A patient with chronic obstructive pulmonary disease uses a metered-dose inhaler (MDI). Which information does the nurse give the patient to ensure he receives the maximum benefit of the glucocorticoids administered by an MDI?

Question

a. Administer two puffs of medication in rapid succession.
b. Maintain a firm seal with lips around the mouthpiece of the inhaler.
c. Dispense the glucocorticoids 30 seconds after a bronchodilator.
d. Instruct the patient to press the MDI after breathing in and out deeply.

Answer 1

B
The nurse instructs the patient to maintain a firm seal around the mouthpiece of the MDI to faci-litate dispensing medication into the lungs so the patient benefits from a full dose of the medica-tion undiluted by room air. The nurse also instructs the patient to take a bronchodilator before any subsequent medications administered by an MDI such as glucocorticoids. An MDI delivers medication by inhalation and does not lend itself to delivering two puffs in rapid succession be-cause 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 patient may not have the ventilatory ca-pacity to quickly inhale two puffs. When administering glucocorticoids after a bronchodilator, the nurse waits 5 minutes to give the bronchodilator time to work and then administers the second agent. To use an MDI, the nurse instructs the patient to exhale and then inhale slowly and deeply to drive the inhalation medication into the lungs.