Various methods of Inhalations.

1. INHALATIONS
By:
Mrs. Babitha K Devu
5/30/2017 1

2. Introduction
Inhalation is the act of drawing in air, vapour or
gas into the lungs. Drugs are inhaled either for
a local effect (e.g. steam inhalations to relieve
congestion in the respiratory tract) or for a
general effect e.g. inhalation of oxygen and
anaesthetics.
5/30/2017 2

3. Inhalation
• Inhalation is the process of entry of air into the
thoracic cavity.
• Inhalation therapies are a group of respiratory
treatments designed to help restore or improve
breathing function in patients
with a variety of diseases.
5/30/2017 3

4. Types of inhalations
Inhalations
Moist/ wet
inhalations
Steam
inhalations
Nebulization
Dry
inhalations
Aerosol
inhalers
Metered
Dose Inhaler
5/30/2017 4

5. Types of inhalations
• Dry Inhalations: it is the inhalation of gases,
fumes from volatile drugs or burning drugs.
Examples are:
1. Inhalation of general anaesthetics
2. Oxygen and CO2 inhalation
3. Inhalation of volatile drugs
4. Aerosol spray/MDI
5/30/2017 5

6. Types of inhalations
• Moist Inhalations: Breathing warm and moist
air produced by a vaporizer is called steam/
moist inhalation.
Examples are:
1. Steam inhalation
2. Nebulization
5/30/2017 6

7. Steam inhalation
5/30/2017 7

8. Steam inhalation
DEFINITION:
Inhalation of warm, moist air into the mucous
membranes and respiratory tract.
5/30/2017 8

9. EFFECTS/ PURPOSES:
1. Relieves inflammation and congestion of the mucous
membranes of the upper respiratory tract.
2. Relieves irritation (throat tickle) by moistening and providing
heat.
3. Loosens/soften thick secretions and stimulates expectoration.
4. Relieves spasmodic breathing.
5. Relaxes muscles and thus relieves coughing.
6. Prevents excessive dryness of the mucous membranes.
7. Provide antiseptic action on the respiratory tract.
5/30/2017 9

10. Drugs Used
1. Tr. Benzoin 5ml per 500 ml of boiling water
2. Eucalyptus 2ml per 500 ml of boiling water
3. Menthol few crystals per 500 ml of boiling
water
4. Camphor few crystals per 500 ml of boiling
water
5. Methyl salicylate few drops per 500 ml of
boiling water
5/30/2017 10

11. Methods For Giving Steam Inhalation
• By Jug Method
• By Steam Tent
• By Electric Steam Inhaler
5/30/2017 11

12. Methods For Giving Steam Inhalation
• By Jug Method:
In this method, a Nelson’s inhaler is used.
The type of the inhalant required and the
boiling water is filled in the jug and the
patient breathes the vapour.
5/30/2017 12

13. NELSONS INHALER
5/30/2017 13

14. JUG METHOD
5/30/2017 14

15. Methods For Giving Steam Inhalation
• By Steam Tent:
When high concentration of steam is required,
a steam tent may be used.
The quick and easy method – place a screen on
either sides on the patient’s bed and stretch
blankets or sheets across them and fix with
safety pins and forming canopy. Steam can
be directed in to the tent from the spout of a
kettle.
5/30/2017 15

16. Methods For Giving Steam Inhalation
• By Steam Tent:
Care should be taken that the stove and the
kettle are placed for AWAY FROM THE SCREEN
and THE BED CLOTHES to prevent of fire. Never
point the spout towards the face of the patient.
The steam is given for 20 – 30minutes , repeat
every 04hrly.
5/30/2017 16

17. Steam Tent
5/30/2017 17

18. Methods For Giving Steam Inhalation
• By Electric Vaporizer :
A small jar with a heating element extending into
the jar. The jar is filled with water, top of the jar
is a removable perforated cup to which is
attached a small metal spout. Cotton saturated
with medication is placed inside the cup and
metal spout is fitted over the cup. As the water
boils, the medication steam is directed through
the spout is inhaled by the patient.
5/30/2017 18

