Chapter 6. Non-Parenteral Medication Administration Show Medications administered through inhalation are dispersed via an aerosol spray, mist, or powder that patients inhale into their airways. Although the primary effect of inhaled medications is respiratory, there are likely to be systemic effects as well. Most patients taking medication by inhaler have asthma or chronic respiratory disease and should learn how to administer these medications independently. A variety of inhalers are available, and specific manufacturers’ instructions should always be followed to ensure appropriate dosing. Administering Medication by Small-Volume NebulizersNebulization is a process by which medications are added to inspired air and converted into a mist that is then inhaled by the patient into their respiratory system (Lilley et al., 2016; Perry et al., 2018). (See Figure 6.20 and 6.21) The air droplets are finer than those created by metered dose inhalers, and delivery of the nebulized medication is by face mask or a mouthpiece held between the patient’s teeth.
Checklist 52 outlines the steps for delivering medication through a small-volume nebulizer.
Medication by Metered Dose Inhaler (MDI)A metered dose inhaler (MDI) is a small handheld device that disperses medication into the airways via an aerosol spray or mist through the activation of a propellant. A measured dose of the drug is delivered with each push of a canister, and dosing is usually achieved with one or two puffs. Attached the MDI to a spacer or valved chamber optimizes medication delivery because the medication is held in the device until the patient inhales. Some MDIs have counters to inform the user how many doses have been administered,
Checklist 53 lists the steps for administering medication by MDI.
Medication by Dry Powder Inhaler (DPI)
Dry powder inhalers (DPIs) were introduced to the market some time after pressurized MDI medications as an alternative for easier delivery of respiratory medications. DPIs don’t require the same level dexterity and coordination as an MDI and thus are thought to result in improved medication adherence and disease management. Ramadan and Sarkis (2017) reviewed a number of studies to determine if in fact DPIs were superior to MDIs and found inconclusive evidence. A concerning finding was the significant number of patients using their device(s) incorrectly. However, those using DPIs demonstrated correct technique more often than those using pressurized MDIs. This data speaks to the importance of teaching clients correct technique when using an inhaled medication and, if necessary, the prescriber ordering medication with a device that is easier for the patient to use. Checklist 54 describes the procedure for administering DPI medication.
The Lung Association of Saskatchewan (2018) provides excellent inhaler demonstration videos and scripts for a number of respiratory medications including MDIs, DPIs, and spacers. Critical Thinking Exercises
Figure 6.21. Hand held nebulizer by author is licensed under a Creative Commons Attribution 4.0 International License. Figure 6.22. Nebulizer medication with MAR by author is licensed under a Creative Commons Attribution 4.0 International License. Figure 6.23 Assorted MDIs by author is licensed under a Creative Commons Attribution 4.0 International License. Figure 6.24. Screenshot from Living With and Managing Asthma; an educational video by the Heart, Lung and Blood Institute by United States National Institutes of Health: Heart, Lung and Blood Institute is copyright free from the U.S. Department of Health & Human Services. Figure 6.23. Baby using inhaler and spacer by Phyllis Buchanan is used under a CC BY-SA 2.0 generic license. Figure 6.25. “Spiriva HandiHaler” brand dry powder inhaler (open) by RonEJ is in the public domain. Figure 6.26. MDI with MAR by author is licensed under a Creative Commons Attribution 4.0 International License. Figure 6.27. Spiriva HandiHaler”-brand dry powder inhaler byRonEJ at English Wikipedia is in the public domain. Figure 6.28. Image of Symbicort Inhaler by One Salient Oversight is in the public domain. |