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Babitha's Note On Inhalations: Its Types
The document discusses different types of inhalation therapies including steam inhalation, nebulization, and dry inhalations from devices like metered dose inhalers. It provides details on how to administer steam inhalations safely including proper positioning of patients, temperature of water, and duration of treatment. The document also covers the preparation, equipment, and procedures for administering nebulized medications to patients.
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Babitha's Note On Inhalations: Its Types
- 1. INHALATIONS By: Mrs. Babitha KDevu 5/30/2017 1
- 2. Introduction Inhalation is theact of drawing in air, vapour or gas into the lungs. Drugs are inhaled either for a local effect (e.g. steam inhalations to relieve congestion in the respiratory tract) or for a general effect e.g. inhalation of oxygen and anaesthetics. 5/30/2017 2
- 3. Inhalation • Inhalation isthe process of entry of air into the thoracic cavity. • Inhalation therapies are a group of respiratory treatments designed to help restore or improve breathing function in patients with a variety of diseases. 5/30/2017 3
- 4. Types of inhalations Inhalations Moist/wet inhalations Steam inhalations Nebulization Dry inhalations Aerosol inhalers Metered Dose Inhaler 5/30/2017 4
- 5. Types of inhalations •Dry Inhalations: it is the inhalation of gases, fumes from volatile drugs or burning drugs. Examples are: 1. Inhalation of general anaesthetics 2. Oxygen and CO2 inhalation 3. Inhalation of volatile drugs 4. Aerosol spray/MDI 5/30/2017 5
- 6. Types of inhalations •Moist Inhalations: Breathing warm and moist air produced by a vaporizer is called steam/ moist inhalation. Examples are: 1. Steam inhalation 2. Nebulization 5/30/2017 6
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- 8. Steam inhalation DEFINITION: Inhalation ofwarm, moist air into the mucous membranes and respiratory tract. 5/30/2017 8
- 9. EFFECTS/ PURPOSES: 1. Relievesinflammation and congestion of the mucous membranes of the upper respiratory tract. 2. Relieves irritation (throat tickle) by moistening and providing heat. 3. Loosens/soften thick secretions and stimulates expectoration. 4. Relieves spasmodic breathing. 5. Relaxes muscles and thus relieves coughing. 6. Prevents excessive dryness of the mucous membranes. 7. Provide antiseptic action on the respiratory tract. 5/30/2017 9
- 10. Drugs Used 1. Tr.Benzoin 5ml per 500 ml of boiling water 2. Eucalyptus 2ml per 500 ml of boiling water 3. Menthol few crystals per 500 ml of boiling water 4. Camphor few crystals per 500 ml of boiling water 5. Methyl salicylate few drops per 500 ml of boiling water 5/30/2017 10
- 11. Methods For GivingSteam Inhalation • By Jug Method • By Steam Tent • By Electric Steam Inhaler 5/30/2017 11
- 12. Methods For GivingSteam Inhalation • By Jug Method: In this method, a Nelson’s inhaler is used. The type of the inhalant required and the boiling water is filled in the jug and the patient breathes the vapour. 5/30/2017 12
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- 15. Methods For GivingSteam Inhalation • By Steam Tent: When high concentration of steam is required, a steam tent may be used. The quick and easy method – place a screen on either sides on the patient’s bed and stretch blankets or sheets across them and fix with safety pins and forming canopy. Steam can be directed in to the tent from the spout of a kettle. 5/30/2017 15
- 16. Methods For GivingSteam Inhalation • By Steam Tent: Care should be taken that the stove and the kettle are placed for AWAY FROM THE SCREEN and THE BED CLOTHES to prevent of fire. Never point the spout towards the face of the patient. The steam is given for 20 – 30minutes , repeat every 04hrly. 5/30/2017 16
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- 18. Methods For GivingSteam Inhalation • By Electric Vaporizer : A small jar with a heating element extending into the jar. The jar is filled with water, top of the jar is a removable perforated cup to which is attached a small metal spout. Cotton saturated with medication is placed inside the cup and metal spout is fitted over the cup. As the water boils, the medication steam is directed through the spout is inhaled by the patient. 5/30/2017 18
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- 20. Follow the instructionswhen giving THE STEAM INHALATION • REMEMBER – danger involved of scalding the patient by STEAM or BOILED WATER COMING OUT of the inhaler. Important when the patient is , very old, Very young, actually ill or in state of confusion. The spout of the inhaler placed in that the patient can’t touch it or put the patient’s face too near. 5/30/2017 20
- 21. • When jugor kettle is used , fill it only 2/3 of boiling water to prevent scalding of the patient. If the inhaler is filled to the brim, possible to draw water into the mouth and scalding the patient. The water must be remained just below the spout. If the spout is filled with the water , it will not act as an air inlet, the patient will not get warmed air. • Always remember the danger of fire. If a stove is used with a kettle to generate steam continuously ,as steam tent, the blankets used may fall on the stove and catch fire. 5/30/2017 21
