Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

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Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)Proper Use of a Holding Chamber with Mouthpiece:1. Remove the cap on the inhaler (MDI) and holding chamber mouthpiece.2. Shake the inhaler well immediately before each use. Insert the inhaler (MDI) into the large opening ofthe inhaler adaptor on the chamber.3. Exhale normally. This will help the individual to prepare to take in a deep breath. It is best to take theinhaled medication while standing or sitting.4. Insert mouthpiece between teeth and seal with the lips around the mouthpiece. Do not block the slotson either side of the mouthpiece with lips.5. Activate canister. Spray one dose of medication into the chamber by squeezing the canister down oncebetween forefinger and thumb.6. Inspiration should begin no later than 1-3 seconds after actuation of the pump. Once the medication isaerosolized, breathe in slowly and deeply through mouth. Try to take 3 to 5 seconds to inhale completelywhile the spray remains suspended in the holding chamber for less than 10 seconds. This will open thevalve, allowing the drug to leave the spacer. Breathing in too quickly will cause the drug to hit the backof the throat and mouth. With the aerochambers, if a whistling sound is heard, this means that inhalingis occurring too fast and one must slow down.7. a) Single-breath technique: Hold breath for 5 to 10 seconds. Holding breath will give the medication timeto settle in the airways.b)Tidal volume technique: Breathe slowly in and out of the spacing device, 3 or 4 times in a row.8. If more than 1 dose is required, wait 30 seconds to 1 minute between puffs and repeat all steps fromthe beginning.Proper Use of a Holding Chamber with Mask:1. Remove the cap from the mouthpiece and shake the inhaler.2. Place the MDI upright in the holding chamber’s back rubber opening.3. Exhale normally. This will help the individual to prepare to take a deep breath in. It is best to take theinhaled medication while standing or sitting.4. Place the mask over the face, making sure that the mouth and nose are covered and that the seal is asairtight as possible without undue discomfort.5. Activate canister. Spray one dose of medication into the chamber by squeezing the canister down oncebetween forefinger and thumb.6. Inspiration should begin no later than 1-3 seconds after actuation of the pump. Once the medication isaerosolized, breathe in slowly and deeply through mouth. Try to take 3 to 5 seconds to inhale completelywhile the spray remains suspended in the holding chamber for less than 10 seconds. This will open thevalve, allowing the drug to leave the spacer. Breathing in too quickly will cause the drug to hit the backof the throat and mouth. With the aerochambers, if a whistling sound is heard, this means that inhalingis occurring too fast and one must slow down.7. a) Single-breath technique: Hold breath for 5 to 10 seconds. Holding breath will give the medicationtime to settle in the airways.b) Tidal volume technique: Breathe slowly in and out of the spacing device, 3 or 4 times in a row.8. If another dose is required, repeat steps 2-7. If more than 1 dose is required, wait 30 seconds to 1 minutebetween puffs and repeat all steps from the beginning.Care of a Holding Chamber (with/without mask)Whichever holding chamber is used, it must be cleaned at least once a week with warm soapy water,and air dried.124
Nursing Best Practice GuidelineB. Dry Powder Inhalers (DPIs)There are several dry powder inhalers available. Examples include the Turbuhaler ® , Diskus ® , Diskhaler ® andthe Handihaler ® .Key PointGeneral points of dry powder inhalers include:■■A quick forceful breath in is required to deliver the medications to thelungs, versus a slow breath for MDIs.Some DPIs contain a lactose carrier or filler.Proper Use of a Turbuhaler ®1. Unscrew the cover and remove it.2. Holding the device upright, turn the coloured wheel one way (right) and back(left) the other way until it clicks. Once the click is heard, the device is loaded.3. Breathe out away from the Turbuhaler ® mouthpiece.4. Place the mouthpiece between lips and tilt head back slightly.5. Breathe in deeply and forcefully.6. Hold breath for 10 seconds or as long as possible.7. If a second dose is prescribed, repeat the steps.When a red mark first appears in the little window, only 20 doses remain. TheTurbuhaler ® is empty and should be discarded when a red mark reaches thelower edge of the window. Newer Turbuhaler ® devices have a counter thatappears in a little window to show the number of doses left.Care of a Turbuhaler ®Clean the mouthpiece two or three times a week. Using a dry cloth, wipe away anyparticles which have collected on the mouthpiece. Never wash themouthpiece.Turbuhaler ®Proper Use of a Diskus ®1. Open – Place thumb on thumb grip. Push thumb away from bodyas far as it will go.2. Slide – Slide the lever until a click is heard. Breathe out away fromthe diskus.3. Inhale – Seal lips around the mouthpiece. Breathe in steadily anddeeply through mouth. Hold breath for about 10 seconds, thenbreathe out slowly.4. Close – Place thumb on thumb grip, and slide the thumb grip towardsbody, as far as it will go.Diskus ®125
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