inhalation meds

Inhalation Medications

Learning Objectives

  • Describe reasons for selecting the inhalation route

  • Discuss advantages and disadvantages of the inhalation route

  • Discuss common inhalation medications

  • Review associated assessments common to the inhalation route

  • Understand devices for inhalation medications

  • Discuss relevant patient teaching

Required Readings/Viewing

  • Adams, M., El-Hussein, M., & Osuji, J. (2024). Pharmacology for nurses: A pathophysiological approach (4th Canadian ed.). Pearson Canada.

    • Chapter 38: ‘Physiology of the Respiratory System’ and ‘Administration of Pulmonary Drugs via Inhalation’

  • Astle, B., Duggleby, W., Potter, P., Stockert, P., Perry, A. G., & Hall, A. (Eds.). (2024). Potter and Perry’s Canadian fundamentals of nursing (7th ed.). Elsevier.

    • Chapter 35: ‘Administering Medications by Inhalation’

    • Skill 35.3: ‘Using Metered-Dose (MDI) and Dry Powder Inhalers’

  • Lung Sask. (2024). COPD Inhaled Medications. copd-inhaled-medications.pdf

  • Presentation by 4th year nursing students: Trost, J. & Dull, B. (2024). Inhaler Technique. Available in Canvas modules

Gas Exchange Pathway of Air

  • Upper Respiratory System:

    • Components: Nose, mouth, pharynx

  • Lower Respiratory System:

    • Components: Trachea, right and left bronchi, and lungs

    • Reference: Potter & Perry 2024, Figure 40-4, p. 958

Gas Exchange Mechanism

  • Conducting Portion:

    • Includes: Nose/mouth to terminal bronchioles

  • Respiratory Portion:

    • Includes: Respiratory bronchioles to alveoli

    • Reference: Potter & Perry 2024, Figure 40-4, p. 958

Steps of Gas Exchange

  1. Ventilation: Breathing process

  2. External Respiration: Pulmonary gas exchange

  3. Internal Respiration: Tissue gas exchange

Functions of the Respiratory System

  • Four Major Functions:

    1. Supplying oxygen for energy production

    2. Removing carbon dioxide (CO2) waste

    3. Maintaining homeostasis

    • Ideal body pH: 7.35-7.45

    1. Maintaining heat exchange

Common Respiratory Conditions

  • Conditions Requiring Inhalation Medications:

    • Asthma

    • Chronic Obstructive Pulmonary Disease (COPD)

    • Respiratory infections

    • References to figures from Ignatavicius, et al. (2024) and Adams, et al. (2024)

Forms of Inhalation Medications

  • Topical Medications Applied at the Respiratory Tract via Aerosol:

    • Types of Inhalation Devices:

    • Nebulizer

    • Dry Powder Inhaler (DPI)

    • Metered-Dose Inhaler (MDI)

    • Reference: Rohatinsky, 2022

Patient Considerations for Inhalation Medications

  • Necessary Patient Aspects for Receiving Inhalation Medications:

    • Assessments conducted before administration must be thorough, including:

    • Patient history

    • Current respiratory status

Inhalation Medication Administration - Skill 35.3

  • Key Steps in Medication Administration:

    • Assess and gather patient information

    • Prepare medication using the 10 rights of medication administration:

    • Right Medication

    • Right Dose

    • Right Route

    • Right Time & Frequency

    • Right Reason

    • Right Patient

    • Right Patient Education

    • Right to Refuse

    • Right Evaluation

    • Right Documentation

    • Reference: Astle, et al. (2024)

Patient Safety Considerations

  • Importance of Safe Medication Use:

    • Some capsules are not meant to be swallowed

    • Reference: ISMP Canada Safety Bulletin (2016) regarding safety considerations for newer inhalation devices

    • Emphasis on proper inhaler techniques

Case Scenario Review

  • Patient Profile:

    • 78-year-old female with a history of COPD and obstructive sleep apnea (OSA)

    • Presented to emergency room with increased shortness of breath (SOB) not resolving with prescribed inhalers

    • Vital signs and current medications discussed extensively

Vital Signs & Laboratory Results

  • AM Lab Results:

    • ABG Results:

    • pH: 7.31 (normal range: 7.35-7.45)

    • PaCO2: 66 mmHg (normal range: 35-45 mmHg)

    • PaO2: 59 mmHg (normal range: 80-100 mmHg)

    • HCO3: 32 mEq/L (normal range: 22-26 mEq/L)

    • SaO2: 88% (normal range: 95-100%)

Patient Monitoring

  • Recording Vital Signs and Response:

    • Documented readings throughout the patient’s stay, monitoring response to treatment and medication administration.

Upcoming Topics

  • Next Lecture:

  • Focus on enteral, rectal (including bowel care), vaginal medications