Algorithm for the use of a pocket inhaler. Technique and algorithm for using a pocket inhaler Technique for using an inhaler

Bronchial asthma is considered one of the most complex and severe chronic diseases that disrupts the lives of many people. Attacks are dangerous because they require an instant reaction, otherwise the patient may begin to suffocate and death will occur.

In recent years, new effective means have appeared to combat bronchial asthma and it is best to use an inhaler. Proper use of a pocket inhaler allows the drug to quickly penetrate the bronchi and thereby alleviate the patient's condition.

In medical practice, several types of inhalers are used.

1. Powder pocket inhalers. With the help of such a drug, it is possible to accelerate the entry into the human body of a certain amount of dry powder. The positive side of such a device is its high efficiency, and it is quite simple to use it. At the same time, the price of such a device is much higher than liquid inhalers.
2. Aerosol pocket inhalers. Such devices ensure that the required amount of the drug is delivered to the aerosol. The advantage of such a device is an affordable price, ease of use and practicality of the mechanism. The downside is the fact that the aerosol enters the respiratory system if there is a simultaneous release of the drug and inspiration. The aerosol is heavier than the powder, and part of it settles in the mouth or is swallowed by the patient.

Rules for using an inhaler

For the correct use of the inhaler, it is necessary to train and follow the instructions attached to the device.

If it is necessary to use a powder device, proceed as follows:

• you need to install a medicine container in the device
• in the event that there is already a medication in the inhaler, then it is simply shaken
• you should take a maximum breath and exhale calmly
• you need to clasp the mouthpiece with your lips and inhale with all the strength of the lungs
• hold your breath for at least 10 seconds
• remove the device from the mouth and exhale calmly

If necessary, the procedure should be repeated and be sure to rinse the oral cavity after the onset of relief.

Instructions for use of an aerosol metered dose inhaler are as follows:

1. remove the protective cap from the mouthpiece and turn the device upside down
2. shake the inhaler several times, then take a maximum breath and exhale
3. clasping the mouthpiece with your lips, inhale with all your might and at the same time press on the bottom of the balloon
4. hold your breath for as long as possible, then remove the device from your mouth and exhale
5. if indicated, it is recommended to repeat inhalation after a while and rinse your mouth with water after the procedure

Many aerosol inhalers have a spacer, which is a special device for inhalation. When using it, one end is inserted into the device, and the other acts as a mouthpiece.

In the presence of a spacer, inhalation is much easier, and the effectiveness of the procedure is increased several times.

To perform inhalation using a spacer, the following steps are recommended:

• remove the cap from the mouthpiece and connect the spacer to it
• shake the can of the inhaler and take a deep breath and exhale
• after that, clasp the spacer with your lips, press the balloon and after a few seconds take a deep, smooth breath
• hold your breath for 10 seconds, then remove the spacer and exhale calmly
• after the procedure, disassemble the structure, rinse the oral cavity with water and dry the spacer well

The use of such a simple device significantly increases the effectiveness of the procedure, since the drug forms a homogeneous mass, which quickly reaches the bronchi. In addition, during inhalation with a spacer, all large particles of the drug settle on the walls of the chamber.

Features of use and contraindications

At elevated body temperature, the use of an inhaler is prohibited!

External method of application of medicinal substances

The external route of administration is the effect of drugs mainly locally on the skin and mucous membranes, in the eyes, nose, ears, through the respiratory tract.

Dosage forms : ointments, emulsions, liniments, lotions, jellies, gels, foams, pastes, solutions, talkers, powders, tinctures, aerosols.

Methods of external administration of drugs:

• inhalation;
• applying ointments to the skin: lubricating the skin, applying ointment to the wound surface;
• rubbing ointments;
• application of patches;
• the use of powders;
• the introduction of drugs into the vagina(vaginal way administration of drugs (per vaginum). Suppositories, solutions for douching, tampons with drugs, etc. are used);
• instillation of drops in the eyes, nose, ear.

Advantages: availability, variety of dosage forms and methods of their application.

