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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is reinforcing teaching with a client about how to use a metered-dose inhaler (MDI) without a spacer. In which order should the PN instruct the client to perform the following steps? Arrange the actions in the correct sequence.

  1. 1Shake the inhaler vigorously for 3 to 5 seconds.
  2. 2Exhale deeply to empty the lungs completely.
  3. 3Place the mouthpiece into the mouth and form a tight seal with the lips.
  4. 4Press down firmly on the canister while inhaling slowly and deeply.
  5. 5Hold the breath for at least 10 seconds before exhaling slowly.

Answer

The correct sequence is to shake the inhaler, exhale deeply, seal the lips around the mouthpiece, press the canister while inhaling slowly, and finally hold the breath for 10 seconds.
Correct administration of a metered-dose inhaler requires a precise sequence to ensure maximum drug delivery to the lungs. Shaking the inhaler prepares the dose. Exhaling deeply creates room for maximum inhalation. Sealing the lips around the mouthpiece prevents medication loss. Actuating the inhaler while taking a slow, deep breath ensures the drug reaches the lower airways. Finally, holding the breath allows the medication to settle onto the bronchial walls for optimal therapeutic effect.

Step-by-Step Solution

1
Shake the inhaler vigorously for 3 to 5 seconds.
The medication and propellant are thoroughly mixed.
Ensures the correct dose of medication is delivered when actuated.
2
Exhale deeply to empty the lungs completely.
The lungs are emptied of air.
Prepares the lungs to take in a deep breath and draw the medication as deeply as possible into the lower airways.
3
Place the mouthpiece into the mouth and form a tight seal with the lips.
A secure airway connection is established.
Prevents the medication from escaping from the corners of the mouth during administration.
4
Press down firmly on the canister while inhaling slowly and deeply.
The medication is released and drawn into the respiratory tract.
Simultaneous actuation and inhalation carry the aerosolized particles down into the bronchioles.
5
Hold the breath for at least 10 seconds before exhaling slowly.
The medication settles in the lower airways.
Allows time for the medication to deposit onto the walls of the airways rather than being immediately exhaled.

Key Concept

Metered-Dose Inhaler (MDI) Administration Sequence
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Topics

Pharmacological Therapies

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