- 22. • The temperaturefor jug method – 120 – 1600F , If water is cold, not produced steam. If water is too hot , cause scalding of the patient. • Keep the patient – warm and prevent DRAUGHT before, during and after the inhalation. – Causing the treatment is the blood vessels of the skin and mucous membrane dilate and the patient is easily chilled by exposed to draught. It will patient to more severe and prolonged attack of inflammation and congestion. The patient not to go into cold spaces for several hours after treatment. Remain in the bed. 5/30/2017 22
- 23. • If volatiledrugs are used ( e.g – Menthol ) warm the patient to keep his eyes closed to prevent the drug irritating the conjunctiva. • Observe the patient closely throughout the procedure for adverse effects. • When give inhalation by jug method , keep spout away from the patient. • Place the sputum cup in the reach of the patient to spit the coughed up during the inhalation. • Explain the procedure to the patient before preparation of the inhalation. Not during procedure.5/30/2017 23
- 24. Preliminary Assessment: • Checkthe patient’s Name, BHT , for identifications. • Find the medical diagnosis and general condition of the patient. • See the physician’s orders to find the specific precautions of movements and position. 5/30/2017 24
- 25. • Assess thepatient’s ability for self care , move, and maintain the relevant position. • Assess the level of consciousness and the ability to follow given instruction by nurse. • Find out the articles available in the patient’s unit. 5/30/2017 25
- 26. Articles Purpose 1. Nelson’sinhaler with mouth piece , tightly fit to the neck of the inhaler 1.To use as a vaporizer 2. Bowel or basin – hold the inhaler 2. To place the inhaler safety. 3. Flannel/Towel 3. To wrap the inhaler for prevent heat loss 4. Face towel 4. To wipe the face 5/30/2017 26
- 27. 5. Bath Blanketor bath towel Put over patient’s head , 6. Tincture benzoin or any other inhalant ordered. Used as a respiratory antiseptic. 7. Teaspoon or a minim glass. To measure the inhalant. 8. Kettle- boiling water. 9. Gauze piece. To wrap the mouth. 10.Cotton swab To plug the spout. 11. Kidney tray /paper bag To collect wastes. 12. Sputum cup To collect sputum. 5/30/2017 27
- 28. • Explain theprocedure – get confidence and cooperation of the patient. • Explain sequence of the procedure and tell patient how can take the inhalation. • Make the patient understand that remain in the bed one – two hours more after inhalation. • Ask the patient want to go to the wash room and empty the bladder and bowels. For bed ridden patient , offer bedpan/urinal. 5/30/2017 28
- 29. • Keep patientin a fowler’s position with bed table. If the movements are restricted, keep the patient in a side lying position or any position is comfortable to patient. ( eg. Sitting with a pillow on the lap ) • Close the doors and windows and put off the fan to prevent draught. • Place the sputum cup in a convenient place within the easy reach of the patient. • Provide the face towel to wipe the sweating from the face during the inhalation. 5/30/2017 29
- 30. Steps of procedureRationale 1. Measure the capacity of inhaler with water. ½ - 2/3 filled capacity. To determine the amount of inhalant. 2. Warm – inhaler by little hot water into the jug and emptying it. To maintain the temperature of the water , constantly. 3. Pour the required amount of inhalant and filled the jug 2/3 with hot water, below spout. If inhaler filled to the brim , possibility of drawing water to mouth and scalds.5/30/2017 30
- 31. 4. Place themouth piece and close the jug tightly . See the mouth piece is in the opposite direction to the spout. Keep the spout away from the patient when inhalation is taken. 5. Cover the mouth piece and plug the spout with cotton ball. To prevent burns of lip. Cotton ball in spout prevent escape steam. 6. Cover the jug with a flannel piece or a towel To insulate the jug and to prevent the heat loss. 7. Place the inhaler in the bowel and take bed side without losing time Placing the jug in the bowel reduces the chances for burns. 5/30/2017 31
- 32. 8. Place theapparatus conveniently in front of the patient with the spout opposite to the patient. Remove cotton plug. To reduces the chances of burns. Removing cotton plug helps to keep up patency of spout for the air. 9. Instruct - place the lip on mouth piece and breath in the vapor. Breath Steam - nostrils Relieve the congestion of mucous membrane. Cover the patient’s head and jug with a bath blanket or a towel To help collect steam around the face, steam concentration increase 5/30/2017 32
- 33. • Continue treatmentfor - 15 to 20 minutes. • Remove the inhaler , after stated time, Wipe off the perspiration from the face. • Remove – back rest , bed table. Adjust position of the patient in bed. Make comfortable. Tidy up the bed. • Instruct patient to remain in bed for 1-2hrs to prevent draught. see next slide… 5/30/2017 33
- 34. • Take thearticles to the utility room. Empty the inhaler, clean, wash with warm soapy water. Rinse with clean water. Removing the gauze covering the mouth piece and clean the mouth piece thoroughly. Boil mouth piece to prevent cross infection. All the other articles are washed soapy water and clean water. Dry and replace proper place. Wash hands. • Record the procedure on nurse’s notes with date ,time, patient’s response to the procedure. • Return to patient, assess comfort, offer hot drink if needed. 5/30/2017 34