Flaws: the method is designed mainly for local effects, since only fat-soluble substances are absorbed through intact skin.

The external method is inhalation route drug administration, i.e. inhalation of the drug (at the height of inspiration). In this case, the drug acts on the mucous membrane of the respiratory system. For inhalation, stationary, portable, pocket inhalers are used. or home appliances. Inhalations are more often used for diseases of the upper respiratory tract, such as laryngitis (inflammation of the larynx), as well as bronchitis, bronchial asthma. Sometimes used for local anesthesia (pain relief) of the mucous membrane of the larynx, trachea and bronchi. Aerosols, gaseous substances (nitrous oxide, oxygen), vapors of volatile liquids (ether, halothane) are introduced.

Advantages of the inhalation route of administration : - act directly at the site of the pathological process in the respiratory tract; - the drug enters the lesion, bypassing the liver, unchanged, which causes its high concentration in the blood.
Disadvantages of the inhalation route of administration: - with a sharp violation of bronchial patency, the drug does not penetrate well into the pathological focus; - irritant effect of the drug on the mucous membrane of the respiratory tract.

Pocket inhalers are used for an attack of bronchial asthma. The nurse teaches the patient how to use the individual inhaler.

Using a pocket personal inhaler

1. Establish a trusting relationship with the patient, explain the course and purpose of the manipulation, obtain consent to conduct

2. Treat hands at a social level, wear gloves.

3. Remove the protective cap from the can by turning the can upside down.

4. Shake the aerosol can well.

5. Take a deep breath.

6. Cover the mouthpiece of the can with your lips, tilt your head slightly back.

7. Take a deep breath and at the same time press firmly on the bottom of the can: at this moment a dose of aerosol is dispensed.

8. Hold your breath for 5-10 seconds, then remove the mouthpiece of the can from your mouth and exhale slowly through your nose.

9. After inhalation, put a protective cap on the can.

10. Remember: the deeper the aerosol dose is injected, the more effective it is.

More effective inhalations are considered inhalations carried out with the help of nebulizers. An aerosol is formed in them - a suspension of small particles of a medicinal substance in the air (“nebula” - fog, cloud; lat.). A nebulizer is a narrower subsection of inhalers. Using a nebulizer, you can more accurately influence certain parts of the respiratory system (upper, middle or lower), selecting the device depending on the particle size of the resulting aerosol. Nebulizers differ in technical device - they are compression and ultrasonic.

REMEMBER!

When using the drug on the skin, you must:

Examine the place of application of the medicine, make sure that there is no redness, rash, swelling, weeping;

Treat with warm water or skin antiseptic;

Dry with a towel or gauze.

Skin lubrication procedure

Goals: as a rule, disinfection of the skin, local effect of the drug on the skin.

Indications: dry skin, skin diseases.

Equipment: ointment, sterile glass rod or spatula, skin antiseptic, sterile gloves, containers with a disinfectant solution for care items and gloves.

Pocket inhalers usually used by patients with bronchial asthma (Fig. 21.8, 21.9). If the child's age does not allow using the inhaler on his own, the use of the inhaler is carried out by the child's parents, and the medical staff must teach the mother how to use it before the child is discharged from the hospital. For young children, inhalers are used with special nozzles - spacers, which avoid the loss of the drug during inhalation (see Fig. 21.10).

Checking the inhaler. Before the first use of the inhaler or after a break in use for more than one week, it must be checked. To do this, remove the cap of the mouthpiece by slightly pressing it on the sides, shake the inhaler well and make one spray into the air to make sure it works adequately.

The inhaler should be used in the following order:

1. Remove the mouthpiece cap and, by lightly pressing it on the sides, make sure that the inner and outer surfaces of the mouthpiece are clean.

2. Shake the inhaler vigorously.

3. Take the inhaler, holding it vertically, between the thumb and all other fingers, and the thumb should be on the body of the inhaler, below the mouthpiece.

