NEBULIZER

BY: Puan Hasnah Zani

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 LEARNING OBJECTIVE
1. Define nebulizer.
2. State the effect of nebulizer.
3. State the indication of nebulizer.
4. State the contraindication of nebulizer.
5. State the type of nebulizer and the
components.
6. List the drugs used for nebulizer.
7. Demonstrate how to teach client using
nebulizer.

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 NEBULIZER
DEFINITION:
• The nebulizer is an electrical or battery
operated device which turns liquid medicine
into a mist by pumping oxygen through the
medicine to vaporize it.

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 WHY NEBULIZER?
• It puts fine water droplets in the air flow.
• This can increase humidity of the air you
breath.
• If pure water mist is inhaled it can cause
productive coughing ...
in normal saline is nebulized it can ease
breathing and/or liquefy mucous.

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 EFFECT
1. Treat bronchospasm
(a) Using bronchodilator eg. Salbutomal

2. Reduce inflammation
(a) Using steroid eg. Beclomethazone

3. Encourage mucus production

(a) Using normal saline and mucolytic agent
eg. Acetylcysteine

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 INDICATION
1. Bronchial asthma
2. Chronic obstructive pulmonary disease
3. Cystic fibrosis
4. Bronchitis
5. Bronchiolitis
6. Emphysema

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 CONTRAINDICATION
1. Sensitivity or cardio toxicity to propellants.
2. Client which did not follow instruction:
(a) Coma
(b) Confused
(c) Restless

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 TYPE OF NEBULIZER
1. Ultrasonic / compressor
2. Jet nebulizer mask

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Jet nebulizer Nebulizer compressor

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PART OF JET NEBULIZER 10
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 MEDICATION
• Type of drugs:
(a) Atrovent + Ventolin + Normal saline
• Dose:
• 2:2:2
• Means atrovent = 2mL, ventolin = 2mL,
normal saline = 2mL.

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 CONTD.
• How to syringe drugs:
• Single use method (for a single patient).
• Syringe normal saline and put in the drug
reservoir.
• Syringe ventoline with same syringe.
• Press atrovent into the drug reservoir.
• Multiple use method (more than one patient)
• Use separate syringe for each drug (ventolin &
normal saline.
• Change syringe if contaminated or more than 24
hours.
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HOW TO USE NEBULIZER?
1. Place the
appropriate amount
of medication in the
drug reservoir.
• Use syringe to
measure amount of
drugs prescribed.

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CONTD.
2. Insert the mouthpiece
/ face mask on the
drug reservoir.
Turn the mouthpiece /
facemask clockwise
until it is tightened.

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CONTD.
3. Connect the oxygen
tubing from the
machine to the drug
reservoir.

4. Turn on the machine.

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CONTD.
5. Insert mouthpiece /
mask in the mouth &
ensure client is
receiving all the
medication from the
nebulizer.
6. Ensure the drug
reservoir is held upright
to avoid spilling.
7. Instruct client to take a
deep breath an inhale
the mist till finish. 17
CONTD.
8. Inhale as much as
possible.
Hold each breathe for
about 10 seconds
before exhaling for the
medicine to deposit in
the respiratory tract.

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8. Turn off the nebulizer
machine.
9. Clean the mouthpiece
and medication cup.
10. Dry the items.
11. Put back inside the
nebulizer machine.

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ORAL & NASAL
SUCTIONING

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 LEARNING OBJECTIVES
1. State the purpose for oral and nasal
suctioning.
2. State the contraindication for oral and nasal
suctioning.
3. List the items for oral and nasal suctioning.
4. Demonstrate how to perform oral and nasal
suctioning.

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 PURPOSE
1. To maintain a patent airway by removing
mucous secretions and all foreign materials
from oropharynx.
2. To prevent infection due to accumulation of
secretions.
3. To collect sputum specimen for investigation.

