The client with chronic obstructive pulmonary disease uses a metered-dose inhaler (MDI). Which does the nurse use to administer glucocorticoids by MDI?
1. Administer two puffs of medication in rapid succession.
2. Maintain firm seal with lips around inhaler's mouthpiece.
3. Dispense glucocorticoid 30 seconds after a bronchodilator.
4. Instruct client press MDI after breathing in and out deeply.
2
2. The nurse instructs the client to maintain a firm seal around the mouthpiece of the MDI to facilitate dispensing of medication into the lungs so the client benefits from a full dose of the medication undiluted by room air. The nurse also instructs the client to take a bronchodilator before any subsequent medications administered by an MDI, such as a glucocorticoid. Although the bronchodilator is important to open the air-way, the glucocorticoid is the most critical medication to deliver deep into the lungs for its anti-inflammatory effect. The client opens the airways with the bronchodilator and then is able to deliver the glucocorticoid deep within the lungs.
1. A MDI delivers medication by inhalation and does not lend itself to delivering two puffs in rapid succession because a short wait is usually required for the medication to reach deeper parts of the lung. Not only is it difficult to activate the MDI quickly, but the client may not have the ventilatory capacity to quickly inhale two puffs.
3. When administering a glucocorticoid after a bronchodilator, the nurse waits 5 mi-nutes to give the bronchodilator time to work and then administers the second agent.
4. To use an MDI, the nurse instructs the client to exhale and then inhale slowly and deeply to drive the inhalation medication into the lungs.
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