1. Nebulized Medication Administration Rachel Gallagher, RN, CPNP, NCSN DPI School Nursing Consultant Rachel.gallagher@dpi.wi.gov (608) 266-8857

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3. Training Knowledge training - webcast Competency checklists are available at: http://dpi.wi.gov/sspw/schlnurse.html

4. Outline What is necessary prior to administration of nebulized medications? What are the medication safety guidelines in administering medications or the 5 Rs? What is asthma? What are the symptoms of an asthma attack? What are the triggers of asthma attacks? What is the Asthma Inhaler Law? What are the similarities and differences between a nebulizer vs. an inhaler? How are nebulized medications administered?

5. What is necessary prior to administration of nebulized medication? Medication authorization form (orders) Medical provider authorization form Parent authorization form Medication Sink with soap and water Gloves Tubing Mouthpiece or mask Nebulizer cup Air compressor

6. What are the medication safety guidelines in administering medications, or the 5 Rs? Right student Right medication Right dosage Right time Right route Right documentation

7. What is Asthma? Chronic inflammatory disease marked by inflammation or swelling of the airways and production of mucous causing constriction or narrowing of the airway. Disease that may cause permanent changes (remodeling) if not properly treated. Disease that cannot be cured but can be controlled with medication and avoidance of triggers.

8. What are symptoms of an asthma attack? Chest tightness Dry hacky cough Wheezing Shortness of breath Inability to talk in complete sentences without taking a breath.

9. What are the triggers of asthma attacks? Allergies Exercise Respiratory infections Strong odors Cockroaches

10. What is the Asthma Inhaler Law? Wis. Stat. sec. 118.291 – Asthmatic Pupil; possession and use of inhalers. A students may possess and use a metered dose inhaler or dry powder inhaler during school day and all school sponsored events or with supervision of a school authority if the following are true: Inhaler used to prevent or treat existing asthma symptoms (rescue inhaler) Written approval of parent (if minor) and medical provider for use of the inhaler Approval letters of parent and medical provider need to be given to principal

11. What are the similarities and differences between a nebulizer vs. an inhaler? Similarities: Provides aerosolized mist of medication. Used for prevention and relief of asthma. Differences: Nebulizers require simple instructions for use with young children. Student assistance or cooperation is not required with a nebulizer. Nebulizers are larger in size and consequently less convenient.

12. How are nebulized medications administered? 1. Review the first 5 rights (student, medication, dosage, time, and route) at initiation of task. 2. Have student sit in a comfortable upright chair. 3. Wash hands and apply gloves. 4. Recheck the first 5 rights. 5. Wash hands and apply gloves.

13. Nebulized medication administration cont. 6. Remove the nebulizer cap. Place the appropriate amount of medication in the plastic nebulizer cup and replace cap. 7. Attach tubing to the compressor and medication cup. 8. Attach mouthpiece or mask to the medication cup. See medication authorization or medication administration record for instructions of which to use. 9. Plug into electricity and turn on the machine.

14. Nebulized medication administration cont. 10. Student should begin breathing normally and continue until all the medication is gone. If you have a small child you will probably want to remain present for the entire treatment. 11. Turn off the machine. 12. Clean the machine per manufacture’s instructions.

15. Nebulized medication administration cont. 13. Remove gloves and wash hands. 14. Secure medication in appropriate locked space. 15. Immediately document the administration of the medication on the medication administration records. 16. Monitor symptoms in response to the medication.

16. Nebulized medication administration cont. 17.Cleaning: After completion of your treatment, rinse all the medication out of the cup. Disassemble the mouthpiece or mask, medication cup (including the baffle in the cup) and "tee" piece. Soak in a warm soapy solution, agitate with gentle motion, rinse, and let it air dry. Once dry, re-assemble for next treatment. (if treatments are frequent open two kits and rotate, while one is drying the other can be used). Never wash the tubing.

17. Nebulized medication administration cont. Disinfection: Once a week, soak the disassembled parts in a warm water/white vinegar solution (one part vinegar/three to four part water) for 30-60 minutes, rinse, and air dry. Or Also suggested to wash in dishwasher on top rack in parts basket. Follow instructions of manaufactures, school nurse or parent.

18. What are the signs that the medication treatment was unsuccessful in reversing the asthma attack? Continuation or worsening of symptoms. Inability to complete a sentence without needing to breath in the middle of a sentence. Movement of shoulders with breathing. Sucking movement or retractions between the ribs. Emergency!!! Call 911, school nurse and parent as needed!!!

19. Demonstration

20. Questions School nurse Parent Medical provider

21. Any comments regarding this webcast? Any suggestions on future school nursing topics? Contact: Rachel Gallagher (608) 266-8857 E-mail: rachel.gallagher@dpi.wi.gov