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 CONTRAINDICATION
Orotracheal suction
• Severe coagulopathy / or unexplained haemoptysis
• Laryngospasm (stridor)
• Acute neck, facial or head injury (particularly basal skull
fractures, or cerebrospinal
• Severe bronchospasm
• Recent oesophageal or tracheal anastomoses
• Haemodynamic instability
• Loose teeth or crowns

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 CONTRAINDICATION
Others:
• Acute neck, facial or head injury
• Haemodynamic instability
• Nasal/oral burns, due to infection risk
• Raised ICP

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 PREPARATION OF EQUIPMENT
1. Suction machine with adjustable pressure regulator
2. Suction catheters
3. Disposable gloves
4. Plain water
5. Tissue paper
6. Apron
7. Receiver
8. Oxygen supply and delivery device (if indicated)
9. Airway
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 HOW TO PERFORM?
1. Informed client regarding procedure.
2. Give privacy.
3. Assist client to a comfortable position:
1. Unconscious client = lateral towards nurse.
2. Conscious = semi Fowler’s.
4. Put a mackintosh/small towel below client’s
chin as a protector.
5. Wash hand medical asespis.
6. Wear disposable glove.
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 CONTD.
7. Prepare suction catheter:
(a) Open suction catheter
packaging.
(b) Connect suction catheter to
the tubing from the suction
machine.
(c) Measure catheter:
- From nose to the ear lobe.
- Adult 8-12 cm.
- Baby & children (4-8 cm)
- Mark the measurement with
your finger.
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 CONTD.
8. Switch on the suction machine.
- Inspect for the pressure by close the suction
control port.
9. Wet the tip of the catheter with water.
10. Do a nasal suction:
(a) Insert catheter through nasal to the nasal
cavity.
(b) Close the control port with your thumb.
(c) Suck the secretion with a rotation movement till
the catheter is out.
(d) Let go your thumb (each suction 10 second).
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 CONTD.
11. Do a oral suction:
(a) Insert catheter through the site of client’s mouth
(same method as nasal suction).
12. Observe client and the secretion.
13. Encourage client to take a deep breath and
cough in between suction.
14. Rinse catheter. Repeat suction as the above.
- Allow only 20-30 second rest in between suction.
- restrict procedure for 5 minutes only.

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 CONTD.
15. Throw catheter and gloves.
16. Cover the connection tubing with a dry
gauze.
17. Comfort client.

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PEAK FLOW METER

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 LEARNING OBJECTIVES
1. Define peak flow meter.
2. State the different color coding in peak flow
meter.
3. Explain how to teach client to use peak flow
meter.

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 PEAK FLOW METER
DEFINITION:
• A peak flow meter is a device used to
measure person's ability to breathe out air.

• It measures the airflow through the bronchi

and thus the degree of obstruction in the
airways.

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 PART OF PEAK FLOW METER

Flow meter

Mouth piece

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 PEAK FLOW ZONE
• Green:
– Means safe. Asthma is under control.
– 80 - 100% of personal best peak flow
measurement.
• Yellow:
– Means caution. Asthma is getting worse.
– 50 – 79% of personal best peak flow
measurement.
– Need to use quick-relief medications or
other medication.
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• Red:
– Danger. Medical alert.
– Below 50% of personal best peak flow
measurement.
– Take quick-relief medication and seek
medical help immediately.

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HOW TO TEACH CLIENT USE
PEAK FLOW METER
1. Slide the little
marker down as far
as it will go.
- This set the meter
to zero.

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2. Stand up.
- Take a big breath
with your mouth
open.
- Hold the meter in
one hand.
- Keep fingers away
from the numbers.

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3. Quickly close the lips
firmly around the
tube.
- Do not put the
tongue in the hole.
- Blow one times as
fast and hard as
possible.

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4. The marker will go
up and stay up.
- Do not touch the
marker.
- Find the number
where the marker
stopped.

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5. Write the number
on a piece of paper
or on a chart.

6. Blow 2 more times.

- Push the button
down each time.

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PEAK FLOW METER CHART

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