Nebulization Therapy

Subject: Fundamentals of Nursing

Overview

Nebulization Therapy

Nebulization is the process of medication administration via inhalation. It utilizes a nebulizer which transports medications to the lungs by means of mist inhalation. Nebulization therapy is to liquefy and remove retained secretions from the respiratory tract. A nebulizer is a device which is used to administer medication to the respiratory tract.

Purposes

  • To administer medications directly into respiratory tract for sputum expectoration.
  • To liquefy and remove retained thick secretion from the lower respiratory tract.
  • To increase vital capacity.
  • To relieve dyspnea.
  • To reduce inflammatory and allergic responses of upper respiratory tract.
  • To prevent post-operative complication.

Indications

Nebulization therapy is used to deliver medications along the respiratory tract and is indicated to various respiratory problems and diseases such as:

  • Bronchospasms
  • Chest tightness
  • Excessive and thick mucus secretions
  • Respiratory congestions
  • Pneumonia
  • Atelectasis
  • Asthma

Contraindications

In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as:

  • The patients with unstable and increased blood pressure.
  • The individuals with cardiac irritability (may result to dysrhythmias).
  • The persons with increased pulses.
  • Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low).

Articles

  • Medication and saline solution
  • Face mask
  • Sputum cup with disinfectant
  • Cotton balls
  • Disposable syringe 5ml
  • Kidney tray
  • Nebulizer and nebulizer connecting tubes

Procedure

S.N. Nursing Action Rationale
1 Identify the patient and check the physician's instructions and nursing care plan. Ensures that right procedure is done for right patient.
2 Assess client's ability to use nebulizer Determines the level of assistance no required.
3 Monitor heart rate before and after the treatment for the patient using bronchodilator drugs. Bronchodilators may cause tachycardia, palpitation, dizziness. nausea and nervousness.
4 Explain the procedure to the patient. Proper explanation helps to ensure client's cooperation and reduce anxiety.
5 Wash hands. Reduces transmission of microorganisms.
6 Assemble equipment at bedside. Facilatates to perform procedure.
7

Place the patient in a comfortable sitting or a semi flower's position.

Position the patient appropriately, allowing optimal ventilation.

 Lungs expansion ensures maximal distribution and deposition of aerosolized particles to base of lungs.
8

Check the orders for the medication.

Add the prescribed amount of medication and saline or sterile water to the nebulizer.

Connect the tubing to the compressor.

Attached the connecting tubes and mouthpiece to the nebulizer.

Turn the machine on.

 Provides therapeutic effect.
9 Place mask on the 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.
10 Instruct the patient to breath slowly and deeply until all the medication is nebulized. Continue until medication is consumed. Medication usually is nebulized within 15 minutes.
11 Offer assistance until he is able to perform proper inhalation.  
12

Reassess patient status from breath sounds, Crespiratory status, pulse rate and other significant respiratory functions needed.

Compare and record significant changes and improvement. Refer if necessary.

 Provides information about therapeutic effect.
13 On completion of the treatment, encourage the patient to cough after several deep breaths. The medication may dilate airways facilitating expectoration of secretions.
14 Observe the patient for any adverse reaction to the treatment. The client may develop bronchospasms due medicine used.
15 Position the client in comfortable position. Makes the patient comfortable.
16 Disassemble and clean nebulizer after each used. Prevents from microorganism growth.
17 Wash hands. Prevents growth of organisms.
18 Record medication used and description of secretion expectorated. Helps to evaluate outcomes and need for changes to therapy.

 

Complications

Possible effects and reactions after nebulisation therapy are as follows:

  • Palpitations
  • Tremors
  • Tachycardia
  • Headache
  • Nausea
  • Bronchospasms (too much ventilation may result or exacerbate bronchospasms)

Inhalation

Inhalation is a method of introducing drug through the respiratory tract to produce rapid localized effects. It is the deep breathing of vapour, air or gas into the lungs for a local effect on the air passage for a systematic effect e.g. relief of bronchial spasms.

Absorption is very rapid from the mucous membrane at the nose and lungs because of the rich blood supply. Drugs used involve volatile drugs and gases. Examples include aerosols like salbutamol; steam inhalations include tincture and Benzoin.

Type of Inhalation

Dry Inhalation: It means inhaling dry gases to produce generalized anesthesia or hypnosis. e.g. ether, chloroform, nitrous oxide

Wet/Moist Inhalation: It means inhaling warm and moist air as it is mixed with water. Vapours may be plain or medicated e.g. plain steam inhalation, o2 inhalation, nebulization.

Advantages

  • Rapid absorption takes place.
  • Rapid onset of action takes place.
  • This route has minimum side effects.
  • This method is easy.
  • Fewer doses is required.

