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  • • Administration of medication to the lungs.

Absolute

  • • Allergic reaction to medication.

Relative

  • • Anatomic abnormalities that cause increasing symptoms with treatment.

  • • Nebulizer and compressor.

    • Metered-dose inhaler with spacer.

    • Dry powder inhaler (Figure 16–1).

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Risks are related to medication rather than delivery method.

  • • Bronchoconstriction secondary to preservative (most solutions are now preservative free).

    • Tachycardia.

    • Arrhythmia (supraventricular tachycardia).

    • Agitation.

    • Oral candidiasis.

  • • If used correctly, each method of delivery of inhalation medications is equally effective.

  • • When using a nebulizer, when mist starts sputtering, tapping on cup allows for aerosolization of remainder of medicine.

    • Effective administration involves transport of medication to the lower airways.

    • The medication must be aerosolized and inhaled to facilitate delivery.

    • Ineffective aerosolization as well as improper technique may result in disposition of medication onto the skin of the face or on the soft palate or posterior pharynx.

    • In some younger children, the use of a spacer with a mask may allow more effective delivery than a spacer with a mouthpiece.

  • • Most children who require inhalation medication for wheezing will be stable.

    • Children with severe bronchospasm or hypoxia should be placed on a cardiac monitor and pulse oximeter. They should be allowed to sit in a position of comfort, preferably upright.

  • • Sitting upright is preferred.

    • Young children should be held by their caregivers.

  • • Effective administration involves transport of medication to the lower airways.

    • The medication must be aerosolized and inhaled to facilitate delivery.

    • Ineffective aerosolization as well as improper technique may result in disposition of medication onto the skin of the face, or on the soft palate or posterior pharynx.

Nebulizer

  • • Provide power to the compressor of the nebulizer machine (electric or battery).

    • Attach oxygen tubing to the compressor and attach the nebulizer cup to the free end of the oxygen tubing.

    • Open the top of the nebulizer cup by twisting and lifting the cap, pour medication into the cup, and reattach the top.

    • Have patient put mouthpiece in mouth with seal made by lips, or if using mask, place it on patient’s face (Figure 16–2).

    • Turn the machine on.

    • Instruct the patient to take slow deep breaths until the mist stops.

Metered-Dose Inhaler and Spacer Device

  • • Shake the inhaler.

    • Remove the cap and attach it to the spacer device.

    • ...

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