19. ELECTRONIC INHALER
5/30/2017 19

20. Follow the instructions when giving
THE STEAM INHALATION
• REMEMBER – danger involved of scalding the
patient by STEAM or BOILED WATER
COMING OUT of the inhaler. Important when
the patient is , very old, Very young, actually ill
or in state of confusion. The spout of the
inhaler placed in that the patient can’t touch it
or put the patient’s face too near.
5/30/2017 20

21. • When jug or kettle is used , fill it only 2/3 of
boiling water to prevent scalding of the
patient. If the inhaler is filled to the brim,
possible to draw water into the mouth and
scalding the patient. The water must be
remained just below the spout. If the spout is
filled with the water , it will not act as an air
inlet, the patient will not get warmed air.
• Always remember the danger of fire. If a stove
is used with a kettle to generate steam
continuously ,as steam tent, the blankets used
may fall on the stove and catch fire.
5/30/2017 21

22. • The temperature for jug method – 120 – 1600F ,
If water is cold, not produced steam. If water is
too hot , cause scalding of the patient.
• Keep the patient – warm and prevent DRAUGHT
before, during and after the inhalation.
– Causing the treatment is the blood vessels of the
skin and mucous membrane dilate and the patient
is easily chilled by exposed to draught. It will
patient to more severe and prolonged attack of
inflammation and congestion. The patient not to go
into cold spaces for several hours after treatment.
Remain in the bed.
5/30/2017 22

23. • If volatile drugs are used ( e.g – Menthol )
warm the patient to keep his eyes closed to
prevent the drug irritating the conjunctiva.
• Observe the patient closely throughout the
procedure for adverse effects.
• When give inhalation by jug method , keep
spout away from the patient.
• Place the sputum cup in the reach of the
patient to spit the coughed up during the
inhalation.
• Explain the procedure to the patient before
preparation of the inhalation. Not during
procedure.5/30/2017 23

24. Preliminary Assessment:
• Check the patient’s Name, BHT , for
identifications.
• Find the medical diagnosis and
general condition of the patient.
• See the physician’s orders to find
the specific precautions
of movements and position.
5/30/2017 24

25. • Assess the patient’s ability for self care ,
move, and maintain the relevant position.
• Assess the level of consciousness and the
ability to follow given instruction by
nurse.
• Find out the articles available in the
patient’s unit.
5/30/2017 25

26. Articles Purpose
1. Nelson’s inhaler with
mouth piece , tightly fit to
the neck of the inhaler
1.To use as a vaporizer
2. Bowel or basin – hold
the inhaler
2. To place the inhaler
safety.
3. Flannel/Towel 3. To wrap the inhaler for
prevent heat loss
4. Face towel 4. To wipe the face
5/30/2017 26

27. 5. Bath Blanket or bath
towel
Put over patient’s head ,
6. Tincture benzoin or any
other inhalant ordered.
Used as a respiratory
antiseptic.
7. Teaspoon or a minim
glass.
To measure the
inhalant.
8. Kettle- boiling water.
9. Gauze piece. To wrap the mouth.
10.Cotton swab To plug the spout.
11. Kidney tray /paper bag To collect wastes.
12. Sputum cup To collect sputum.
5/30/2017 27

28. • Explain the procedure – get confidence and
cooperation of the patient.
• Explain sequence of the procedure and tell
patient how can take the inhalation.
• Make the patient understand that remain in the
bed one – two hours more after inhalation.
• Ask the patient want to go to the wash room
and empty the bladder and bowels. For bed
ridden patient , offer bedpan/urinal.
5/30/2017 28

29. • Keep patient in a fowler’s position with bed
table. If the movements are restricted, keep
the patient in a side lying position or any
position is comfortable to patient. ( eg. Sitting
with a pillow on the lap )
• Close the doors and windows and put off the
fan to prevent draught.
• Place the sputum cup in a convenient place
within the easy reach of the patient.
• Provide the face towel to wipe the sweating
from the face during the inhalation.
5/30/2017 29

