Inhaled Medication Administration of a Metered-dose Inhaler (MDI) (Nursing)

00:04 Hi, welcome to the skill Inhaled Medication Administration of a Metered-dose Inhaler, sounds like a lot of words, or otherwise known as an MDI.

00:15 Really, this is a skill you're gonna use quite a bit for maybe a pediatric patient or an adult patient who has asthma and they're using their inhaler.

00:23 So, let's look at the equipment we're gonna need.

00:27 First, you need the medication itself, then that medication usually slides into a specific mouthpiece like you see here in the middle.

00:36 And some inhalers, not all of them, having something called a spacer, so now, let's take a minute to talk about this.

00:43 A spacer is an extra piece of equipment that goes on this device, on the mouthpiece and so, this is really useful in regards to medication delivery to the patient.

00:56 So, when you put on a spacer with a mouthpiece and with this type of drug, when it squirts into the spacer, what happens is it aerosols that, it traps it in the spacer itself, in that clear portion, so it doesn't escape in the air.

01:12 So, it contains the medication and the advantages of that is it gives little bit more time for the patient to be able to breathe that into their lungs and get the maximum effect.

01:23 So, just know that not all inhalers has a spacer but it's recommended, if useful.

01:29 Let's take a look at inhaled medication administration.

01:32 So, don't forget about your seven rights, make sure you check those first.

01:37 Sometimes, as a nurse, we need to assess a patient's baseline breath sounds.

01:41 The reason why we may do this, if we hear wheezing, or maybe the patient is short of breath, we need to assess our patients first.

01:49 So, just keep in mind, some metered dose inhalers aren't always what we call rescue inhalers.

01:56 What I mean by that, is some medication is just to help relieve inflammation, but it doesn't necessarily help with breathing immediately so it depends on the medication, so assessment is key first, as the nurse.

02:11 Alright. So, now let's talk about the medication delivery specifically.

02:15 We've gotta take that drug and put it into the mouthpiece as you see here.

02:20 Then, we're gonna take that and shake that up to make sure we've mixed the medication thoroughly.

02:25 Now, what we've gotta do next is prime that and what I mean by that is push the medicine into the mouthpiece and give it a couple of sprays.

02:35 The reason why we wanna do this before we give it to the patient, to get it all the way to the end of the mouthpiece, so when the patient uses it, they get the drug.

02:45 So, now that we've primed our metered dose inhaler, if you have a spacer that's indicated with yours, then this is a good time to connect that at this time.

02:55 So, before giving it to the patient, have the patient fully exhale and then before inhalation occurs, have the patient put the spacer in their mouth, instruct the patient to push down on the metered dose inhaler, at least one time, and then take the breath in slowly and deeply.

03:16 So, what we want to instruct the patient here is when they're getting that medication, we don't want them to breath in sharply, this is a time we take a good, slow deep breath in.

03:27 Once the patient has inhaled the medication, we want the patient to hold that breath for at least 10 seconds.

03:34 We wanna make sure all that medication gets into their lungs to help with that breathing.

03:40 Also, at this point, you can remove the spacer if needed.

03:43 Now, once the patient's held that breath, if they can do it for a full 10 seconds, then instruct them to exhale slowly through pursed lips.

03:52 We also may need to repeat this if ordered by the doctor.

03:56 Now, once we've completed all of this, we can remove the metered dose inhaler from the spacer and clean this thoroughly.

04:09 I'd like to take a moment to talk to you about metered dose inhalers.

04:12 So, first of all, let's take a look at the equipment.

04:15 It's kind of odd to navigate, so I'm just gonna take a few minutes and talk about inhalers with you.

04:21 So, let's look at a regular inhaler, so we have here.

04:24 So, this could be a steroid or something like that, that's prescribed, particularly for maybe, asthma, for example.

04:30 So, we've got the medication itself that's prescribed by the pharmacy, so this piece is gonna go in, the med is gonna go in to what we call the mouthpiece.

04:41 So, notice there's pieces of this.

04:43 So, I'm going to take the medicine itself and place it into the mouthpiece.

04:49 So, for patient's use, this is first.

04:51 So, this just sets very nicely and it snaps down in there.

04:56 So, notice there's a cap, and we're gonna take this off.

05:01 So, now, with inhalers just know, there's these two pieces, the med and the mouthpiece itself.

