Res 105 unit 2: MDIs, DPIs, and Peak flow monitoring

What does the meter mean in MDI?

Metered b/c you get a measured amount of dose for the medication

What are the advantages of MDI therapy?

1.) Promotes self-care

2.) Requires less time than aerosol therapy

3.) More portable

4.)Less equipment required

5.) More options fo available medications for patient and medical professional's benefit

What kind of pressure do MDI's have?

High pressure

How many doses does a MDI's pressured canister have?

150-300 doses

What makes MDIs able to have a small particle size?

The high vapor pressure creates the smaller particle size

Why is the dose counter important with MDIs

So patient knows when its low to reorder so they don't run out of meds

What is each activation of the MDI called?

Puff

What does and doesn't not sue a propellant with medication?

MDI uses propellants

Respimat doesn't use propellants

What do the surfactant inside the MDI do?

Keep the drug suspended

Why are HFA MDI used not instead of the old CFC?

CFC harms the ozone and can cause reactions in some patients

HFA doesn't have chlorine and is safer for the environment

What are the requirements to establish the need for an MDI treatment?

1.)Patent must be able to perform a breath hold

2.) Patients can't be in severe acute asthma attack

3.)Stable respiratory pattern and rate

4.) adequate vital capacity (> 30%)

5.) Medication is only given in MDI form that they need

What form of medication delivery should an asthma patient having a acute asthma attack have?

Aerosol therapy

What % of the population is not using their MDI correctly?

50-90%

What does HFA stand for?

hydrofluoroalkane

What does CFC stand for?

Chlorofluorocarbons

What does the law say about MDI and dose counters?

It is required to have a dose counter on the medications

What are the contraindications for MDI treatment?

1.) Reaction to propellant or to the cold aerosol

2.) Foreign body aspiration

3.) Not having hadn't eye coordination

4.) Not being able to do a breath hold

5.) Not being cooperative

6.) Vital capacity (<30%)

What often happens with MDIs because they have a high velocity of gas?

Can cause the medication to be deposited into the oropharynx

What % of the MDI is deposited into the lungs vs what is deposited into the oropharynx?

10-25% reaches the lungs

80% is deposited in the oropharynx

What would help more medication delivery to the lungs?

A spacer or holding chamber

Who pays for the patient to get a spacer or holding chamber?

The patient has to pay for it out of pocket, insurance won't cover it

How long do most spacers last?

1 year

What must be done to the MDI before use?

Shake and warm the canister to mix the medication and the propellant

What is the purpose of the antistatic chamber?

It helps prevent the medication from sticking to the side of the chamber

What are the benefits for using a spacer of holding chamber?

1.) Reduces the oropharyngeal deposition

2.) Patient's w/o hand eye coordination can use it

3.) Allows for more vaporization of the propellant

4.) Larger particles shrink to smaller ones b/c it allows for evaporation, so its a more therapeutic size

5.) A SPACER MUST ALWAYS BE USED WITH A SPACER

6.) Pediatric patients can use MDI w/ chamber

7.) Patient's who can't do a breath hold can use it w/ a spacer

What is the difference between a spacer and holding chamber?

-A spacer is an extension for the MDI that creates more space (doesn't hav e a valve)

-A holding chamber has a one-way valve that prevents the aerosol form being cleared on exhalation

Explain how a flow-triggered MDI works? (autohaler)

-the patient sets the lever one the top to the upright position

-Medication is automatically released when the patient initiates 30 L/min of flow during inspiration

* Basically the patient moves the lever up which pushes down some springs. The medication will flow out once the patient inhales. This helps to take away needing hand breath coordination

What is the only drug available for flow triggered MDI? (autohaler)

Pitbuterol (bronchodilator)

What are the steps for administering MDI inhaler?

1.) Check orders

2.) Wash hands, have patient sit up, check vitals, and explain procedure .

3.) Warm canister and shake well. Uncap mouthpiece

4.) After normal exhalation, have patient open mouth wide keeping tongue down,

5.) Hold MDI upright with outlet aimed at the mouth 4 cm away (approx. 2 finger-breaths) away.

6.) Instruct patient to breath out normally,

7.) As they slowly begin to inhale, activate one puff from the MDI, and continue to have them inhale maximally.

8.) Breath hold up to 10 sec.

