Nebulization
o a method of administering a drug by spraying
it into the respiratory passages of the patient.
o The medication may be given with or without
oxygen to help carry it into the lungs.
Nebulizer
o the device/machine used to change liquid
medicine into fine droplets (in aerosol or mist
form) that are inhaled through a mouthpiece
or mask delivered directly into the lungs.
Purpose:
o To open the collapse alveoli and deliver Medications
medicated aerosol therapy. o Albuterol/Salbutamol: Hivent
o To relieve patient from having shortness of o Salbutamol + Ipratropium: Combivent,
breath. Duavent
o Help expand the lungs thus loosen secretions. o Inhaled steroids: Budesonide, Flixotide
o Commonly used at home on a long-term basis o Bricanyl nebule
especially for those patients with Chronic o Ventar solution in bottle form
Obstructive Pulmonary Disease (COPD) to
dispense inhaled medication. Common side-effects
o Tachycardia, palpitations, drying of the oral
Indications mucosa, dizziness, nervousness, nausea
o Indicated to patient having difficulty in
raising/expectorating respiratory secretions. Assessment
o Reduced vital capacity and less costly method o Check client respiratory status
of loosening secretions. (note if patient use accessory muscles
or nasal flaring).
Contraindications o Respiratory distress is the primary reason to
o Inability of patient to cooperate in taking deep administer nebulizer medications.
breathes o Determine the cause of respiratory distress
o Adverse reaction encountered with the (COPD).
medication o The client’s ability to use the nebulizer
determine the ability to hold and
Equipment's manipulate the equipment, this allows
o Nebulizer machine the nurse to determine the need for the
o Nebulizer kit/set (tubing, mouthpiece, client education to promote
manifold, mask) compliance.
o Syringe 3 cc o Medications currently ordered;
o Saline solution (NSS) action, purpose, common side effects,
time of onset and peak of action
o Air compressor, wall air, wall oxygen (O2 this permits the nurse to anticipate
driven) what to observe to form the client
o Medication administration record o The oral medications the client is currently
o Baffle (controls the air, helps in the taking
convention) some meds can interact; beta-blockers
o T-piece like atenolol and propranolol that can
antagonize the beta antagonist and can
cause or increase asthma symptoms
o The client knowledge regarding the
medication
in order to determine the client ability
to understand and follow directions.
Health Teachings
o Explain the purpose and need for this type of
treatment, show the client how to hold the
nebulizer upright to prevent spilling of the hold each breath for two to three seconds
medications. before breathing out until all of the
o Remind the client to keep the mouth sealed medication is nebulized.
around the mouthpiece and breathe in slowly d. Simultaneously do chest physiotherapy.
and deeply to get the maximum benefit. i. Chest tapping
o Have the client return demonstrate the e. Turn the compressor off. Instruct patient to
procedure to ensure understanding on the take several deep breaths and cough to clear
importance of the length of time for the any secretions he/she might have his/her
treatment, proper placement of the mouth. lungs. Also instruct patient to cough the
o Alert the client to the common side effects of secretions into a tissue and dispose of it
the medications being used properly then wash hands.
Follow-up Phase
Check the functionality of the nebulizer and the a. Record medication given and the description
situation of the power cord of secretions and side-effects (nurses' notes)
The functionality of the nebulizing kit if any.
Preparation of Medication Care of the Nebulizer
a. Place the air compressor on a sturdy surface. o Cleaning should be done in a dust-and smoke-
i. Plug the cord from the compressor into free area away from open windows.
a properly grounded (three prong) o After each treatment, rinse the nebulizer cup
electrical outlet. with warm water, shake off excess water and
b. Wash your hands with soap and warm water, let it air dry.
and dry completely with a clean towel. o At the end of each day, the nebulizer cup,
c. Carefully measure the medicine exactly as mask, or mouthpiece should be washed in
you have been instructed. warm, soapy water using mild detergent,
i. Use a separate, clean measuring device rinsed thoroughly and allowed to air dry
(eyedropper or syringe) for each o Every third day, after washing your
medicine. Look the medication at eye equipment, disinfect the equipment using a
level. vinegar/water solution or the disinfect
d. Remove the top part of the nebulizer cup as solution your supplier suggests.
shown. Place your medicine in the bottom of o To use the vinegar solution, mix ½ cup white
the nebulizer cup. vinegar with 1- 1/2 cups of water. Soak the
e. Cover the cup and fasten. Connect and fasten equipment for 30 minutes and rinse well
the mouthpiece/T-piece or face mask to the under a steady stream of water.
cup. Then connect the tubing to both the o Shake off the excess water and allow to air dry
aerosol compressor and nebulizer cup. on a paper towel. Always allow the
equipment to completely dry before storing
Preparation of the Patient in a plastic, zipper storage bag.
a. Monitor patient’s heart rate before and after
treatment. Note:
i. Exceeding 100 bpm: inform the There is no need to clean the tubing that connects the
physician and wait for the instruction to nebulizer to the air compressor. Cover the compressor
hold or give medication with a clean cloth when not in use. Keep it clean by wiping
b. Explain the procedure to the patient. This it with a clean, damp cloth as needed. Unplug the
therapy depends on patient’s effort. compressor before cleaning it.
c. Place the patient in a comfortable sitting or
semi-fowler’s position.
Working Phase
a. Turn on the compressor with the on/off
switch. Once you turn on the compressor, you
should see a light mist coming from the back
of the tube opposite the mouthpiece.
b. If using a mask, position it comfortably and
securely on patient’s face. If using a
mouthpiece, instruct patient to place it
between teeth and seal lips around. Nose
clips are sometimes used if the patient has
difficulty breathing through the mouth
c. Instruct patient to take slow, deep breaths
through your mouth. If possible, let him/her
