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Procedures

Procedure for Administering Metered Dose Inhaler

The following procedure is provided for use when delivering medications by means of a metered dose inhaler:

A.Check Order. Verify the physician's order as follows:

    1. Compare the requisition with the physician's order to ensure that no discrepancies exist.
    2. Review the order to ensure that the following are prescribed:
      • Medication to be used
      • Frequency of therapy
      • Duration of therapy
      • Any special devices or chambers required

B. Review Chart. Use the following procedure to review the patient's chart:

    1. On the patient's chart, identify all pertinent data in the following areas:
      • History and physical
      • Admitting diagnosis
      • Progress notes
      • Blood gas analysis
      • Chest x-rays
    2. Based on the patient data, identify the following:
      • Conditions that indicate the need for metered dose inhaler delivery
      • Potential hazards of aerosol medication delivery for the patient

C. Maintain Asepsis. While performing the remainder of this procedure, you are expected to maintain aseptic. This includes the use of universal precautions and handwashing. Hands should be washed:

    • Before obtaining equipment
    • Following performance of Step J. Conclude Procedure
    • Anytime during the procedure that contamination is suspected.

D. Obtain Equipment Collect the following equipment and supplies:

    • Metered Dose Inhaler (as prescribed)
    • Any special devices or chambers (as applicable)
    • Stethoscope

E. Assemble Equipment Prepare the equipment for use as follows:

    1. Shake the inhaler to mix the medications.

    2. Remove the cap and attach the mouthpiece.

    3. If a chamber is ordered, attach the device to the mouthpiece.

F. Confirm Patient. Ensure that the procedure is performed on the correct patient as follows:

    1. Match the information on the order with the following:
      1. Room number
      2. Name on the door or bed
      3. Name on the wristband
    2. Greet the patient by name (in a questioning manner if unknown).
    3. Resolve any discrepancies in the patient identification information by conferring with the nursing staff.

G. Inform Patient. Interact with the patient as follows:

    1. Introduce yourself by name and department (if not already acquainted).
    2. Tell the patient what procedure is to be performed.
    3. Explain the procedure by describing:
      • Why it is to be performed
      • How it will be performed
      • What the patient is expected to do
      • What you will be doing
      • How frequently it will be performed

H. Implement Procedure. Perform the following tasks:

    1. Position the patient in an upright position (45 to 90° angle).
    2. Instruct the patient as follows:
      1. Grasp the MDI medication chamber between the thumb and first two fingers with the thumb on the bottom of the chamber.
      2. Hold the mouthpiece of the medication chamber (or additional chamber device if ordered) in front of the mouth with the lips around the mouthpiece but not closed on.
      3. If the patient has difficulty holding the device without closing the lips, instruct huTiher to rest the mouthpiece on the lower lip for balance.
      4. Exhale completely. Begin to inhale deeply through the mouth and immediately compress the medication chamber between the thumb and fingers to release the medication.
      5. Following complete inhalation, hold his/her breath for 5 to 10 seconds.
      6. If an additional chamber was used, inhale from the device again, without compressing the medication chamber, to ensure complete aerosol delivery.
      7. Repeat the process until the prescribed duration is accomplished.

I. Monitor Patient Determine the patient's response to the therapy as follows:

    1. Determine the pulse rate. (Count for at least one minute).
    2. Determine the respiratory rate. (Count for at least one minute).
    3. Observe respiration to identify any abnormalities in the breathing pattern.
    4. Auscultate the patient's chest
    5. Note any abnormalities in the patients appearance or behavior.

J. Conclude Procedure. Complete the following tasks:

    1. Place the patient in a comfortable position.
    2. Assure that the call bell and bedside table are within the patient's reach.
    3. Ask if the patient has any needs.
    4. Answer any questions as effectively as possible.

K. Record Results. Record the following data on the laboratory data form and on the patient's chart as required:

    • Patient name Room number
    • Aerosol medication delivered
    • Pulse rate
    • Respiratory rate
    • Breath sounds
    • Volume, color and consistence of sputum
    • Any adverse patient reactions
    • Therapy-related patient complaints

L. Report Observations. Report the following information:

    1. Report any significant adverse changes in the patient's condition to the nurse or physician.
    2. Following the procedure, inform the appropriate personnel of:
      • Patient requests
      • Patient complaints
      • Unexpressed patient needs
    3. Following the procedure, report to the nurse or physician:
      • Any non-critical adverse reactions to the therapy
      • Other pertinent observations of the patient's condition
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