Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

Name of Student: ________________________________ Grade: _________________

Year & Section: _________________________________ Date: __________________

PROCEDURE CHECKLIST

Administering Medication via Small-Volume Nebulizer

Instruction: Below is the grading scale which will be used in rating your performance.
5 - Excellent - 95-100
4 - Very Satisfactory - 88-94
3 - Satisfactory - 82-87
2 - Fair - 76-81
1 - Needs Practice - 70-75

PURPOSES
 Used for emergency treatment of many respiratory diseases
 To deliver liquid medications to the mid-to-lower airways
 Management of exacerbations and long treatment of COPD, Cystic fibrosis,
Bronchiectasis.
EQUIPMENT
 Nebulizer
 Tubing
 Clean gloves
 Medicine
 Stethoscope
 Pulse Oximeter
IMPLEMENTATION
Prior to performing the procedure, introduce self and verify the client’s identity using
agency protocol. Explain to the client what you are going to do, why it is necessary, and how he
or she can participate. Provide for a means of communication, such as eye blinking or raising a
finger, to indicate pain or distress. Follow through by carefully observing the client throughout
the procedure, offering periodic eye contact, caring touch, and verbal reassurance.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

PERFORMANCE

5 4 3 2 1
1. Gather equipment. Check each medication order against the original
order in the health record, according to facility policy. Clarify any
inconsistencies. Check the patient’s health record for allergies.

2. Know the actions, special nursing considerations, safe dose ranges,

purpose of administration, and adverse effects of the medications to be
administered. Consider the appropriateness of the medication for this
patient.

3. Wash hands with soap and warm water and dry thoroughly, wear clean
gloves and put on PPE, if indicated.

4. Prepare medications for one patient at a time.

5. Transport medications to the patient’s bedside carefully, and keep the

medications in sight at all times.

6. Ensure that the patient receives the medications at the correct time.

7. Identify the patient. The patient should be identified using at least two
of the following methods:

1. Check the name on the patient’s identification band.

2. Check the identification number on the patient’s identification
band.
3. Check the birth date on the patient’s identification band.
4. Ask the patient to state his or her name and birth date, based on
facility policy.

8. Explain the procedure then assemble tubing, nebulizer cup, and

mouthpiece (or mask). Place premeasured unit-dose medication in the
bottom section of the cup or use a dropper to place a concentrated
dose of medication in the cup. Add prescribed diluent (usually saline),
if required.

9. Attach one end of tubing to the stem on the bottom of the nebulizer cuff
and the other end to the air compressor or oxygen source.

10. Assist the patient to sit in an upright position. Connect the nebulizer to
a power source. Check that a fine medication mist is produced by
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

opening the valve. Have the patient place the mouthpiece into the mouth
and grasp securely with teeth and lips.

11. Instruct the patient to inhale slowly and deeply through the mouth. A
nose clip may be necessary if the patient is also breathing through the
nose. Hold each breath for a slight pause, before exhaling.

12. Continue this inhalation technique until all medication in the nebulizer
cup has been aerosolized (usually about
15 minutes). if given with a pause, maximum of 10-25 minutes. Once
the fine mist decreases in amount, gently flick the sides of the nebulizer
cup.

13. When the medication in the nebulizer cup has been completely
aerosolized, the cup will be empty. Have the patient remove the
nebulizer from the mouth and gargle and rinse with tap water, as
indicated. Clean and store the nebulizer and equipment according to the
manufacturer’s directions and facility policy.

14. Remove gloves and additional PPE, if used. Perform hand hygiene.

15. Document the administration of the medication immediately after

administration.

16. Evaluate patient’s response to the medication within

an appropriate time frame. Reassess lung sounds, oxygen saturation
level, and respirations, as indicated.

REMARKS: __________________________________________________________________
_____________________________________________________________________________________
_______________________________________________________________________

Date/Time: ______________________________
Clinical Instructor: ________________________