Nebulization
NCM 107
Learning Outcomes:
At the end of the recorded discussion, students will:
1.Define nebulization.
2.State the purposes, indication and contraindication of
the procedure.
3.Enumerate the equipment’s needed.
4.Identify parts of nebulizer and the nebulizing kit.
5.Demonstrate the procedure competently.
NEBULIZATION
Definition: a method of administering a drug by spraying it
into the respiratory passages of the patient. The
medication may be given with or without oxygen to
help carry it into the lungs.
Nebulizer – the device/machine used to change liquid
medicine into fine droplets (in aerosol or mist
form) that are inhaled through a mouthpiece or
mask delivered directly into the lungs.
Purposes
❑ To open the collapse alveoli and deliver medicated
aerosol therapy.
❑ To relieve patient from having shortness of breath.
❑ Help expand the lungs thus loosen secretions.
❑ Commonly used at home on a long-term basis
especially for those patients with Chronic Obstructive
Pulmonary Disease (COPD) to dispense inhaled
medication.
Indications
▪ Indicated to patient having difficulty in raising/expectorating
respiratory secretions.
▪ Reduced vital capacity and less costly method of loosening
secretions.
Contraindications
▪ Inability of patient to cooperate in taking deep breathes
▪ Adverse reaction encountered with the medication
Equipment's
• Nebulizer machine
• Nebulizer kit/set (tubing, mouthpiece, manifold, mask)
• Syringe 3 cc
• Saline solution (NSS)
• Air compressor, wall air, wall oxygen (O2 driven)
• Medication administration record
• Baffle (controls the air, helps in the convention)
• T-piece
Medications
o Albuterol/Salbutamol: Hivent
o Salbutamol + Ipratropium: Combivent, Duavent
o Inhaled steroids: Budesonide, Flixotide
o Bricanyl nebule
o Ventar solution in bottle form
Common side-effects
• Tachycardia, palpitations, drying of the oral mucosa,
dizziness, nervousness, nausea
Assessment
• Check client respiratory status (note if patient use accessory muscles or
nasal flaring).
• Respiratory distress is the primary reason to administer nebulizer
medications.
• Determine the cause of respiratory distress (COPD).
• Determine the cause of respiratory distress.
• The client’s ability to use the nebulizer (determine the ability to hold
and manipulate the equipment, this allows the nurse to determine
the need for the client education to promote compliance.
• Medications currently ordered; action, purpose, common side effects,
time of onset and peak of action (this permits the nurse to anticipate
what to observe to form the client).
• The oral medications the client is currently taking (some meds can
interact; beta-blockers like atenolol and propranolol that can
antagonize the beta antagonist and can cause or increase asthma
symptoms).
• The client knowledge regarding the medication – in order to
determine the client ability to understand and follow directions.
Health Teachings
• Explain the purpose and need for this type of treatment, show
the client how to hold the nebulizer upright to prevent spilling
of the medications.
• Remind the client to keep the mouth sealed around the
mouthpiece and breathe in slowly and deeply to get the
maximum benefit.
• Have the client return demonstrate the procedure to ensure
understanding on the importance of the length of time for
the treatment, proper placement of the mouth.
• Alert the client to the common side effects of the medications
being used.
PREPARATION OF MEDICATION
1. Place the air compressor on a
sturdy surface. Plug the cord from
the compressor into a properly
grounded (three prong) electrical
outlet.
2. Wash your hands with soap and
warm water, and dry completely
with a clean towel.
3. Carefully measure the medicine exactly as
you have been instructed. Use a separate,
clean measuring device (eyedropper or
syringe) for each medicine. Look the
medication at eye level.
4. Remove the top part of the nebulizer cup
as shown. Place your medicine in the
bottom of the nebulizer cup.
5. Cover the cup and fasten.
Connect and fasten the
mouthpiece/T-piece or face
mask to the cup. Then
connect the tubing to both
the aerosol compressor and
nebulizer cup.
PREPARATION OF THE PATIENT
6. Monitor patient’s heart rate before and
after treatment.
7. Explain the procedure to the patient.
This therapy depends on patient’s
effort.
8. Place the patient in a comfortable
sitting or semi-fowler’s position.
WORKING PHASE
9. Turn on the compressor with the on/off switch.
Once you turn on the compressor, you should see a
light mist coming from the back of the tube
opposite the mouthpiece.
10. If using a mask, position it comfortably and
securely on patient’s face. If using a mouthpiece,
instruct patient to place it between teeth and seal
lips around. Nose clips are sometimes used if the
patient has difficulty breathing through the mouth.
11. Instruct patient to take slow,
deep breaths through your
mouth. If possible, let
him/her hold each breath for
two to three seconds before
breathing out until all of the
medication is nebulized.
12. Simultaneously do chest
physiotherapy.
13. Turn the compressor off.
Instruct patient to take several
deep breaths and cough to
clear any secretions he/she
might have his/her lungs. Also
instruct patient to cough the
secretions into a tissue and
dispose of it properly then wash
hands.
FOLLOW-UP PHASE
14. Record medication given and
the description of secretions
and side-effects if any.
Care of the nebulizer
❑ Cleaning should be done in a dust-and smoke-free area
away from open windows.
❑ After each treatment, rinse the nebulizer cup with warm
water, shake off excess water and let it air dry.
❑ At the end of each day, the nebulizer cup, mask, or
mouthpiece should be washed in warm, soapy water using
mild detergent, rinsed thoroughly and allowed to air dry.
❑ Every third day, after washing your equipment, disinfect the
equipment using a vinegar/water solution or the disinfect
solution your supplier suggests.
❑ To use the vinegar solution, mix ½ cup white vinegar with 1-
1/2 cups of water. Soak the equipment for 30 minutes and
rinse well under a steady stream of water.
❑ Shake off the excess water and allow to air dry on a paper
towel. Always allow the equipment to completely dry
before storing in a plastic, zipper storage bag.
Note:
There is no need to clean the tubing that connects the
nebulizer to the air compressor. Cover the compressor with
a clean cloth when not in use. Keep it clean by wiping it
with a clean, damp cloth as needed. Unplug the
,
compressor before cleaning it.