4. Exhale as deeply as possible, then take the mouthpiece in your mouth between your teeth and cover it with your lips without biting.

5. Start inhaling through your mouth, at the same moment press the top of the inhaler (drugs will begin spraying). In this case, the patient should inhale slowly and deeply. One click on the top of the inhaler corresponds to one dose.

6. Hold your breath, remove the inhaler from your mouth and remove your finger from the top of the inhaler. The child should hold his breath as long as he can.

7. If you need to perform the next inhalation, you need to wait about 30 seconds, holding the inhaler vertically. After that, you need to follow the steps described in paragraphs 2-6.

In recent years, pediatrics has widely introduced nebulizer inhalation therapy, which is based on fine spraying of the medicinal substance with the help of a compressor.

Methods and techniques for supplying humidified oxygen and using an oxygen cushion. Oxygen therapy is used to eliminate or reduce arterial hypoxemia. This is a fairly effective method that allows you to increase the oxygen content in the patient's blood. Oxygen is prescribed in cases of insufficient oxygen supply to organs and tissues that occur with various diseases of the respiratory system, circulatory organs, in case of poisoning, shock, pulmonary edema, after complex surgical interventions.

The duration of oxygen therapy ranges from several hours to several days, depending on the patient's condition. Oxygen supplied to a sick child must be humidified, and its constant concentration in the air inhaled by the patient is 24-44%. Humidified oxygen is supplied by various means.

For this, plastic nasal catheters are used, which are inserted directly into the nasal passages and fixed with a plaster. Catheters, as well as the water through which oxygen is supplied, must be sterile. In addition to catheters, humidified oxygen is supplied through face masks (Fig. 21.12), plastic caps or head tents, in which, unlike oxygen tents, the required oxygen concentration is maintained using an oxygen therapy apparatus.

One means of oxygen delivery is the use of an oxygen cushion.

When the amount of oxygen is significantly reduced, it is squeezed out with the free hand. Before use, the mouthpiece is treated with disinfectant solutions, boiled or wiped with alcohol.

The use of oxygen and an oxygen cushion is possible only on prescription. An overdose of oxygen is just as dangerous as its insufficient amount. Particularly severe complications in oxygen overdose develop in young children.

test questions

1. Rules for the storage of medicines.

2. Accounting for potent and narcotic substances, the rules for their storage.

3. Storage of medicines at the post of a nurse.

4. Technique for giving the child tablets, powders, mixtures, syrups, solutions for internal use.

5. Technique for introducing rectal suppositories.

6. Features of intramuscular, intravenous and subcutaneous injections for children.

7. Features of the use of ear and eye drops in children.

8. Rules for the use of pocket and stationary inhalers.

9. Features of inhalation in children.

10. Methods and techniques for supplying humidified oxygen, using an oxygen cushion.

Purpose: medical, educational.

Indications: diseases of the cardiovascular and respiratory systems.

Equipment: 2 pocket inhalers: one - used, the second - with medicinal substance.

INTRODUCING A SUPPOSITORY WITH A LAXATIVE ACTION TO A PATIENT

Purpose: curative.

Indications: doctor's prescription.

Equipment: gloves, suppository, oilcloth, diaper, toilet paper, screen, disinfectant

AMPOULE SET

Purpose: to perform an injection.

Indications: injection methods of administration of medicinal solutions.

Equipment: a sterile syringe in assembled form, a sterile tray, a container for the used material, sterile tweezers, a book of prescriptions for a procedural nurse, medicines in ampoules, nail files, a bix with a sterile dressing, alcohol 70 °, sterile gloves.

ANTIBIOTIC DILUTION

Through the mouth.

