Nebulized Medication Administration

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Nebulized Medication Administration

• Rachel Gallagher, RN, CPNP, NCSN
• DPI School Nursing Consultant
• Rachel.gallagher_at_dpi.wi.gov
• [phone]

2
Audio difficulties.

• Make sure the volume is turned up (volume button
  beneath the speakers picture)
• Make sure the volume on the computer is turned up
  (volume icon located on the right hand side of
  your computer taskbar)
• Contact your IT department
• If audio and visual is lost during the program,
  go back to http//media2.wi.gov/dpi/catalog/,
  and click on the Student Services Prevention and
  Wellness Team link on the left, then when the
  SSPW Team page of archived programs appears,
  select the program link desired.
• If problem persists contact Rachel Gallagher
  [phone].

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Training

• Knowledge training - webcast
• Competency checklists are available at
  http//dpi.wi.gov/sspw/schlnurse.html

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Outline

• What is necessary prior to administration of
  nebulized medications?
• What are the medication safety guidelines in
  administering medications or the 5 Rs?
• What is asthma?
• What are the symptoms of an asthma attack?
• What are the triggers of asthma attacks?
• What is the Asthma Inhaler Law?
• What are the similarities and differences between
  a nebulizer vs. an inhaler?
• How are nebulized medications administered?

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What is necessary prior to administration of
nebulized medication?

• Medication authorization form (orders)
• Medical provider authorization form
• Parent authorization form
• Medication
• Sink with soap and water
• Gloves
• Tubing
• Mouthpiece or mask
• Nebulizer cup
• Air compressor

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What are the medication safety guidelines in
administering medications, or the 5 Rs?

• Right student
• Right medication
• Right dosage
• Right time
• Right route
• Right documentation

7
What is Asthma?

• Chronic inflammatory disease marked by
  inflammation or swelling of the airways and
  production of mucous causing constriction or
  narrowing of the airway.
• Disease that may cause permanent changes
  (remodeling) if not properly treated.
• Disease that cannot be cured but can be
  controlled with medication and avoidance of
  triggers.

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What are symptoms of an asthma attack?

• Chest tightness
• Dry hacky cough
• Wheezing
• Shortness of breath
• Inability to talk in complete sentences without
  taking a breath.

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What are the triggers of asthma attacks?

• Allergies
• Exercise
• Respiratory infections
• Strong odors
• Cockroaches

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What is the Asthma Inhaler Law?

• Wis. Stat. sec. 118.291 Asthmatic Pupil
  possession and use of inhalers.
• A students may possess and use a metered dose
  inhaler or dry powder inhaler during school day
  and all school sponsored events or with
  supervision of a school authority if the
  following are true
• Inhaler used to prevent or treat existing asthma
  symptoms (rescue inhaler)
• Written approval of parent (if minor) and medical
  provider for use of the inhaler
• Approval letters of parent and medical provider
  need to be given to principal

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What are the similarities and differences between
a nebulizer vs. an inhaler?

• Similarities
• Provides aerosolized mist of medication.
• Used for prevention and relief of asthma.
• Differences
• Nebulizers require simple instructions for use
  with young children.
• Student assistance or cooperation is not required
  with a nebulizer.
• Nebulizers are larger in size and consequently
  less convenient.

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How are nebulized medications administered?

• 1. Review the first 5 rights
• (student, medication, dosage, time, and route)
  at initiation of task.
• 2. Have student sit in a comfortable upright
  chair.
• 3. Wash hands and apply gloves.
• 4. Recheck the first 5 rights.
• 5. Wash hands and apply gloves.

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Nebulized medication administration cont.

• 6. Remove the nebulizer cap. Place the
  appropriate amount of medication in the plastic
  nebulizer cup and replace cap.
• 7. Attach tubing to the compressor and medication
  cup.
• 8. Attach mouthpiece or mask to the medication
  cup. See medication authorization or medication
  administration record for instructions of which
  to use.
• 9. Plug into electricity and turn on the machine.
  

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Nebulized medication administration cont.

• 10. Student should begin breathing normally and
  continue until all the medication is gone. If you
  have a small child you will probably want to
  remain present for the entire treatment.
• 11. Turn off the machine.
• 12. Clean the machine per manufactures
  instructions.

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Nebulized medication administration cont.

• 13. Remove gloves and wash hands.
• 14. Secure medication in appropriate locked
  space.
• 15. Immediately document the administration of
  the medication on the medication administration
  records.
• 16. Monitor symptoms in response to the
  medication.

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Nebulized medication administration cont.

• Cleaning After completion of your treatment,
  rinse all the medication out of the cup.
  Disassemble the mouthpiece or mask, medication
  cup (including the baffle in the cup) and "tee"
  piece. Soak in a warm soapy solution, agitate
  with gentle motion, rinse, and let it air dry.
  Once dry, re-assemble for next treatment. (if
  treatments are frequent open two kits and rotate,
  while one is drying the other can be used).
• Never wash the tubing.

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Nebulized medication administration cont.

• Disinfection Once a week, soak the disassembled
  parts in a warm water/white vinegar solution (one
  part vinegar/three to four part water) for 30-60
  minutes, rinse, and air dry.
• Or
• Also suggested to wash in dishwasher on top rack
  in parts basket.
• Follow instructions of manaufactures, school
  nurse or parent.

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What are the signs that the medication treatment
was unsuccessful in reversing the asthma attack?

• Continuation or worsening of symptoms.
• Inability to complete a sentence without needing
  to breath in the middle of a sentence.
• Movement of shoulders with breathing.
• Sucking movement or retractions between the ribs.
• Emergency!!!
• Call 911, school nurse and parent as needed!!!

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• Demonstration

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Questions

• School nurse
• Parent
• Medical provider

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• Any comments regarding this webcast?
• Any suggestions on future school nursing topics?
• Contact
• Rachel Gallagher
• [phone]
• E-mail rachel.gallagher_at_dpi.wi.gov