Fonte: Madeline Lassche, MSNEd, RN e Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Medicamentos inalados são prescritos para condições que afetam os brônquios, que se ramificam fora da traqueia, e brônquios, que são progressivamente menores condução vias aéreas espalhadas por todo o tecido pulmonar. Essas condições podem ser classificadas como agudas (ou seja, temporárias, com início rápido) ou crônicas (ou seja, sintomas persistentes e/ou recorrentes que duram meses a anos). As condições agudas comuns que requerem medicamentos inalados incluem bronquite aguda, pneumonia, tuberculose, edema pulmonar e síndrome do sofrimento respiratório agudo. As condições crônicas que requerem medicamentos inalados abrangem as classificadas como DPOC (ou seja, asma, bronquite crônica e enfisema), bem como outras condições crônicas, incluindo fibrose cística, câncer de pulmão e pneumoconiose.
Essas condições muitas vezes requerem medicamentos para abrir as vias aéreas, diminuir a inflamação das vias aéreas e promover o fluxo de ar. A entrega de medicamentos diretamente nas vias aéreas permite uma resposta mais rápida quando comparada a medicamentos administrados sistematicamente e diminui o impacto dos efeitos colaterais sistêmicos. Medicamentos inalados vêm de diferentes formas e dispositivos de entrega. Medicamentos inalados comuns incluem broncodilatadores de ação curta e longa e corticosteroides. Estes podem ser entregues usando vários tipos de dispositivos de entrega de inalação, como inaladores de dose medida, inaladores de pó seco e inaladores ativados pela respiração. Estes dispositivos requerem um propulsor químico, inalação profunda ou uma névoa fina para fornecer a medicação. Independentemente do tipo de parto, o objetivo é o mesmo: entregar os medicamentos para os brônquios inferiores e bronquioles. Para aqueles que usam inaladores de dose medida e que têm dificuldades em inalar os medicamentos nas vias aéreas inferiores, um dispositivo chamado espaçador pode ser usado para ajudar a coordenar a respiração com liberação de medicamentos do dispositivo.
Como esses medicamentos exigem administração coordenada com o ciclo respiratório, é importante educar o paciente sobre o procedimento antes de administrar a medicação e que o paciente tenha uma compreensão do processo antes de iniciar a administração de medicamentos inalados. Uma avaliação respiratória minuciosa também deve ser concluída antes de administrar qualquer medicamento inalado para garantir a adequação da medicação e dispositivo de entrega e a capacidade de cumprir o procedimento administrativo.
Esta demonstração apresentará a preparação e administração de medicamentos inalados usando o inalador de dose medida como o dispositivo de entrega do protótipo.
This demonstration provides instructions on the administration of inhaled medications using a metered-dose inhaler, with mouthpiece and spacer variations. For effective inhaled medication administration, it is important for the patient to be able to follow the instructions and to have adequate respiratory functioning to allow for a full, complete inhalation. If the patient is unable to coordinate the inhalation with depression of the inhaler canister, using a spacer can help to increase the likelihood of the patient receiving the full medication dose. Proper training by medical professionals will promote proper patient use and effective airway management. It is important to instruct the patient to keep the inhaler at room temperature; if it drops below room temperature, it should be warmed only with the hands prior to use to promote the effectiveness of the chemical propellant. The device should never be warmed with anything other than hands, nor should it be punctured (to avoid injury). It is important that the patient is instructed on the proper cleaning of the inhaler. To do this, the patient should remove the medication canister from the inhaler holder and mouthpiece. The inhaler and cap should be rinsed with warm water and dried completely before recombining the inhaler components. Common errors with the administration of inhaled medications include performing poor breath/dose administration coordination, failing to hold the breath at the top of inhalation for a long enough duration, breathing in too quickly to receive the full dose, failing to shake the inhaler adequately, inhaling through the nose instead of the mouth, and failing to allow sufficient time between medication doses.
Inhaled medications open airways, decrease inflammation, promote airflow, and can lead to a quicker response with reduced systemic side effects. These medications are prescribed for conditions affecting bronchi, which are the small airways that branch off the trachea and bronchioles and spread through the lung tissue.
Conditions treated with the help of inhaled medications may be acute or chronic in nature. Common acute conditions include acute bronchitis, pneumonia, tuberculosis, pulmonary edema, and acute respiratory distress syndrome. Chronic conditions include asthma, chronic bronchitis, emphysema, cystic fibrosis, lung cancer, and pneumoconiosis.
Inhaled medications are available in different forms and delivery devices. These forms include short- and long-acting bronchodilators and corticosteroids. Some patients will benefit from the use of a spacer with a metered dose inhaler to assist in coordinating breathing with the medication.
