To reduce inflammatory and allergic responses of the upper respiratory tract.

5. To correct humidify deficit resulting from inspired air by passing the airway during the use of mechanical ventilation in critically and post surgical patents. When a person has a acute asthma attack. When a person is in respiratory distress. If a person is unable to use a inhaler.

6. If a person has stridor. Respiratory congestions Pneumonia Atelectasis Asthma

7. HIS T O R Y The first "powered" or pressurized inhaler was invented in France by Sales-Girons in 1858. This device used pressure to atomize the liquid medication. The pump handle is operated like a bicycle pump. When the pump is pulled up, it draws liquid from the reservoir, and upon the force of the user's hand, the liquid is pressurized through an atomizer, to be sprayed out for inhalation near the user's mouth.

8. In 1864, the first steam-driven nebulizer was invented in Germany. This inhaler, known as "Siegle’s steam spray inhaler”. The first electrical nebulizer was invented in the 1930s and called a Pneumostat.

9. BERNOULIIS PRINCIPLE: By the mid 19th century the search was on for a device that would turn a solution into a spray. It was believed that such a device would break down the solution into atoms, and in this way the solution could be inhaled. This breakdown was thus referred to as atomization, pulverizing or nebulizing, and the devices created were often referred to as atomizers, pulverizers or nebulizers. Yet no such machine would have been invented if not for the discovery of the Bernoulli Principle. Daniel Bernoulli observed that when water hits a rock it creates a mist that can be inhaled. He published a book in 1738 where he described that a similar effect could be created by forcing water through a narrow tube.

10. His concept was based on the fact that the faster water flows through a tube, the less the lateral pressure will be. A decreased lateral pressure is also referred to as a negative side stream pressure. If there is a hole in the side of the tube, the negative pressure will force water into the stream. This same concept was used in creating the first nebulizers, only using air. Air is forced through a tube, and a hole in the tube is connected to a container with a solution in it that contains the medication. The fluid is basically sucked in due to the negative sidewall pressure, and turned into a spray or mist.

11. TYPES OF NEBULIZER: Inhaler or meterd-dose nebulizer Jet nebulizer Ultrasonic nebulizer

12. FUNCTION: A nebulizer is a device that uses a small compressor to convert liquid medication into tiny droplets of mist that can be inhaled directly into the lungs. Since the medication goes straight to the lungs, onset of the medication’s action often takes place rapidly.

13. This promotes quick symptom relief in the case of illnesses such as asthma, where fast relief is desirable. Also, it minimizes the risk of side effects of the medication, preventing the medication from being metabolized into a less effective form by the body.

14. EQUIPME N TS: Nebulizer and nebulizer connecting tube Mouthpiece/mask Respiratory medication to be administered Normal saline solution Sterile water Cotton balls

15. Face mask Sputum mug with disinfectant Disposable tissues Kidney tray Medication card

16. SNO. PROCEDURE RATIONALE 1. Identify patient and check physician’s instructions. Ensures that the right procedure has been done for the patent. 2. Monitor heart rate before and after the t reat m ent for pati e nts us i ng bronchodilator drugs. Drugs may cause tachycardia pa l pita t i on, dizz i ne s s, n a use a , or nervousness 3. Explain the procedure to the pati e nt. T his t h e ra p y d e p e n d s on the patient’s effort. Proper explanation of the procedure he l ps t o e ns u re pati e n t ’ s c oop e rat i on and effectiveness of the treatment. 4. Place the pt in a comfortable sitting or a semi fowlers position. Diaphragmatic excursion and lung compliance are greater in this position. This ensures maximal distribution and deposition of aerosolized particles tp the base of lungs.

17. 5. Add the prescribed amount of medications to the medicine chamber of the tubing. Connect the tube to the compressor. A fine mist from the device should be visible. Aerosol particles enable deep penetration into tracheobronchial tree. 6. Place the mask on patient’s face to cover his mouth and nose and instruct him to inhale deeply and slowly through mouth, hold breath and then exhale several times. This encourages optimal dispersion of the medication. 7. Observe expansion of chest to ascertain that patient is taking deep breaths. This will ensure that the medication is deposited below the level in the oropharynx. 8. Instruct the pt to breath slowly and deeply until all the medications is nebulized. Medication will usually be nebulized within 15 mins.

18. 9. On completion of the treatment enco u r a ge t he pati e nt t o c ough a ft e r several deep breaths. The medication may dilate airways faci l i t a t i ng ex p e c t o rat i on of secretions. 10. Observe the pt for any adverse reaction to the treatments. Patient may develop bronchospasms due to inhalation of aerosol. The fluid may also cause dried and retained secretions in airways, leading to narrowing of the airway. 11. Document the medication used and the description of the secretions expectorated. Proper documentation is a proof of work done and observed. 12. Disassemble and clean nebulizer after each use. Keep the equipment in pt’s room. Tubing’s to be changed in every 48hrs. Proper cleaning, sterilization and st o r a ge o f e quip m ents p r even t s organisms from entering the lungs. 13. Wash hands.

19. PROCEDURE: Position the patient appropriately, allowing optimal ventilation. (semi fowlers position) Assess and record breath sounds, respiratory status, pulse rate and other significant respiratory functions. Teach patient the proper way of inhalation.

20. Prepare equipments at hand Check doctor’s orders for the medication, prepare thereafter Place the medication in the nebulizer (can add a amount of saline solution if ordered) Attach the nebulizer to the compressed gas source Attach the connecting tubes and mouthpiece to the nebulizer

21. Turn the machine on (notice the mist produced by the nebulizer) 10. Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation (if unable to hold the nebulizer [pediatric/geriatric/special cases], replace the mouthpiece with mask.

22. AFTER CARE Each time it is used, wash the nebulizer chamber in warm water or clean with a spirit swab and then rinse thoroughly with clean water. Do not use a brush to clean the nebulizer chamber as it may damage it. Reconnect the nebulizer chamber to the tubing and blow air from it.

23. This will dry the nebulizer chamber and tubing. Disconnect the nebulizer chamber from the tubing and allow it to dry completely. Disconnect the tubing from the compressor unit.

24. SIDE EFFECTS Dry or irritated throat, temporary or occasional cough Sneezing, stuffy or itchy nose, watery eyes. Burning or bleeding of your nose Nausea, heartburn, stomach pain.

25. Urinating more or less than usual. Dizziness, drowsiness, headache. Unusual or unpleasant taste in your mouth.

26. CONTRAINDICATIONS: In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as: Patients with unstable and increased blood pressure Individuals with cardiac irritability (may result to dysrhythmias) Persons with increased pulses Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)

27. Thank you