How to Use a Metered Dose Inhaler (MDI) (Nursing)

00:00 Okay now this part is gonna be fun.

00:03 I want you to walk through how to use an MDI - Metered Dose Inhaler.

00:08 So I want you to be very clear on how to use these steps because you're gonna have to teach a patient very soon on how to do this.

00:15 Okay, so if the inhaler is new or hasn't been used in a while, the first thing that you wanna do is to shake the inhaler, okay? then aim it away, now if you're looking at the picture, see where the darker piece is where your mouth would go? Aim that away from you, because if you don't, you're gonna squirt yourself in the face.

00:33 So, if it hasn't been used before, it's brand new or haven't used it in a while, you wanna shake the inhaler, aim it away from you and spray 3 or 4 short puffs.

00:47 That's because we wanna make sure the patient gets the medication at full dose with each administration.

00:53 Next, you wanna teach the patient to exhale completely with a long breath and then place the inhaler in front of your mouth.

01:01 Okay, so you ready? Make sure the canister is upright, so do this with me.

01:05 Exhale completely a long breath, (exhales) then put the canister mouthpiece in your mouth.

01:15 Okay, you're gonna have to use your fingers just like I am, unless you happen to have one there with you.

01:20 So first we've shaken it up if it's brand new or we haven't used it in a while.

01:24 Squirt it away then I'm gonna exhale completely (exhales) put the canister in my mouth, open my mouth, start breathing in slow and deep as I press down so, then press down firmly on the top of the canister.

01:41 deep breath) That way I'm getting all the medication in my lungs.

01:48 Okay, Now you start again those three steps with you.

01:50 Shake it if you haven't used it in a while, turn it away, spray it, then exhale completely, (exhales) put it in front of your mouth, open your mouth, start a deep breath and then press down on the inhaler.

02:07 (deep breath) Okay. So we've made it to the first 3 steps.

02:13 You wanna walk your patient through these very slowly.

02:16 and as you're teaching them this, you want them to do it along with you without using an inhaler first.

02:22 Because you wanted to make sure that 1, they have adequate medication available to them.

02:26 That's why you do the test sprays if it hasn't been used for a while or it's new.

02:30 We want to empty their lungs of as much air as possible so the air that we are replacing it with is full of an appropriate dose of medication.

02:39 Those are the first 3 steps.

02:42 Now the next one is the hardest.

02:45 You're gonna hold your breath for 10 seconds.

02:48 That is not easy to do because we always wanna short change that.

02:53 We wanna wait at least 1 minute between puffs for the 2nd puff.

02:57 So after they've held their breath for 10 seconds, they can let it out and then you want them to wait in between.

03:03 Now an important point about this type of medication administration, if I have two types of medications which you know I will, alright.

03:11 I'm gonna have a medication that treats bronchoconstriction that will open airways and I'm gonna have a medication that deals with inflammation.

03:20 So here's a question for you.

03:22 Which one of these medications should I give first? the inhaled glucocorticoid or corticosteroid, the anti-inflammatory or should I take the bronchodilator first? Okay. Well the correct answer is you always wanna take the bronchodialtor first.

03:42 Because if you take that bronchodilator first, it'll open up those airways, you wait time in between administration, now when I give the anti-inflammatory it's gonna get tucked down into all those nooks and crannies.

03:55 Remember, you wanna give it time to work.

03:57 So for some medications, one minute isn't really enough.

04:01 You wanna give it maybe 3 or 4 minutes, have that medication really start kicking in.

04:07 So 5 minutes between a bronchodilator and an anti-inflammatory is really what we recommend.

04:13 Now I wanna go back through those steps again, Let's see if you can do that from the beginning.

04:19 Okay, so step 1, we know inhaler.

04:21 If I just took it in the morning, I'm probably okay.

04:24 but if it's brand knew or haven't used it at all, then you do these steps with me.

04:28 I'm going to shake it, turn it away from me, I'm gonna squirt 2,3,4 puffs just to make sure the medication is down there.

04:37 Then I'm gonna do what? Right, exhale completely.

04:41 (exhale) Put the inhaler here, open my mouth, (start breathing in slow and deep and then press the canister.

04:51 (deep breath) Ten seconds, ready, go.

05:07 Wow, that is a long time.

05:11 Okay, now I want you to do that with your patients.

05:14 The next time you have a patient with a metered dose inhaler, check them on how they do that.

05:18 You would be amazed.

05:19 Even in my own family, I've had to work with people very delicately as you can understand.

05:25 But I want you to do is make sure you know these 6 key things about using a metered dose inhaler.

05:31 You can do it yourself and did you see how long 10 seconds was? Most patients don't do that for 10 seconds.

05:39 But you want them to understand, holding your breath like that would really give that medication a chance to get in there and do what it's supposed to do.

05:46 So practice that before you go to clinicals, before you're in a setting where you're gonna teach a patient with that.

05:52 Do it with them and help them know, "Listen, this is gonna be the longest 10 seconds in your life but it's really important that you do that." So that's how you teach a patient how to use a metered dose inhaler.