TOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING

Transcription

1 TOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING PROGRAM: School Health APPROVED BY: Board of Health POLICY: Nebulizer Therapy DATE: PROCEDURE: a) Nebulizer Therapy With Non-oxygenated Mechanical Nebulizer POLICY Definition: Nebulize means to convert a liquid to a fine spray. A Mechanical Nebulizer is a device powered by either oxygen or a compressed air that produces a stable aerosol of fluid particles. An Ultrasonic Nebulizer is a device with fluid in a chamber that is vibrated rapidly causing fluid to break down into small particles which are then carried by a flow of compressed air or oxygen to the student. Purpose: a) To improve breathing by the administration of bronchodilators, mucolytics, or other medication directly into the tracheo-bronchial tree by means of aerosol instillation. b) To provide an atmosphere of high humidity to assist the break up of pulmonary bronchial secretions and aid the student in coughing them up. School Personnel Who May Appropriately Provide Care or Assist The Student: a) Routine, non-medicated and non-oxygenated nebulized mist: SCHOOL NURSE, RN, LPN, certified personnel, physical therapist, and occupational therapist. b) Nebulizer PRN, with oxygen or with medications: - SCHOOL NURSE, RN, LPN Consultation: Those responsible for providing care, training, and supervision may need to obtain consultation from their clinical supervisor or from other health care providers in the community. Delegation Decision: By the school nurse to other appropriate personnel. Training and Supervision: To be determined/provided by the school nurse. Circumstances Which Require School Nurse Action: If routine, non-medicated and non-oxygenated nebulizer therapy is delegated to personnel other than licensed nurses, the nurse must initiate the procedure and remain available in the building. The school nurse should be notified whenever there is evidence of respiratory distress or obstruction.

2 Page 2 Physician s Order Required: Yes Parent/Guardian Permission Required: Yes Special Considerations: I. Various types and models of nebulizers are available. Always read manufacturer s instructions carefully. II. Assessment of respiratory status must be done by the licensed nurse and includes: a) Auscultation (perception and interpretation of breath sounds): wheezing, crackles, egophny (nasal speech), bronchial breathing, snoring, grunting, diminished breath sounds. b) Observation for signs of respiratory distress: Tachypnea, dyspnea, nasal flaring, using accessory muscles, stridor (harsh rales), shallow breathing Cheynes-Stokes respiration, cyanosis, intercostal and substernal retractions, increased cough, restlessness/anxiety. c) Evaluation of sputum: consistency, amount, odor, and color. III. Observe student for complications of nebulizer therapy: a) Overhydration: unexplained sudden weight gain, pulmonary edema, crackles, and signs of electrolyte imbalance, e.g., confusion. b) Bronchospasm and dyspnea due to irritated mucosa. c) Adverse reactions from medications.

3 Page 3 PROCEDURE: NEBULIZER THERAPY WITH NON-OXYGENATED MECHANICAL NEBULIZER Note that some of the specific information below pertains to the commonly used Pulmo-Aide compressor/nebulizer. For other types of nebulizers, see manufacturer s instructions. For Pulmo-Aide and other types, keep instructions with nebulizer. Equipment: Provided by parent: a) Nebulizer/compressor with power cord and connector (AC to DC adapter may be required for Pulmo-Aide check manufacturer s instructions). b) Mask or mouthpiece. c) Tubing, nebulizer connector, baffle, chamber, cap. d) Medicine dropper or measured dose container. e) Medication or saline solution. f) Dishwashing detergent, white vinegar, clean bowl or container for soaking equipment. Alternately, disinfectant solution per manufacturer s instructions. g) Spare filters and toothpicks for removing old filters. h) See manufacturer s directions for any other necessary equipment. i) Disposable gloves. Also, mask and eye protection if splattering likely. j) Emesis basin. k) Cup and water for rinsing mouth as needed. l) Paper towels. Steps: a) Provide an environment that is comfortable, private, has a level table or counter top, access to a grounded wall outlet, sink, and chair. b) Review physician s order to determine medication, dose, time, frequency. c) Assemble equipment, including medication, if ordered. d) Assess respiratory status of student before and after each treatment. e) Wash hands. f) Place compressor on a level surface. g) Following manufacturer s directions, select and connect appropriate power source to the compressor. (For Pulmo-Aide, connect power source to front panel of compressor at D/C power input.)

