Respiratory System Notes

Respiratory Medications: MDI (Metered-Dose Inhalers)

• Medications administered with handheld metered-dose inhalers (MDIs) are dispersed through an aerosol spray, mist, or powder that penetrates the airways.

• Dosing is usually achieved with 1 or 2 puffs.

• Different types of medications that can be administered through MDIs, most commonly: Bronchodialators and Corticosteroids.

MDI Administration

1. Always perform 3 Med checks and 10 Rights.

2. Check 2 client identifiers at bedside before administering.

3. Shake the MDI 5-6 times.

4. Have client place MDI mouth piece between teeth, with mouth sealed around it.

5. Instruct them to completely exhale before depressing the cannister.

6. Have the client inhale through their mouth and depress the cannister.

7. Instruct the client to hold their breath for 10 seconds.

MDI Spacers

• A spacer is a tube or chamber that attaches to a metered-dose inhaler (MDI) to help deliver medication to the lungs.

• Spacers can make it easier to use an MDI, especially for people who have trouble coordinating breathing and depressing the cannister.

MDI Special Considerations

• When administering both a bronchodilator (ex: salbutamol) and a corticosteroid (ex: fluticasone), always begin with the bronchodilator to keep the airways open and enhance the effects of the corticosteroids.

• Always instruct your client to rinse out their mouth after administering a corticosteroid MDI, as the medication residue can lead to oral thrush, and throat irritation.

• If a beta adrenergic bronchodilator was administered, monitor pulse as it can lead to tachycardia.

Respiratory Medications: Nebulizers

• Nebulization is a treatment that involves turning liquid medication into a mist that a patient inhales through a mask or mouthpiece.

• The mist is delivered into the lungs through the airway.

When to Use a Nebulizer over an Inhaler

1. Difficulty with Inhaler Technique: When patients struggle with the proper use of an inhaler, such as young children, the elderly, or individuals with limited dexterity.

2. Acute or Severe Symptoms: In cases of acute asthma exacerbations or severe respiratory distress, a nebulizer can deliver higher doses of medication more effectively.

3. Multiple Medications: When multiple medications need to be administered simultaneously, a nebulizer allows for the combined delivery of treatments.

4. Chronic or Serious Respiratory Conditions: For patients with chronic conditions such as COPD or severe asthma, a nebulizer may provide more consistent and comprehensive management.

Nebulizer Administration

1. Always perform 3 Med checks and 10 Rights.

2. Check 2 client identifiers at bedside before administering.

3. Pour prescribed medication in the nebulizer cup.

4. Attach cup and secure to face mask.

5. Attach tubing to aerosol compressor and nebulizer cup. OR connect tubing to oxygen/medical air connection.

6. Place mask on client.

7. Turn on compressor/administer oxygen.

8. Instruct client to take slow deep breaths.

9. Nebulizers typically take 10-15 mins to be administered.

10. Remove mask and turn off compressor.

Nebulizers Special Considerations

• Nebulizers can also be administered through a mouthpiece instead of a mask.

• IF a corticosteroid has been given through nebulization, instruct client to rinse out their mouth to prevent risk of oral thrush.

• If a beta-adrenergic bronchodilator (salbutamol) was administered, monitor pulse as it can lead to tachycardia.

Oxygen Therapy

• Oxygen is required for life and cell function.

• Oxygen is measured in FiO2. FiO2 is the percentage of oxygen in inhaled air.

• Room air is about 21% oxygen, so without supplemental oxygen, a person's FiO2 is 21%.

• When nurses administer FiO2, it is measured in Liters per minute (L/min).

• L/min is the flow rate of oxygen delivered to a patient.

• A general rule of thumb is that for every liter of oxygen supplied, the FiO2 increases by about 4%.

Oxygen Flow

• In hospital settings, the oxygen flow meter typically goes up to 15L/min = 80% FiO2.

• The appropriate flow rate depends on the doctor's clinical picture.

• Higher flow rates (10-15L/min) are typically used on clients with severe respiratory conditions or in emergency situations.

• LPNs require a doctor's order to administer O2 unless it is an emergency situation!

• Oxygen administration can be misused and can lead to harm to the client. MORE is not always better.

Oxygen Toxicity

• Caused by excessive or prolonged oxygen use, can damage the lungs and other organs.

• High oxygen levels increase free radicals, leading to lung injuries like tracheobronchitis or alveolar damage.

• Typical supplemental oxygen patients using low-flow settings on their oxygen concentrators are not at risk of oxygen toxicity.

• Those at particular risk for oxygen toxicity include hyperbaric oxygen therapy patients, patients exposed to prolonged high levels of oxygen, premature infants, and underwater divers.

• Symptoms of oxygen toxicity include coughing and shortness of breath.

• To avoid these effects, oxygen should be given at the lowest effective dose to maintain target saturation levels.

Oxygen Delivery Methods

Nasal Cannula

• Also known as nasal prongs, can administer a flow rate between 1/4 - 6 L/min of oxygen.

• Note that tubing goes behind the ears from the front and does NOT encircle the neck!

Simple Face Mask

• Covers the mouth and nose.

• It can administer between 5- 10L/min.

• It is important not to administer a flow rate lower than 5L/min, as this could lead to rebreathing carbon dioxide.

Non-Rebreather Mask

• Delivers the highest FiO2, 60-100% at flows of 10-15 L/min by means of a one-way valve on the mask.

• This valve prevents the room air and client’s exhaled air from entering the bag so that only the oxygen is the bag