Disadvantages

  • Special apparatus is required.
  • Irritation of the respiratory tract may take place.
  • Cooperation of the patient is required.
  • Airway must be patent.

Steam Inhalation

It is deep breathing of warm and moist air into the lungs for local effect on the air passages or for a systemic effect.

Purposes

  • To relieve the inflammation and congestion of the mucous membranes of the respiratory tract and paranasal sinuses.
  • To improve breathing.
  • To soften thick, tenacious mucous this helps in its expulsion from the respiratory tract.
  • To relieve coughing.
  • To provide moisture and heat and to prevent dryness of the mucous membranes of the lungs and upper respiratory passages following operation such as trachestomy.
  • To aid in absorption of O2.
  • To prevent post-operative complication.
  • To provide medication on respiratory tract.

Articles

A tray containing

  • Towel
  • Inhaler
  • Sputum cup
  • Inhaler mouth piece (if needed)
  • Gauze piece
  • Cotton ball
  • Face towel
  • Kidney tray or paper bag
  • Cardiac table / Back rest / Extra pillows
  • Boiling water

Procedure

S.N. Nursing Action Rationale
1

Identify the patient and check the physician's instructions and nursing care plan.

Assess client's ability to take steam inhalation.

 Ensures that right procedure is done for right patient.
2 Explain the procedure to the patient. Proper explanation helps to ensure client's cooperation.
3 Wash hands. Reduces transmission of microorganisms.
4 Assemble equipment at bedside. Facilatates to perform procedure.
5 Position the patient in a comfortable position either sitting up with a back rest and pillow and cardiac table in front or lying down on the side with pillows. Lungs expansion ensures maximal distribution and deposition of aerosolized particles to base of lungs.
6 Take vital signs especially pulse and respiration. Provides baseline information.
7 Screen the patient. Maintains privacy.
8 Put off the fan, close windows and doors which are near the patient. Prevents from drafts and dust.
9 Warm the inhaler by pouring a little hot water into the inhaler and emptying it after one minute. Reduces loss of heat from inhaler during procedure.
10

Nelsion's inhaler method

  • Check the capacity of the inhaler up to spout.
  • Pour the required amount of inhalant into the inhaler and full to a level below the spout with boiling water.
  • Place sterile mouth piece and close the inhaler tightly. See that the mouthpiece is in the opposite direction to the spout.
  • Cover the mouth piece with a gauge piece and plug the spout with a cotton ball.
  • Place a towel around the inhaler and position it in the bowel.
  • Take it to the patient without losing time.
  • Position the patient in high fowler's or sitting position.
  • Place the apparatus conveniently in front of the patient on cardiac table with spout opposite to the patient. Remove the cotton plug and discard it into the paper bag.
  • Instruct the patient to place lips on the mouth piece and take a deep breath. After removing the lips from the mouthpiece, breathe out through nose. Directing the steam out through the nostril relieves the congestion of the mucous membranes of the nostril.

If the inhaler is filled up to the level of spout there is possibility of drawing water into the mouth when inhaling and if the spout is filled with water, it will not act as an air inlet.

Mouth peace in opposite direction will keep the spout away from the patient when inhalations are taken in.

Covering the mouth piece with a gauze piece will prevent burns on the lips.

A towel prevents heat loss.

Keeping the spout opposite to the client reduces the chance of burns.

Steam out through the nostril relieves the congestion of the mucous membranes of the nostril.
11

Jug method

  • Pour the boiling water 3/4 in a container.
  • Wrap the inhaler in its cover or towel and place it in a bowl. Keep the bowl with the inhaler in a small tray and take it to the bedside.
  • Place the tray on the table near the bed if the patient is lying down or on the cardiac table.

  • Ask the patient to breath in the steam through the small hole made on the top of the cone.

  • If a plastic inhaler is used, ask the patient to place mouth and nose on the mouth and nose piece of inhaler.

  • Cover the patient's head and inhaler with the bath sheet or bath blanket.

Covering container prevents heat loss.

Will facilitate easy access for the clients.

Breathing helps to inhale steam. Covering client's head prevents heat loss.

 
12 Continue the treatment for 15 to 20 minutes as long as the patient gets vapours. Observe the patient during the procedure. Sufficient duration helps in effectiveness of the procedure.
13 Remove the inhaler from the patient after the stated time, wipe off perspiration from the patients' face. Enhances comfort of patient.
14 Give chest physiotherapy and encourage the patient to bring out sputum by coughing. Helps to expel sputum.
15 Instruct the patient to remain in the bed for 1 to 2 hours. It helps to reduce chances of dizziness and effects of sudden temperature variations.
16 Clean, dry and replace articles. Avoids contamination and cross infection.
17 Wash hands.  
18 Record the procedure in the nurse's record with  date, time, purpose and patient's response to the procedure. Communicates to staff about effectiveness of the procedure.

