Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...
Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...
Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...
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<strong>Nurs<strong>in</strong>g</strong> <strong>Care</strong> <strong>of</strong> <strong>Dyspnea</strong>: <strong>The</strong> <strong>6th</strong> <strong>Vital</strong> <strong>Sign</strong> <strong>in</strong> <strong>Individuals</strong> <strong>with</strong> Chronic Obstructive Pulmonary Disease (COPD)Appendix M: Device TechniqueMedications: Inhalation DevicesMedications come <strong>in</strong> many forms. However, most <strong>of</strong>ten they are taken by the <strong>in</strong>haled route:■Metered Dose Inhaler (puffer)■ Dry Powder Inhalers (Turbuhaler ® , Diskus ® , Diskhaler ® , Spiriva ® , HandiHaler ® )■NebulizerAccurate technique for us<strong>in</strong>g these devices is extremely important.Delivery Device<strong>The</strong> <strong>in</strong>haled route is the most effective method to deliver the medication directly to the airways. As a result<strong>of</strong> us<strong>in</strong>g the <strong>in</strong>haled route, the total dose <strong>of</strong> medication required is greatly reduced, thereby reduc<strong>in</strong>g thechance for the medication to have a systemic effect.A. Metered Dose Inhalers (MDI)Metered dose <strong>in</strong>halers (MDI), or puffers, deliver a precisedose <strong>of</strong> medication to the airways when used appropriately. Itis very important to have a good technique. A hold<strong>in</strong>gchamber or spacer is recommended for use <strong>with</strong> a MDI,particularly for those not able to use a puffer accurately. Todeterm<strong>in</strong>e whether the puffer is empty: (1) calculate thenumber <strong>of</strong> doses used, or (2) <strong>in</strong>vert or shake it close to the earseveral times and listen/feel for movement <strong>of</strong> liquid. Oneadvantage <strong>of</strong> us<strong>in</strong>g the MDI is that it is quite portable. Anumber <strong>of</strong> different metered dose <strong>in</strong>halers are available.Different pharmaceutical companies manufacture similarmedications that are <strong>in</strong> different <strong>in</strong>halers.Metered Dose Inhaler: Proper Use <strong>of</strong> a MDI1. Remove the cap from the mouthpiece and shake the <strong>in</strong>haler.2. Breathe out to the end <strong>of</strong> a normal breath.3. a) Position the mouthpiece end <strong>of</strong> the <strong>in</strong>haler about 2-3f<strong>in</strong>ger widths from the mouth, open mouth widely andtilt head back slightly, ORb) Close lips around the mouthpiece and tilt head back Metered Dose Inhalerslightly.4. Start to breathe <strong>in</strong> slowly, and then depress the conta<strong>in</strong>er once.5. Cont<strong>in</strong>ue breath<strong>in</strong>g <strong>in</strong> slowly until the lungs are full.6. Once breath<strong>in</strong>g <strong>in</strong> fully, HOLD breath for 10 seconds or as long as possible, up to 10 seconds.7. If a second puff is required, wait one m<strong>in</strong>ute and repeat the steps.122
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