30. Steps of procedure Rationale
1. Measure the capacity of
inhaler with water. ½ - 2/3
filled capacity.
To determine the amount
of inhalant.
2. Warm – inhaler by little
hot water into the jug and
emptying it.
To maintain the
temperature of the water ,
constantly.
3. Pour the required
amount of inhalant and
filled the jug 2/3 with hot
water, below spout.
If inhaler filled to the brim
, possibility of drawing
water to mouth and
scalds.5/30/2017 30

31. 4. Place the mouth piece
and close the jug tightly .
See the mouth piece is in
the opposite direction to
the spout.
Keep the spout away from
the patient when
inhalation is taken.
5. Cover the mouth piece
and plug the spout with
cotton ball.
To prevent burns of lip.
Cotton ball in spout
prevent escape steam.
6. Cover the jug with a
flannel piece or a towel
To insulate the jug and to
prevent the heat loss.
7. Place the inhaler in the
bowel and take bed side
without losing time
Placing the jug in the bowel
reduces the chances for
burns.
5/30/2017 31

32. 8. Place the apparatus
conveniently in front of
the patient with the spout
opposite to the patient.
Remove cotton plug.
To reduces the chances of
burns. Removing cotton
plug helps to keep up
patency of spout for the
air.
9. Instruct - place the lip
on mouth piece and
breath in the vapor.
Breath Steam - nostrils
Relieve the congestion of
mucous membrane.
Cover the patient’s head
and jug with a bath
blanket or a towel
To help collect steam
around the face, steam
concentration increase
5/30/2017 32

33. • Continue treatment for - 15 to 20 minutes.
• Remove the inhaler , after stated time, Wipe
off the perspiration from the face.
• Remove – back rest , bed table. Adjust
position of the patient in bed. Make
comfortable. Tidy up the bed.
• Instruct patient to remain in bed for 1-2hrs to
prevent draught.
see next slide…
5/30/2017 33

34. • Take the articles to the utility room. Empty
the inhaler, clean, wash with warm soapy
water. Rinse with clean water. Removing the
gauze covering the mouth piece and clean the
mouth piece thoroughly. Boil mouth piece to
prevent cross infection. All the other articles
are washed soapy water and clean water. Dry
and replace proper place. Wash hands.
• Record the procedure on nurse’s notes with
date ,time, patient’s response to the
procedure.
• Return to patient, assess comfort, offer hot
drink if needed.
5/30/2017 34

35. Nebulization
5/30/2017 35

36. NEBULIZATION
Definition: -
Nebulization is means of administering drugs by
inhalation.
Equalizer breaks up the solution to be inhaled
into fine droplets which are then suspended in
a stream of gas.
The patient actively inhales this gas stream
containing the drug.
5/30/2017 36

37. Indications of Nebulization: -
1) Delivery of bronchodilator drugs : -
• On acute attack of asthma Nebulization is the most
common means of delivery.
• Respiratory patients who are too short of breath to
use pressurized aerosol or Rotahaler effectively may
be prescribed bronchodilators.
2) Infants and children with asthma : -
• Inhalation by nebulizer is the only means of effective
inhalation therapy until a child is about 4 yrs. Old.
5/30/2017 37

38. Indications of Nebulization: -
3) Administration of antibiotics and antifungal agents.
• In some cases of resistant chest infections for e.g.
cystic fibrosis or bronchiectasis,
• antibiotics may be prescribed to be inhaled directly
into the lungs.
4) To aid expectoration: -
• Inhalation of hypertonic saline has been found to
increase clearance of bronchial secretions.
5) Local analgesia : -
• To relieve dyspnea in some terminally in patients such
as those suffering from alveolar carcinoma
5/30/2017 38

