1. Use of Inhalers and Nebulizers Staff Training

2. What are Inhalers and Nebulizers Used for
Inhalers and nebulizers are used to administer medications into the lungs
Most commonly used to treat asthma and other respiratory illnesses.

3. An inhaler is a device that helps deliver a specific amount of medication to the lungs, usually by supplying a short burst of aerosolized medicine that is inhaled by the patient.

4. A nebulizer is a device used to administer medication to people in the form of a mist inhaled into the lungs.

5. What is Asthma
Asthma is a chronic, or long-term, disease.
If you have asthma, at times your airways (the air passages of your lungs) become inflamed.
When this happens, your airways get red and swollen.
They become narrow, making it harder for you to breathe. You may also wheeze or cough.
This is called an asthma flare-up (or "attack").
Even when you feel good, your airways can be inflamed.
Certain things, such as smoke, dust, pollen or other allergens, colds can start or trigger an asthma attack.

6. Asthma Attacks
Act fast if an asthma attack starts. Know the signs that an asthma attack is starting:
Coughing
Wheezing
Tight chest
Waking up at night
Nasal flaring

7. What To Do Move student to a quiet setting
If you can ask the student “do you think you nay need your inhaler or nebulizer”
Assist the student to use the inhaler or nebulizer
Contact program nurse or nurse on call

8. Medications administered by inhalers or nebulizers may be administered either on a regular basis for maintenance or on a PRN basis for rescue during a flare-up of asthma symptoms.
These medications usually are are either bronchodilators (opens the airways) or steroid medications (reduces inflammation)

9. As with all medications, these treatments may only be done by non-licensed staff who have been trained and cleared for inhaler/nebulizer medication administration by Health Services

10. Your Responsibilities
Know which students have physicians orders for inhalers and nebulizers
Know who has regularly schedule treatments and who has PRN (rescue) treatments
Know where to quickly locate these students inhalers and nebulizers
Know the signs of asthma and respiratory distress and what to do for each student
Take immediate action if a student is having an asthma attack

11. How to Administer Check the 5 Rights Before Administering
right student
right medication
right dose
right route
right time: based up the medication protocol

12. How to Use an Inhaler Without a spacer
Take off the cap. Shake the inhaler.
Breathe out.
Put the inhaler in your mouth or put it just in front of your mouth.
As you start to breathe in, push down on the top of the inhaler and keep breathing in slowly.
Hold your breath for 10 seconds. Breathe out.
If you need a second puff, wait one minute between puffs

13. With a spacer
A spacer, or a holding chamber, makes it easier to use a spray inhaler.
Spacers are add-on devices which are tubes attached to the inhaler that act as a reservoir or holding chamber and reduce the speed at which the aerosol enters the mouth. Put the open end of the spacer in your mouth, or cover mouth with mask.
Spray the asthma medicine into the spacer one time.
Take a deep breath and hold it for 10 seconds.
Breathe out into the spacer.
Breathe in again, but do not spray the inhaler again
If unable to hold breath allow student to breath normally into spacer
If orders to repeat, wait one minute before repeating
Some inhalers require students to rinse mouth after use

14. A metered dose inhaler contains enough medication for a certain number of puffs which is printed on the canister.
Even though the inhaler may continue to work beyond that number of uses, the amount of medication delivered may not be correct.
It is important to keep track of the number of times an inhaler was used, so that it can be replaced after its recommended number of uses

15. Changes: How to Use the New HFA Inhalers
Priming:
When you first use an inhaler, or if you haven’t used it in awhile, you need to “prime” the pump to ensure that you’re getting the accurate dose of medication.
Priming entails spraying a dose or doses into the air, and priming requirements are different for each inhaler.
Ask your program nurse, pharmacist or check the package insert for your inhaler’s priming requirements

16. Inhaling:
The spray from HFA inhalers doesn’t come out as forcefully, and some people have reported feeling as if they’re not getting enough medication, this may be due to improper technique.
It’s your inhalation that carries your medicine where it needs to go.
Start to breathe in as you press the inhaler.
For more detailed instructions on the proper technique for using an inhaler, ask your program nurse, doctor or pharmacist, or check the package insert, which also has instructions for using the inhaler

17. Cleaning:
HFA inhalers need to be cleaned more often than CFC inhalers.
HFAs are a little more sticky and tend to accumulate. If you see white powder in your inhaler, that’s a dirty inhaler
To do to clean the inhaler rinse it in warm water and let it dry out overnight

18. How to Use a Nebulizer
Place the compressor where it can safely reach its power source and where you can reach the ON/OFF switch.
Wash your hands prior to preparing each treatment.
Measure the correct dose of medication and other solutions prescribed by your physician. Add these to the nebulizer.
Connect the air tubing from the compressor to the nebulizer base. Make sure all connections are snug.
Attach a mask to the nebulizer.
Turn the compressor on and check the nebulizer for misting.
Hold the mask to the face so both the nose and mouth are covered. The mask may be secured to the head with an elastic band.
Turn the compressor on to start the mist. The head should be held upright. This correctly positions the nebulizer and opens the airway.
Do deep breathing throughout the treatment.
Occasionally tapping the side of the nebulizer helps the solution to drop to where it can be misted.
Continue the treatment until the onset of inconsistent nebulization, i.e. sputtering

20. What To Do If the Medication Doesn’t Help
Any time a student requires a PRN treatment for breathing by inhaler or nebulizer you must contact Health Services or the Nurse-on Call
If the medication has not adequately helped immediately contact Health Services or the Nurse-on-Call
Call 911 if
The medicine does not help for very long or it does not help at all.
Breathing is still fast and hard.
It is hard to walk or talk.
Lips or fingernails turn gray or blue.
The nose opens wide when breathing.
Skin is pulled in around the ribs and neck with breaths.
Heartbeat or pulse is very fast.

21. References Familydoctor.org NationalJewishHealth.org
nlm.nih.gov/medlineplus