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Difficulty: HardPharmacological Therapies

A client with persistent asthma is scheduled to receive a dose of inhaled fluticasone propionate using a metered-dose inhaler (MDI) and a spacer device. How should the practical nurse sequence the actions to administer this medication? Arrange the following steps in the correct chronological order.

  1. 1Shake the inhaler canister vigorously to mix the medication.
  2. 2Attach the mouthpiece of the inhaler to the spacer device.
  3. 3Instruct the client to exhale completely to empty the lungs.
  4. 4Depress the canister to release one puff while the client inhales slowly and deeply.
  5. 5Coach the client to hold their breath for at least 10 seconds.
  6. 6Assist the client in rinsing their mouth with water and spitting it out.

Answer

The correct sequence is: Shake the canister, attach it to the spacer, have the client exhale completely, depress the canister while the client inhales, hold the breath for 10 seconds, and finally rinse the mouth with water.
Safe administration of a corticosteroid MDI requires meticulous preparation of the device (shaking and attaching the spacer), optimizing the client's respiratory mechanics (exhaling before inhaling), ensuring medication deposition (holding the breath), and preventing drug-specific adverse effects (rinsing the mouth to prevent thrush).

Step-by-Step Solution

1
Shake the inhaler canister.
The medication and propellant are evenly mixed.
Ensures the prescribed dosage of the active medication is delivered rather than just the propellant.
2
Attach the inhaler to the spacer.
The MDI is secured to the delivery chamber.
Spacers eliminate the need for perfect hand-breath coordination and increase the amount of medication reaching the lungs.
3
Instruct the client to exhale completely.
The client's lungs are emptied of functional reserve air.
Prepares the respiratory tract to take in the maximum volume of medicated air.
4
Depress the canister and have the client inhale.
The medication is drawn deeply into the lower respiratory tract.
A slow, deep inhalation pulls the aerosolized particles past the upper airway and into the bronchioles.
5
Instruct the client to hold their breath for 10 seconds.
The air remains trapped in the lungs momentarily.
Provides time for the medication particles to precipitate out of the air and coat the lung tissue.
6
Have the client rinse their mouth and spit.
Steroid residue is cleared from the oral mucosa.
Prevents localized immunosuppression in the mouth, which can lead to fungal infections such as thrush.

Key Concept

Pharmacological Therapies: Safe Administration of Inhaled Corticosteroids via MDI
Estimated Time:1m 30s
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Pharmacological Therapies

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