 

Blood Transfusion

Blood transfusion consists of administration of compatible donor's whole blood or any of its components to correct/ treat any clinical condition.

Purpose

  • To restore circulating blood volume.
  • To correct platelet and coagulation factor deficiencies.
  • To correct anemia.

Articles Needed

A clean tray containing:

  • Blood transfusion set
  • Normal saline
  • Blood/blood components
  • Cannula no (according to patient vein)
  • Sterile gauze
  • Tourniquet
  • Adhesive tape
  • Scissors
  • Roller bandage and splint (if required)
  • Infusion stand
  • Disposable bag / kidney tray
  • Disposable gloves
  • Pressure bag (optional in case of severe bleeding)
  • Specimen container

Procedure

S.N. Nursing Action Rationale
1 Identify the patient. Prevents errors and eliminates possibility of tranfussion reactions.
2 Check the physician's order, patient condition and histry of teansmission reaction. Obtains specific baseline data.
3 obtain blood from blood bank according oeganization policy.  
4 Explain about the procedure, need for transmission and approximate length of time. Provides ressueance and facilitates cooperation.
5 Obtain informed consent from the patient. Minimizes institution's legal risk.
6 close door/bed curtain. Ensure privacy.
7 Wash and dry hands. Reduces risk of transmission of infection.
8 Prepare required articles. Collecting equipment saves time and energy.
9 Find out the patient condition by taking vital signs. Document the client's pre-transfusion vital signs. Obtains base line data to compare with changes post transmission.
10 Check type and cross match has been completed. Eliminates error and possibility of tranfussion reactions.
11 Encourage the patient to empty bowel and bladder and collect urine specimen. Urine specimen collected before transfusion will serve as base line data to identify transfusion reaction if it occurs.
12 Keep the patient in a comfortable position. Ensures comfort of the patient.
13 Wash hand and dry hands. Don disposable gloves. Reduces risk of transmission of infection.
14

If canula is already inserted, determine patency of the client's IV and begin infusion of normal saline.

Insert the IV cannula if not already cannulized in a large peripheral vein and initiate infusion of normal saline solution using blood transfusion set.

Normal saline is the only crystalloid that is compatible blood and priming of the blood set helps in reducing risk of hemolysis of blood in contact with tubing.

Large bore whole cannula permits infusion of the whole blood, reducing chance of hemolysis.
15

Inspect the blood product (by 2 nurses)

  • Patient's name
  • Identification number
  • Blood group and type
  • Expiry date
  • Compatibility
  • Abnormal color, clots, excess air, etc.

Safe stoeage of blood is limited to 35 days before erythrocytes are- damaged.

Verification reduces chances of mismatched transfusion and reaction after transfusion.
16 Warm blood if needed using special blood warmer or immerse partially in tepid water (98.6 degree F). Cold blood can cause hypothermia and cardiac arrhythmias
17 if blood product is found to be correct, stop the saline solution remove insertion spike from saline container and insert spike into blood container Priming of tubing is essential for preventing hemolysis.
18 Start blood product slowly at the rate of 25-50  ml (7-14 drops per minute) per hour for the first 15 minutes, stay with the patient and check vital signs every 15 minutes according to hospital policy. Transfusion reaction typically occurs during this period. checking vital signs frequently helps in early identification of complication.
19 Increase infusion rate if no adverse reactions are noticed. The flow rate should be within safe limits. Flow rate is determined by the physician's instruction and the patient's condition.
20 Assess the condition of the patient every 30  minutes and if any adverse effect is observed, stop transfusion and start saline. Send urine sample, blood sample and remaining blood product in container with transfusion set, back to the blood bank. Helps in identifying early transfusion reaction.
21 Complete transfusion if no adverse reaction is observed.  
22 Assist the patient to a comfortable position. Ensures patient's comfort.
23 Relace articles and dispose blood product container and set an appropriate policy. Reduces the transmission of microorganisms.
24 Removes gloves and wash hands.  
25

Record the following:

  • Product and volume transfused. identification number and blood group.
  • Time of administration started and completed.
  • Name and signature of nursing staff carrying out procedure and the patient's condition.
 Prompt documentation prevents ereors and enable communication between staff members.
26

Observe patient for any reaction to the transfusion.

 The patient may also develop reaction and complication.

 

Points to be Remembered

  • Do not administer medication through the same line.
  • Blood transfusion should be completed over a period of 4 hours from the time of initiation.
  • Gently rotate the blood bag periodically to prevent clumping of cells.
  • Cover the blood bag with a towel when it hangs on the IV pole.
  • Pre-medication such as anti-allergic medicine may be prescribed.
  • Do not immerse the blood bag fully into the water as it may cause hemolysis.
Things to remember

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