Inhalation of medication using the device-metered dose inhaler (MDI) that delivers a measured amount of medication as a mist into the lungs.
Definition
A Metered Dose Inhalation (MDI) is a handheld device that delivers a precise amount of medication—usually a bronchodilator, corticosteroid, or combination—directly into the lungs in the form of a fine mist. It’s commonly used to treat asthma, COPD, and other respiratory conditions requiring fast or controlled drug delivery.
Types of Medication used in MDI
- Bronchodilator: A substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs.
- Mucolytic agent: Agent which dissolves thick mucus and is usually used to help relieve respiratory difficulties.
Purposes for MDI
1. To relieve inflammation and congestion of the mucous membranes.
2. To improve clearance of pulmonary secretions.
3. To act as a bronchodilator and mucolytic agent.
Articles
1. MDI (Metered dose inhaler with medication canister).
2. Facial tissues.
Procedure for MDI
| Nursing action | Rationale | |
| 1. | Review the physician’s medication order, including patient’s name, drug name, dosage, number of inhalations, and time of administration. | Ensures safe and correct administration of medication. |
| 2. | Assess the patient’s ability to hold and manipulate inhaler. | Impairment of grip strength, muscle strength, and tremors of the hands interfere with ability to depress inhaler canister. |
| 3. | Assess drug schedule and number of inhalations prescribed for each dose. | Reduces risk of errors. |
| 4. | Instruct the patient to be in a comfortable environment by sitting in chair, in hospital room or at kitchen table at home. | |
| 5. | Allow the patient to use the metered dose inhaler and get familiarized with the parts of the device inhaler and canister. Explain and demonstrate how canister fits into inhaler. | Patient must be familiar with how to use articles. |
| 6. | Explain metered dose and warn patient about overuse of inhaler, including drug side effects. | Patient must not arbitrarily decide to administer excessive inhalations because of risk of serious side effects. If given in recommended doses, side effects are uncommon. |
| 7. | Explain steps used to administer inhaled dose of medication (Demonstrate steps when possible). Remove cap and hold inhaler upright, grasping it with thumb and first two fingers. | Use of simple, step by step explanation allows patient to ask questions at any point during procedure. |
| Shake inhaler. | Mixes medications evenly within solution to that aerosol drug concentration is uniform. | |
| Tilt head back slightly and breathe out. | Maximizes airway exposure to medication from inhaler. | |
| Position inhaler in one of the following ways: Hold the inhaler 0.5-1 inch (1-2 cm) away from mouth. Optional: Attach spacer to mouthpiece of inhaler. Place the mouthpiece inhaler or spacer in mouth. | Avoid rapid influx of inhaled medication and subsequent airway irritation. Eliminates rapid influx of particles from inhaled drugs, which reduces irritant properties and tendency to cough. Spacer is recommended for young children and older adults. Medication is distributed to airways during inhalation. | |
| Press the canister down once (one puff) to release the medication which inhaling slowly. | Inhalation through mouth rather than nose draws medication more effectively into airways. As patient inhales, particles of medication are delivered into airway. Allows tiny drops of aerosol spray to reach deeper branches of airways. | |
| Hold breath for approximately 10 seconds. | Allows maximal airway effect from first puff of medication. Therefore, airways are more open for second delivery. Thus, more particles are delivered directly into airways. | |
| Repeat puffs as ordered, waiting 1 minute between puffs. | ||
| 8. | If two inhaled medications are prescribed, wait 5-10 minutes between inhalation as ordered by physician. | Drugs must be inhaled sequentially, usually bronchodilators are giver first to maximize airway opening. Followed by other inhaled medications, such as steroids. |
| 9. | Explain that patient may feel gagging sensation in throat caused by droplets of medication on pharynx or tongue. | Results when inhalant is sprayed and inhaled incorrectly. |
| 10. | Instruct the patient in removing medication canister and cleaning inhaler in warm water. | Accumulation of spray around mouthpiece can interfere with proper distribution during use. Accumulation at the mouthpiece increases risk of microorganism. accumulation and oral infections. |
| 11. | Ask if patient has any question. | Allows clarification of misconceptions or misunderstanding. |
After care of the patient
- Teach about cleanliness of inhaler (MDI).
- Instruct the patient against repeating inhalations before next schedule.
- Describe in nurses’ notes, the content of skill taught and patient’s ability to perform skill.
Special Considerations
- Gargle with plain water after steroid inhalers, to reduce chances of infection.
- To check when the canister is to be replaced:
- Note the total number of puffs listed on the canister.
- Note the numbers of puffs ordered for the patient per day.
- Divide the total number of puffs available in the canister by number of puffs to be taken per day.
- This will give the total number of days for which the canister may last.
- Teach patient to replace the canister before this calculated date.
- Newer delivery systems such as dry powder inhalants are available which are simple to use. They contain dry powdered medication and are breath activated.
- An aerosol is created when patient inhales through reservoir containing dose.
- Do not put inhaler in water.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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