05:08 So, when we start to give this with the patients, first thing's really important, I put this med in and I give it a really good shake.

05:17 This is gonna make sure the medication is nice and mixed up for the patient.

05:21 Then to prime the medication, we wanna make sure we give it at least one good spray or two.

05:27 So, we're gonna push on med, and that's gonna come out the mouthpiece.

05:32 Alright. So, now, we're primed.

05:34 So, now, it's ready for the patient, and this is if the patient just needs this alone.

05:40 Now, sometimes, it's also prescribed to put a spacer on the metered dose inhaler.

05:46 So, why do we do this? We've talked about this a little bit early, but this is odd-looking device, right? But what's amazing about this, this is gonna connect to the mouthpiece, so we're gonna go ahead and show you that.

05:58 So, notice how lovely this fits in here, this is that piece then I'm gonna take this piece off and the cap.

06:06 This part is what the patient's going to use and one thing I wanna note about why we use spacers.

06:13 When I go and give this medication, so we give it a pump, this is going to trap that med in the spacer, so we don't lose all of it and escape in the air.

06:24 The other thing a reason why a spacer is really great is it's going to keep that medicine in there a little bit longer, give your patient a little bit more time, to slowly inhale a lot more of that medication.

06:37 So, this is the spacer. So, this is just a good look for you guys to see.

06:41 Alright, so we're done with that now.

06:43 Next, I wanna talk about some different types of inhalers.

06:47 So, you may see something like this, this weird little turtle disk, they're very handy, but these are great, what we call maintenance inhalers, so we'll talk about that a little bit more in a few.

06:58 But you may see a patient on something like this.

07:01 So, this thing has a little clip, you just move it to the side.

07:07 Also, it's usually gonna have a number of the dosing and your patient will need to know is it one click, two clicks, they will move it as prescribed, put their mouth on it, inhale slowly and deeply, and then once they're done, it just clicks nice back in.

07:23 So, this is an example of a maintenance inhaler.

07:26 So, here's one kind, another kind may look like this.

07:31 So, this is kind of an odd little, little inhaler that you may see.

07:35 This one has a particular capsule that actually goes with it.

07:39 You're gonna open this up, there's one more opening, open this up, place the capsule, put this back on and crush the pill.

07:51 So, by crushing the pill in here, it releases the medicine, then the patient's gonna put their mouth on it and slowly and deeply inhale that medicine.

08:01 So, this is another type of inhaler that you really commonly see in clinical practice.

08:06 Alright, so let's take a one more moment to talk about something.

08:10 These are typically what we call a maintenance inhaler.

08:14 So, we wanna talk about the difference between maintenance and a rescue.

08:18 A maintenance inhaler is something that we're gonna take every day.

08:22 It's something like we take our vitamins every day.

08:25 So, let's talk about an asthma patient.

08:28 They may be on a maintenance inhaler to keep down inflammation for the patient long-term.

08:34 This is really gonna help because this will hopefully keep the patient from having really severe random asthmatic attacks for example.

08:42 Now, if that severe asthmatic attack happens, that's what a rescue inhaler is for.

08:50 A rescue inhaler can open everything up immediately, help relieve breathing, and that's why we call it a rescue inhaler.

08:58 So, think about maybe that kid on the soccer field that's running and all of a sudden, they stop mid-play because they can't breathe.

09:06 Those guys are gonna be using a rescue inhaler, not a maintenance.

09:16 Let's take a closer look at metered dose inhalers.

09:18 Some things to consider is do not give a quick release medication closer than 30 seconds apart.

09:24 We do not wanna disregard any whistling sounds that may be included in spacers.

09:30 What this could mean is that we are inhaling too quickly and forcefully.

09:34 If you remember when we're using inhaler, inhale slowly and deeply.

09:40 Things to make sure we do is administer a bronchodilator first, if multiple medications are given, this is gonna help decrease inflammation and we wanna make sure the patient gets all of that medication.

09:54 Those bronchodilators are key.

09:56 And lastly, don't forget to have the patient rinse their mouth with water after taking a metered dose inhaler.

10:03 Things we forget is once the patient takes that medication it can sometimes stay in the patient's mouth therefore bacteria can accumulate and then we don't want that for our patient so make sure they rinse with water or have a drink of water.