资料来源： 马德琳 Lassche、 MSNEd，RN 和凯蒂 · 巴拉基，MSN，RN，护理学院，犹他大学，UT
吸入的药物而订明的条件影响支气管，从气管分支，并逐步缩小进行航空公司的细支气管蔓延整个肺组织。这些条件可以分类为急性(即，临时的并快速起效) 或慢性 （即，持久性和/或复发症状持久个月至年）。需要吸入的药物的常见急性条件包括急性支气管炎、 肺炎、 肺结核、 肺水肿和急性呼吸窘迫综合征。慢性疾病需要吸入的药物包括那些列为慢性阻塞性肺病 （即，哮喘、 慢性支气管炎和肺气肿），以及其他慢性的条件，包括囊性纤维化、 肺癌和肺尘埃沉着病。
这些条件往往需要药物来打开气道，降低气道炎症，促进气流。直接进入呼吸道药物运送允许更快的响应时相比，全身给药和降低全身副作用的影响。吸入的药物来在不同的形式和输送装置。常见的吸入的药物包括长短效支气管扩张剂和皮质类固醇。这些可交付使用各种类型的吸入输送装置，计量吸入器、 干粉吸入器和呼吸激活吸入器等。这些设备需要化学推进剂，深吸气或细水雾送去的药物。无论类型的交付，目标是一致的： 向较低的支气管和细支气管提供药物。对于那些使用计量吸入器和那些吸进呼吸道药物有困难，一种叫做间隔装置可用于帮助药物释放从设备坐标呼吸。
因为这些药物需要协调与呼吸周期的管理，它是重要的是教育过程之前服药病人之前开始吸入药物管理的工作过程的理解，关于病人的病情。彻底的呼吸评估也应该在任何吸入的服药以确保药物的副作用和交付设备和遵守行政程序能力妥当之前完成。
本演示将目前的制备和吸入药物使用计量吸入作为原型交付设备管理。
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!