This video illustrates the preparation and administration of inhaled medications using a metered dose inhaler for treatment of acute and chronic conditions that affect the airways.
Upon entering the room, wash hands with soap or apply hand sanitizer with friction for at least 20 seconds.
At the bedside computer, logs into the patient’s electronic health record to review their medical history and past administration times. Verify with the patient any medication allergies and discuss the physical allergic responses and reactions. In the MAR, review the inhaled medications that are due to be administered and clarify with the patient if they have a preference or concerns with regard to administration.
Next, assess the patient’s respiratory status by auscultating the breath sounds and rate to determine appropriateness of medication delivery. If the patient is experiencing shallow respirations or increased work of breathing, do not forget to notify the care provider.
Review the medication administration process with the patient. Because these medications require administration that is coordinated with the breathing cycle, it is important to educate the patient about the procedure prior to administering the medication and for the patient to have a working understanding of the process before beginning inhaled medication administration. This is also an opportunity to determine if the patient needs additional education on the medication, delivery device, and/or effect on the body.
Now, leave the room and wash hands, as previously described. Then go to the medication preparation area to obtain the medication and complete the first safety check, adhering to the five “rights” of medication administration. Verify the expiration date and complete the second safety check, following the five “rights.” After the second safety check, gather the needed supplies, including a cup of water, basin, and a spacer if necessary, and go to the patient’s room.
Now, with the medications and supplies, enter the patient’s room and perform hand hygiene, as described previously. Then, complete the third and final safety check, following the five “rights.”
As with any medication administration, review the purpose of the medication with the patient, possible adverse reactions, and how it will be administered. Help the patient to an upright position to facilitate lung expansion. Now, vigorously shake the inhaler and then remove the mouthpiece cover.
Next, have the patient hold the lower portion of the inhaler between their thumb and middle finger. The index or middle finger should be placed at the top of the canister. Finally, have the patient place the mouthpiece of the inhaler between the upper and lower lips and close them tight.
Now, instruct the patient to inhale deeply and fully while depressing the canister with their index or middle finger to release the medication. At the top of the patient’s inhalation, ask them to hold their breath for 10 seconds, or as long as it is comfortable, and to release their finger from the top of the canister. If a second inhaled dose is ordered, have the patient wait for approximately 1 minute prior to administering the second dose. Ask them to follow the same steps as for the first dose.
Some patients will use a spacer to help administer the inhaled medication. This is the case when a patient has difficulty with coordinating inhalation and pressing on the canister. If using a spacer, first shake the inhaler with vigor and remove the mouth piece cover. Next, while holding the inhaler near the bottom with your non-dominant hand, and the spacer in your dominant hand, insert the mouthpiece of the inhaler into the spacer end.
Next, ask the patient to hold the lower portion of the inhaler between the thumb and middle finger, with their index or middle finger at the top of the canister, and have them support the spacer between the index finger and thumb of their non-dominant hand. Then instruct the patient to place the mouthpiece of the spacer between the upper and lower lips, to close the lips tightly around the mouthpiece, and to breathe normally.
Now ask the patient to depress the canister with their finger to release the medication and to take in a slow, deep breath. At the top of the patient’s inhalation, ask them to hold their breath for 10 seconds, or as long as it is comfortable, then release the finger from the top of the canister, and to remove the spacer from their mouth before they exhale slowly. If a second inhaled dose is ordered, have the patient wait for approximately 1 minute prior to administering the second dose.
If the medication is a corticosteroid, or if the patient requests, give the patient a cup of water to swish around in their mouth and spit out in the basin.
Now, document the date, time, and location of the medication administration in the electronic MAR. Remind the patient about the possibility of side effects from the medication and/or when they should call the nurse. Then leave the room and wash hands for at least 20 seconds with vigorous friction.
“Proper training by medical professionals will promote proper patient use and effective airway management. It is important for the patient to be instructed to keep their inhaler at room temperature; if it drops below room temperature, it should be warmed only with the hands prior to use to promote the effectiveness of the chemical propellant. The device should never be warmed with anything other than hands, nor should it be punctured, to avoid injury.”
“Common errors with administration of inhaled medications include poor breath/dose administration coordination, failure to hold breath at the top of inhalation for a long enough duration, breathing in too quickly to receive the full dose, failure to shake the inhaler adequately, inhaling through nose instead of mouth, and failure to allow sufficient time between doses.”
You’ve just watched JoVE’s video on administration of inhaled medications. You should now understand common indications for use, how they work, and how to administer inhaled medications. As always, thanks for watching!