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- 36. NEBULIZATION Definition: - Nebulization ismeans of administering drugs by inhalation. Equalizer breaks up the solution to be inhaled into fine droplets which are then suspended in a stream of gas. The patient actively inhales this gas stream containing the drug. 5/30/2017 36
- 37. Indications of Nebulization:- 1) Delivery of bronchodilator drugs : - • On acute attack of asthma Nebulization is the most common means of delivery. • Respiratory patients who are too short of breath to use pressurized aerosol or Rotahaler effectively may be prescribed bronchodilators. 2) Infants and children with asthma : - • Inhalation by nebulizer is the only means of effective inhalation therapy until a child is about 4 yrs. Old. 5/30/2017 37
- 38. Indications of Nebulization:- 3) Administration of antibiotics and antifungal agents. • In some cases of resistant chest infections for e.g. cystic fibrosis or bronchiectasis, • antibiotics may be prescribed to be inhaled directly into the lungs. 4) To aid expectoration: - • Inhalation of hypertonic saline has been found to increase clearance of bronchial secretions. 5) Local analgesia : - • To relieve dyspnea in some terminally in patients such as those suffering from alveolar carcinoma 5/30/2017 38
- 39. Types of Nebulizer: I)Jet Nebulizers: A high velocity of gas is blown through a fine hole creating an area of negative pressure. Fluid is drawn from the reservoir by the Bernville effect into the jet stream and is impacted on a battle breaking the fluid into droplets large droplets fall back to into the reservoir while the smaller ones may be inhaled. II) Ultrasonic nebulizer: High frequency sound waves are passed through a solution in a reservoir to create an aerosol. Advantage is that they operate quietly but they are less robust and need more careful maintenance than jet nebulizers and air compressors. 5/30/2017 39
- 40. Factors which affectnebulization • Method of administration / method of inhalation. • Viscosity and other physical characteristics of the liquid aerosolized. • Distribution of inspired gas (degree of airflow obstruction) • Flow rate of gas. 5/30/2017 40
- 41. Preparation of articles: •Nebulizers • Pressurized gas source • Flow meter • Oxygen tubing • T- Piece mouthpiece or mask or other appropriate gas delivery device. • Sterile normal saline solution or sterile distilled water 5/30/2017 41 •5 ml syringe and water. •Prescribed medication •Suction equipment •Sputum mug •Kidney tray •Stethoscope •B.P. apparatus, TPR tray
- 42. Preparing solution: - •It is important to use a minimum of 3 ml of solution and preferably 4 ml in order to deliver an adequate percentage of the prescribed drug. • In an assessment of jet nebulizers when 2 ml was used only 50 % of dose was released as aerosol whereas with volume of 4 ml 60 – 80%. 5/30/2017 42
- 43. Preparation of patient& environment: Preparation of patient: - • Explain the procedure to the patient • The patient should be in a well supported position. • Breathe slowly and deeply using the lower chest. Preparation of environment: - • The environment should be free from draughts of air. • The bed should be comfortable. 5/30/2017 43
- 44. Nurse’s Responsibility: • Verifythe order on the patient’s medication record by checking it against doctor’s order. • Check the label of the medication (expiry date) • Confirm patient’s identity by asking his name and by checking his name, room number, bed no. • Check gas flow. • Wash hands before procedure. • Explain procedure to patient • Record patient’s vital signs to establishment a baseline5/30/2017 44
- 45. Procedure: • Place patientin sitting or high fowlers position to facility lung expansion an aerosol dispersion • Attach free end of the oxygen tubing to pressurized gas source • Turn on the gas source and check outflow port, usually a setting of 5 – 6 liters / min is adequate. • Instruct the patient to breathe slowly deeply and evenly through his mouth 5/30/2017 45
- 46. Procedure: • After aboutthree deep breaths he should breath gently using his lower chest (breathing control) It encouraged to breathe deeply throughout the entire treatment the patient suffer from effect of hyperventilation . • It possible, remain with the patient during treatment (usually 15 – 20 minutes ) • Take vital signs to detect adverse reactions to medications. 5/30/2017 46
- 47. Care of patient: •Make sure the patient is comfortable • Provide a sputum mug for spiting the expectoration 5/30/2017 47
- 48. Documentations: - • Recordtime date and duration of therapy type, amount of medication added to nebulizer. • Baseline and subsequent vital signs and breath sounds. • Result of therapy such as loosened secretions • Any complications and nursing action taken • Patient’s tolerance of the treatment • Continuously watch changes & complications 5/30/2017 48
- 49. Procedure: • Encourage andassist the patient to cough and expectorate,. • Briefly stop the treatment if he needs rest. • Instruct patient to report warmth discomfort or hot tubing • Check water level frequently to prevent complications from inhaling hot air 5/30/2017 49
- 50. Complications or Nebulization:- • Infection • over hydration leading to pulmonary edema • Ultra fine particulate can act as irritant to susceptible patients and cause bronchospasms • wheezing 5/30/2017 50
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