4 h) Connect one end of air tubing compressor and tighten as needed. (For Pulmo-Aide, tighten tubing connector by turning clockwise then connect tubing to compressor.)

5 Page 4 Steps (Cont d): i) Assemble nebulizer chamber, cap, and mask or mouthpiece. Add prescribed medication or saline using a medicine dropper or measured dose container. (For Pulmo-Aide push baffle tightly down into nebulizer chamber with thumb. Holding chamber stationary, screw on nebulizer cap. Add prescribed medication or saline through the opening on cap. Insert mouthpiece or bottom of aerosol mask into the top of the nebulizer cap.) j) Connect other end of air tubing to nebulizer air inlet connector. k) Before plugging in, make sure the power switch is in the off position. Turn on and observe for proper mist formation. l) Put on gloves (also mask and eye protection if splattering likely, e.g., if assisting child with frequent, forceful cough). With child sitting, assist him/her to position mouthpiece or mask. Instruct to inhale deeply and slowly and to hold breath for 10 seconds, then exhale slowly. If child is severely dyspenic and cannot hold breath for 10 seconds, begin with 6 seconds, gradually increasing to 10 seconds as possible. The child can breath through the nose or mouth if using a mask. If a mouthpiece is used, child should inhale and exhale through the mouth. Child should continue this breathing procedure throughout the nebulizer treatment. m) Gently tap side of nebulizer chamber periodically during treatment to drain any accumulated fluid. If child needs to pause to cough, tilt the chamber to the side so that the medication/solution will not be nebulized and wasted. Treatment is finished when all medication/solution is used and no mist is seen. n) Turn power off and unplug compressor. o) Have child rinse mouth with water if using inhaled steroids. This reduces the potential for developing oral yeast infections. If using other medications, child may rinse mouth, if desired. p) Praise child for cooperation. q) Follow manufacturer s special instructions for cleaning equipment: - Remove mouthpiece or mask from cap. Disassemble nebulizer chamber. (For Pulmo-Aide, turn counterclockwise.) - Wash all items, except tubing, in a hot water/dishwashing detergent solution. Rinse under hot tap water to remove detergent residue. - Using a clean container or bowl, soak items in three parts hot water to one part white vinegar for 30 minutes. - Rinse with hot tap water and air dry on a clean paper towel.

6 Page 5 Steps (Cont d): q) Follow manufacturer s special instructions for cleaning equipment Cont d: - If using medical disinfectant cleaners, follow manufacturer s instructions carefully. - Keep the outer surface of the tubing dust-free by wiping regularly (the tubing does not have to be washed because only filtered air passes through it). - Wipe compressor unit with a clean, damp paper towel. - Change filter by removing with a toothpick once a month or when filter turns gray in color. Documentation: Document respiratory assessment information; the child s ability to use nebulizer correctly and his/her understanding of symptoms of respiratory distress. Note date, time, and duration of treatment, type, and dose of medication administered and respiratory status after treatment. References: Arrow, Debra et al: Nursing Procedures, Springhouse, PA Springhouse Corporation. DeVilbiss Pulmo-Aide Traveler Compressor/Nebulizer Instruction Guide, DeVilbiss Health Care, Inc. Somerset, PA. Smith, et al: Comprehensive Child and Family Nursing Skills, St. Louis, Mosby Year Book, Inc. State of Connecticut Department of Education, Serving Students With Special Health Needs, Hartford, CT. SHM, Vol. II, Sec. 4, Spec.Hlth. Care Needs