1. Remove the protective cap from the can and turn it upside down.2. Shake the aerosol can well.3. Grab the mouthpiece with your lips.4. Take a deep breath and, as you inhale, press down on the bottom of the can. 5. Inhalation should be carried out slowly, starting 1-2 seconds before pressing the inhaler valve. Inhalation should occur at the time of the maximum inspiratory rate.6. Inspiration is not fixed, because it leads to spasm of the distal bronchi.7. You should hold your breath for a few seconds (5-10), then pull the mouthpiece out of your mouth and exhale slowly. 8. After inhalation, put a protective cap on the can. Through the nose. 1. Remove the protective cap from the can and turn it upside down.2. Shake the aerosol can well.3. Tilt your head back slightly.4. Press the right wing of the nose and nasal septum.5. Exhale through your mouth.6. Insert the tip of the inhaler into the left half of the nose.7. While inhaling through the nose, press the bottom of the canister.8. Hold your breath for a few seconds, then exhale slowly through your mouth.9. Repeat the manipulation by inserting the tip into the other half of the nose.10. After inhalation, put a protective cap on the can.

Additional oral corticosteroid therapy should be considered during periods of exposure to stress or prior to scheduled surgery. It is recommended that the corticosteroid be regularly monitored for growth in children over long periods of time. If growth retardation is detected, the treatment and dose of inhaled corticosteroid should be re-evaluated, if possible, to the lowest dose that provides effective asthma control. In addition, referral to a pediatric pulmonologist should be considered.

Some people may be more sensitive to an inhaled corticosteroid than most patients. Because of the potential for adrenal disorders, patients on oral steroids switching to inhaled propionate should be under special care, and adrenal function should be systematically monitored. Following the administration of inhaled fluticasone propionate, the reduction in oral steroid doses should be gradual and patients should be advised to document the need for additional steroids in general in case of stress.

6. Rules for the administration of insulin. In 1 ml 40 units. 1) Get insulin out of the refrigerator 2) Check expiration dates 3) Treat hands and put on sterile gloves 4) Draw the prescribed dose into the syringe + 2 units more 5) Release the air and leave the dose prescribed by the doctor in the syringe 6) Process skin twice sterilized with a ball with an antiseptic, dry dry 7) Insert the needle at an angle of 90 degrees. 8) Wipe with a dry ball 9) Disinfection. Insulin injection sites: 1) on the arms: the outer part of the arms from the shoulder to the elbow; 2) on the abdomen: the belt to the left and right of the navel with a slight transition to the back; 3) on the legs: the front of the thighs from the groin to the knees; 4) under the shoulder blades: the area at the base of the shoulder blades, to the left and right of the spine. 8. Features of intramuscular injection of Bicillin. Bitsillin-Z and Bitsillin-5 are long-acting penicillin preparations. So, a suspension on water for injection of bicillin-3 - 600,000 IU is administered intramuscularly 1 time in 7 days, bicillin-5 - 1,500,000 IU is administered 1 time in 4 weeks. Due to the fact that the suspension of bicillin crystallizes and clogs the lumen of the needle, everything must be done correctly and quickly. Samples (scarification, intradermal and intramuscular) are performed with a solution of benzylpenicillin sodium salt. 10,000 units of the second dilution of penicillin are injected intramuscularly into the thigh. Monitor the patient's condition during the day.1. After making sure that the patient normally tolerates benzylpenicillin sodium salt, immediately before administration under aseptic conditions, inject 6 ml of water for injection or sterile isotonic sodium chloride solution into the vial of bicillin-3. Enter 10 ml of the solvent into the vial with bicillin-5.2. Shake the bottle vigorously.3. Quickly draw up the resulting suspension into a syringe.4. Replace the needle.5. Disinfect the anatomical site.6. Shake the syringe vigorously, release the air from the needle and inject the drug into the gluteal muscle.

Dose reduction of the oral steroid should begin after a week of concomitant use of fluticasone propionate. Dose reductions should be maintained at intervals of at least 1 week. Maintenance doses of 10 mg/day or less based on prednisolone should be reduced no faster than 1 mg daily at weekly intervals. For maintenance doses of prednisone greater than 10 mg per day, cautious dosing may be reduced by more than 1 mg per day at weekly intervals. Some patients experience non-specific symptoms of malaise when oral steroid doses are reduced, even though respiratory function is improved.