Fonte: Madeline Lassche, MSNEd, RN e Katie Baraki, MSN, RN, College of Nursing, Università dello Utah, UT
I farmaci per via inalatoria sono prescritti per le condizioni che colpiscono i bronchi, che si diramano dalla trachea, e i bronchioli, che sono progressivamente più piccoli che conducono le vie aeree diffuse in tutto il tessuto polmonare. Queste condizioni possono essere classificate come acute (cioè temporanee, ad insorgenza rapida) o croniche(cioè sintomi persistenti e/o ricorrenti che durano mesi o anni). Le condizioni acute comuni che richiedono farmaci per via inalatoria includono bronchite acuta, polmonite, tubercolosi, edema polmonare e sindrome da distress respiratorio acuto. Le condizioni croniche che richiedono farmaci per via inalatoria comprendono quelle classificate come BPCO(cioè asma, bronchite cronica ed enfisema), così come altre condizioni croniche, tra cui la fibrosi cistica, il cancro ai polmoni e la pneumoconiosi.
Queste condizioni spesso richiedono farmaci per aprire le vie aeree, ridurre l’infiammazione delle vie aeree e promuovere il flusso d’aria. La somministrazione di farmaci direttamente nelle vie aeree consente una risposta più rapida rispetto ai farmaci somministrati per via sistemica e riduce l’impatto degli effetti collaterali sistemici. I farmaci inalati sono disponibili in diverse forme e dispositivi di consegna. I farmaci inalati comuni includono broncodilatatori e corticosteroidi a breve e lunga durata d’azione. Questi possono essere somministrati utilizzando vari tipi di dispositivi di somministrazione per inalazione, come inalatori a dose dosata, inalatori a polvere secca e inalatori attivati dal respiro. Questi dispositivi richiedono un propellente chimico, un’inalazione profonda o una nebbia fine per fornire il farmaco. Indipendentemente dal tipo di consegna, l’obiettivo è lo stesso: consegnare i farmaci ai bronchi inferiori e ai bronchioli. Per coloro che utilizzano inalatori a dose misurata e che hanno difficoltà a inalare i farmaci nelle vie aeree inferiori, un dispositivo chiamato distanziatore può essere utilizzato per aiutare a coordinare la respirazione con il rilascio di farmaci dal dispositivo.
Poiché questi farmaci richiedono una somministrazione coordinata con il ciclo respiratorio, è importante educare il paziente sulla procedura prima di somministrare il farmaco e affinché il paziente abbia una comprensione funzionante del processo prima di iniziare la somministrazione di farmaci per via inalatoria. Una valutazione respiratoria approfondita deve anche essere completata prima di somministrare qualsiasi farmaco inalato per garantire l’adeguatezza del farmaco e del dispositivo di consegna e la capacità di rispettare la procedura di somministrazione.
Questa dimostrazione presenterà la preparazione e la somministrazione di farmaci per via inalatoria utilizzando l’inalatore a dose dosata come dispositivo di consegna prototipo.
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!
