Anika R.

Pleños
Name: ___________________________________________________________________ April 11, 2021
Date: ______________
Betsy D. Sabdani, RN, MAN
Evaluator/Signature: ________________________________________________________ Grade:2021
_____________

ADMINISTERING MEDICATION VIA A METERED-DOSE INHALER (MDI)

Definition: A metereddose inhaler (MDI) is a handheld inhaler that uses an aerosol spray or mist to deliver a controlled dose of medication with each compression of the
canister. The medication is then absorbed rapidly through the lung tissue, resulting in local and systemic effects.

Purpose: The medication is administered and breathed in by the patient and the patient experiences the intended effect of the medication. Drugs administered by inhalation
provide control of airway hyperactivity or constriction.
Helps deliver a certain amount of medicine through the mouth and into the lungs in order to improve lung expansion and breath sounds.

Indication: indicated to pts. With breathing difficulties such as asthma, copd and other respiratory problems

Teaching
• Allow for supervised practice of the procedures. Patients may have difficulty timing an inhalation with activation of the medication canister without proper instruction
(Lewis et al., 2011).
• Teach patient to keep track of the number of inhalations in the MDI (Box 21-4).
• Teach patients to use small, handheld peak flowmeters to monitor response to therapy when inhalers are prescribed (Barrons et al., 2011).
Pediatric
• A spacer is of benefit to young children because they have difficulty coordinating inhaler activation and inhaling (Hockenberry and Wilson, 2011).
• Educate child and parent about the need to use the inhaler during school hours. Help family find resources within the school or day care facility. Many school systems do
not permit self-administration of MDIs. Follow school policy regarding having the MDI available for use during school hours. A health care provider’s order may be
necessary.
Gerontologic
• Older adults may be unable to depress medication canisters because of weakened grasp or inability to coordinate actuation of the canister with inhalation. The use of a
spacer device may be helpful.
Home Care
• Remind patients to carry prescribed inhalers to use as immediate treatment in case of an acute asthma attack.

Equipment:
1. Inhaler device with medication canister (MDI or DPI)
2. Spacer device such as AeroChamber or InspirEase (optional)
3. Facial tissues (optional)
4. Stethoscope
5. Medication administration record (MAR) (electronic or printed)
6. Pulse oximeter (optional)
ATERND CHILD

ACTION RATIONALE PERFORMED REMARKS

YES NO

1. Gather equipment. Check each medication order This comparison helps to identify errors that may have occurred when
against the original order in the medical record, orders were transcribed. The primary care provider’s order is the legal
according to facility policy. Clarify any
record of medication orders for each facility
inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe This knowledge aids the nurse in evaluating the therapeutic effect of the
dose ranges, purpose of administration, and adverse medication in relation to the patient’s disorder and can also be used to
effects of the medications to be administered.
educate the patient about the medication.
 Consider the appropriateness of the medication for
this patient.

3. Perform hand hygiene. To avoid cross-contamination and/or prevent spread of microorganisms.

4. Move the medication cart to the outside of the Organization facilitates error-free administration and saves time.
patient’s room or prepare for administration in the
medication area.

5. Unlock the medication cart or drawer. Enter pass code Locking the cart or drawer safeguards each patient’s medication supply.
and scan employee identification, if required. Hospital accrediting organizations require medication carts to be locked
when not in use. Entering pass code and scanning ID allows only
authorized users into the system and identifies user for documentation by
the computer.

6. Prepare medications for one patient at a time. This prevents errors in medication administration.

7. Read the CMAR/MAR and select the proper This is the first check of the label.
medication from the patient’s medication drawer or unit
stock.
 ACTION RATIONALE PERFORMED REMARKS

YES NO

8. Compare the label with the CMAR/MAR. Check This is the second check of the label. Verify calculations with
expiration dates and perform calculations, if another nurse to ensure safety, if necessary.
necessary. Scan the bar code on the package, if
required.

9. When all medications for one patient have been This is a third check to ensure accuracy and to prevent errors. Some
prepared, recheck the label with the MAR before facilities require the third check to occur at the bedside, after identifying
taking them to the patient.
the patient and before administration.

10. Lock the medication cart before leaving it. Locking the cart or drawer safeguards the patient’s medication supply.
Hospital accrediting organizations require medication carts to be locked
when not in use.

11. Transport medications to the patient’s bedside Careful handling and close observation prevent accidental or deliberate
carefully, and keep the medications in sight at all times. disarrangement of medications.