9.) Wait 1 minute between puffs

10.) Repeat until prescribed puffs have been given

11.) Recap mouthpiece

12.) Have patient expectorate

13.) Check vitals

14.) Chart

What are the steps for MDI with holding chamber?

1.) Check orders

2.) Wash hands, have patient sit up, check vitals, and explain procedure .

3.) Warm canister and shake well. Insert canister into holding chamber keeping the canister upright.

4.) Place mouth piece in mouth or mask on face.

5.) Have patient breath normally and activate canister at the beginning of an inspiration.

6.) Have patient breath normally for 3 breaths. (at least 3 breaths) (5-10 for peds)

7.) Wait 1 minute between puffs

8.) Repeat until prescribed puffs have been given

9.) Disassemble and recap mouthpiece

10.) Have patient expectorate and rinse mouth if a steroid was given

11.) Check vitals

12.) Chart

After how many days of MDI not being used do you have to reprise?

7 days

What are the steps for delivering MDI via ventilator?

1.) Insert appropriate ventilator MDI adaptor near patient Wye on the inspiratory limb.

2.) Activate canister at end expiration.

3.) Wait 15 sec between activations

4.) Encourage breath hold when appropriate

What sequence should be given when more than one medication class is prescribed?

1.) Bronchodilator (SABA, or rescue)

2.) nAnticholinergics

3.) Steroids

What is the criteria for patients to do the treatment themselves?

1.) Coordinate breath wit activation of MDI

2.) Follow directions and preform breath hold

3.) No adverse reactions

How will you know if patient is breathing to fast with MDI?

The holding chamber will make a humming noise

What is a DPI?

Breath actuated meter dosing system

Do DPIs use propellants?

No

Do you need hand-breath coordination with DPIs?

No

What kind of flow is created when the DPI power medication is aerosolized when the patient inhales?

turbulent flow

What are the limitations for DPIs?

-Patients must generate flows of at least 40 - 60 lpm to produce an aerosol.

-Not used with children younger than 5 because they generally cannot generate high enough peak inspiratory flows.

-Difficult for weak, compromised patients to generate adequate inspiratory flow rates (neuromuscular patients).

-Humidity can cause the powder to clump

What are the steps for delivery of DPIs?

1.) Check orders

2.) Wash hands, have patient sit up, check vitals, and explain procedure .

3.) Assemble apparatus and load dose

4.) Have patient exhale slowly to FRC

5.) Seal lips around mouthpiece and have patient inhale deeply and forcefully

6.)Repeat until prescribed dose is given

7.) Have patient expectorate

8.) Check vitals

9.) Chart

When would an alternative aerosol device be used instead of DPI?

- With acute exasperation of asthma (respiratory distress)

-Severe increased WOB

-Inability to breath hold or follow directions

How does a Peak flow monitor work?

-It measures flow and turns it into a volume amount

-A peak flow is a pneumotachometer which measures flow

What is peak flow used for?

To evaluate the effectiveness of the bronchodilator therapy by measuring the peak expiration flows

How often should peak flow be used to monitor the patients asthma control?

daily

What is the advantage of peak flows?

It is a large permanent device or a small portable device that can easily be used at home

When should a peak flow monitor be used with a bronchodilator treatment?

Before and after treatment then 2 times a day

How often should peak flow monitor be used at home when a patient is trying to find their baseline?

3-4x a day (morning , lunch, dinner, bed) until base line is established

Once a baseline is established for a patient how often should they use their peak flow monitors at home for a COPD patient and asthmatic patients?

2x a day (adjust with severity)

How is the baseline found once the week is over when using peak flow 4x a day?

average out the numbers and that is the baseline

Describe the monitoring zones for asthma patients (green, yellow, red) with %'s

*Colors are similar to a traffic light

-Green - means "Go" asthma is in good control and values are between 80 - 100% of personal best

-Yellow - means "caution". Asthma is not in good control. Values are between 50 - 80%

-Red - Means "stop". Asthma is in poor control. Values are less than 50%. Contact physician immediately or go to local ED.

What are the steps for performing peak flow?

1.) Instruct patient to sit up (preferably stand)

2.) Have the patient take a deep, full breath

3.) Put mouth piece in mouth and exhale forcefully and fully.

4.) Repeat 3 times

5.) Record personal best