39. Types of Nebulizer:
I) Jet Nebulizers:
A high velocity of gas is blown through a fine hole
creating an area of negative pressure. Fluid is drawn
from the reservoir by the Bernville effect into the jet
stream and is impacted on a battle breaking the fluid
into droplets large droplets fall back to into the
reservoir while the smaller ones may be inhaled.
II) Ultrasonic nebulizer:
High frequency sound waves are passed through a
solution in a reservoir to create an aerosol. Advantage
is that they operate quietly but they are less robust and
need more careful maintenance than jet nebulizers and
air compressors.
5/30/2017 39

40. Factors which affect nebulization
• Method of administration / method of
inhalation.
• Viscosity and other physical characteristics of
the liquid aerosolized.
• Distribution of inspired gas (degree of airflow
obstruction)
• Flow rate of gas.
5/30/2017 40

41. Preparation of articles:
• Nebulizers
• Pressurized gas source
• Flow meter
• Oxygen tubing
• T- Piece mouthpiece or
mask or other
appropriate gas
delivery device.
• Sterile normal saline
solution or sterile
distilled water
5/30/2017 41
•5 ml syringe and
water.
•Prescribed
medication
•Suction equipment
•Sputum mug
•Kidney tray
•Stethoscope
•B.P. apparatus, TPR
tray

42. Preparing solution: -
• It is important to use a minimum of 3 ml of
solution and preferably 4 ml in order to deliver
an adequate percentage of the prescribed
drug.
• In an assessment of jet nebulizers when 2 ml
was used only 50 % of dose was released as
aerosol whereas with volume of 4 ml 60 –
80%.
5/30/2017 42

43. Preparation of patient & environment:
Preparation of patient: -
• Explain the procedure to the patient
• The patient should be in a well supported
position.
• Breathe slowly and deeply using the lower
chest.
Preparation of environment: -
• The environment should be free from
draughts of air.
• The bed should be comfortable.
5/30/2017 43

44. Nurse’s Responsibility:
• Verify the order on the patient’s medication
record by checking it against doctor’s order.
• Check the label of the medication (expiry date)
• Confirm patient’s identity by asking his name and
by checking his name, room number, bed no.
• Check gas flow.
• Wash hands before procedure.
• Explain procedure to patient
• Record patient’s vital signs to establishment a
baseline5/30/2017 44

45. Procedure:
• Place patient in sitting or high fowlers position to
facility lung expansion an aerosol dispersion
• Attach free end of the oxygen tubing to pressurized
gas source
• Turn on the gas source and check outflow port,
usually a setting of 5 – 6 liters / min is adequate.
• Instruct the patient to breathe slowly deeply and
evenly through his mouth
5/30/2017 45

46. Procedure:
• After about three deep breaths he should breath
gently using his lower chest (breathing control) It
encouraged to breathe deeply throughout the entire
treatment the patient suffer from effect of
hyperventilation .
• It possible, remain with the patient during treatment
(usually 15 – 20 minutes )
• Take vital signs to detect adverse reactions to
medications.
5/30/2017 46

47. Care of patient:
• Make sure the patient is comfortable
• Provide a sputum mug for spiting the
expectoration
5/30/2017 47

48. Documentations: -
• Record time date and duration of therapy type,
amount of medication added to nebulizer.
• Baseline and subsequent vital signs and breath
sounds.
• Result of therapy such as loosened secretions
• Any complications and nursing action taken
• Patient’s tolerance of the treatment
• Continuously watch changes & complications
5/30/2017 48

49. Procedure:
• Encourage and assist the patient to cough and
expectorate,.
• Briefly stop the treatment if he needs rest.
• Instruct patient to report warmth discomfort or hot
tubing
• Check water level frequently to prevent
complications from inhaling hot air
5/30/2017 49

50. Complications or Nebulization: -
• Infection
• over hydration leading to pulmonary edema
• Ultra fine particulate can act as irritant to
susceptible patients and cause
bronchospasms
• wheezing
5/30/2017 50

51. DRY INHALATIONS
5/30/2017 51

52. Metered Dose Inhalers
5/30/2017 52

53. Child With Spacer
5/30/2017 53

54. Dry powder inhaler
5/30/2017 54

55. 5/30/2017 55