12. Ensure that the patient receives the medications at the Check agency policy, which may allow for administration within a period
correct time. of 30 minutes before or 30 minutes after designated time.

13. Perform hand hygiene and put on PPE, if indicated. To avoid cross-contamination and/or prevent spread of microorganisms.

14. Identify the patient. Usually, the patient should be Identifying the patient ensures the right patient receives the medications
identified using two methods. Compare information and helps prevent errors.
with the CMAR/MAR.

15. Check the name and identification number on the This is the most reliable method. Replace the identification band if
patient’s identification band. it is missing or inaccurate in any way.

COMPETENCY WORKBOOK 32
ACTION RATIONALE PERFORMED REMARKS
 YES NO

16. Ask the patient to state his or her name and birth date, This requires a response from the patient, but illness and strange
based on facility policy. surroundings often cause patients to be confused.

17. If the patient cannot identify him- or herself, verify the This is another way to double-check identity. Do not use the name on
patient’s identification with a staff member who knows the door or over the bed, because these signs may be inaccurate.
the patient for the second source.

18. Complete necessary assessments before administering Assessment is a prerequisite to administration of medications.
medications. Check the patient’s allergy bracelet or ask Explanation relieves anxiety and facilitates cooperation.
the patient about allergies. Explain what you are going
to do and the reason to the patient.

19. Remove the mouthpiece cover from the MDI and the The use of a spacer is preferred because it traps the medication and
spacer. Attach the MDI to the spacer. (See aids in delivery of the correct dose.
accompanying Skill Variation for using an MDI without
a spacer.)

20. Shake the inhaler and spacer well. The medication and propellant may separate when the canister is not
in use. Shaking well ensures that the patient is receiving the correct
dosage of medication.

21. Have patient place the spacer’s mouthpiece into mouth, Medication should not leak out around the mouthpiece.
grasping securely with teeth and lips. Have patient
breathe normally through the spacer.

22. Patient should depress the canister, releasing one puff The spacer will hold the medication in suspension for a short period
into the spacer, then inhale slowly and deeply through so that the patient can receive more of the prescribed medication
the mouth. than if it had been projected into the air. Breathing slowly and deeply
distributes the medication deep into the airways.

23. Instruct patient to hold his or her breath for 5 to 10 This allows better distribution and longer absorption time for the
seconds, or as long as possible, and then to exhale medication.
slowly through pursed lips.
24. Wait 1 to 5 minutes, as prescribed, before administering This ensures that both puffs are absorbed as much as possible.
the next puff. Bronchodilation after the first puff allows for deeper penetration by
subsequent puffs.

25. After the prescribed amount of puffs has been By replacing the cap, the patient is preventing any dust or dirt from
administered, have patient remove the MDI from the entering and being propelled into the bronchioles with later doses.
spacer and replace the caps on both.

26. Have the patient gargle and rinse with tap water after Rinsing removes medication residue from the mouth. Rinsing is
using an MDI, as necessary. Clean the MDI according necessary when using inhaled steroids because oral fungal infections
to the manufacturer’s directions. can occur. The buildup of medication in the device can attract
bacteria and affect how the medication is delivered.

27. Remove gloves and additional PPE, if used. Perform Removing PPE properly reduces the risk for infection transmission
hand hygiene. and contamination of other items. Hand hygiene prevents the spread
of microorganisms.

28. Document the administration of the medication Timely documentation helps to ensure patient safety.
immediately after administration.

29. Evaluate the patient’s response to medication within The patient needs to be evaluated for therapeutic and adverse effects
appropriate time frame. Reassess lung sounds, from the medication. Lung sounds and oxygenation saturation may
oxygenation saturation if ordered, and respirations. improve after MDI use. Respirations may decrease after MDI use.

Learner’s Reflection: (What did you learn most of the activity? What is its impact Instructor’s Comments:
to you?)

In this activity, I was able to learn on how to administer medication via

Metered-dose Inhaler. It was fun and interesting. I discovered that the drugs
administered by inhalation provide control of airway hyperactivity or constriction.
Metered-dose inhalers (MDI) are used to treat many respiratory disorders. I also
found out that the use of a spacer is preferred because it traps the medication and
aids in delivery of the correct dose. And it’s impact to me as a future nurse, is that
nurses should include patient teaching regarding MDI use, particularly how to tell
when an inhaler is empty, as part of their nursing care. It is important to keep a diary
or record of inhaler use and discard the inhaler on reaching the labeled number of
doses.

AH NURSING COMPETENCY WORKBOOK 71