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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is preparing to administer a prescribed dose of inhaled fluticasone via a metered-dose inhaler (MDI) with a spacer to a client with chronic asthma. Arrange the following steps for administering this medication in the correct chronological order.

  1. 1Shake the metered-dose inhaler vigorously and insert it into the end of the spacer.
  2. 2Instruct the client to exhale completely to empty the lungs.
  3. 3Place the spacer mouthpiece into the client's mouth and ensure the lips are sealed tightly around it.
  4. 4Depress the inhaler canister once to release the medication into the spacer chamber.
  5. 5Instruct the client to inhale slowly and deeply, then hold their breath for 10 seconds.
  6. 6Assist the client to rinse their mouth with water and spit it out.

Answer

The correct sequence is: shake and attach the inhaler, instruct the client to exhale completely, seal the lips tightly around the spacer mouthpiece, depress the canister to release medication, have the client inhale slowly and hold their breath, and finally, rinse the mouth and spit.
Administering a corticosteroid via an MDI with a spacer requires a precise sequence to ensure maximum medication delivery to the lungs and to minimize local adverse effects. The sequence begins with device preparation (shaking and attaching). Next, the client must be prepared by exhaling completely to allow for a maximal inspiratory volume. Once the lungs are emptied, a tight seal is made around the mouthpiece to prevent leakage. Only then is the canister depressed to suspend the medication in the spacer. The client then inhales slowly and holds their breath for 10 seconds, allowing the particles to settle deeply in the bronchioles. Because fluticasone is a corticosteroid, the final and mandatory step is rinsing the mouth and spitting to prevent oral candidiasis.

Step-by-Step Solution

1
Shake the metered-dose inhaler vigorously and insert it into the end of the spacer.
The medication is uniformly mixed and the device is assembled.
Inhaled suspensions can separate; shaking ensures the client receives an accurate, measured dose.
2
Instruct the client to exhale completely to empty the lungs.
The client's lungs are emptied of residual volume.
Starting with empty lungs maximizes the volume of the subsequent inhalation, drawing the medication deeper into the respiratory tract.
3
Place the spacer mouthpiece into the client's mouth and ensure the lips are sealed tightly around it.
A closed system is created between the spacer and the client's airway.
A tight seal prevents the aerosolized medication from escaping out of the mouth during release.
4
Depress the inhaler canister once to release the medication into the spacer chamber.
One dose of medication is suspended inside the spacer.
The spacer holds the medication in a fine cloud, removing the need for the client to perfectly coordinate pressing the canister with inhaling.
5
Instruct the client to inhale slowly and deeply, then hold their breath for 10 seconds.
The medication travels to the lower airways and settles.
Slow inhalation prevents turbulent airflow from depositing medication in the back of the throat. Holding the breath maximizes absorption in the lungs.
6
Assist the client to rinse their mouth with water and spit it out.
Residual medication is cleared from the oropharynx.
Fluticasone is an inhaled corticosteroid. Leaving residue in the mouth increases the risk of oral fungal infections (candidiasis) and systemic absorption.

Key Concept

Safe Administration Sequence for Inhaled Corticosteroids via MDI with Spacer
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Topics

Pharmacological Therapies

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