A total of 85 patients using MDI were included in this study .The mean age of the participants was 44 years and 25% were female.
MDI use presents a clear difficulty in simultaneous coordination of respiratory and motor movements for the patient with airway obstruction. We found that only 20 % of the patients were able to perform inhalation technique correctly as we evaluated the technique by visual observation and scored it on the checklist. A total of 68 patients (80%) performed at least one essential step incorrectly.The considerable number of mistakes regarding inhalationtechnique as observed in our study is in line with previous studies.
Study done by Buckley D[2] reported that only 18 out of 71 patients (25%) had perfect technique, 26 (37%) had adequate technique and 27 (38%) had poor technique and the patients most likely to have poor technique were those using a Metered Dose Inhaler (M.D.I.).Study by Molimard et al.[3] also reported similar results that at least 76 % of the MDI users made >/ 1 mistake .
In our study initial education on inhaler use was predominantly provided by doctors (55%) followed by trained nurses (24.70%) and around 12 % of the patients were taught by relative , or a neighbouring patient .It was also found that the association between correctness of various steps was significantly related to the steps being taught by the doctor (Table no.4). Approximately 6% of the patients had self taught the technique with the help of brochures .Only 2% of patients received their initial training from pharmacists. This highlights the varied spectrum of guides the patient comes in contact withand also calls attention to the fact that proper training of healthcare team like staff nurses and pharmacists could help i...
... middle of paper ...
...nique and follow up observation could go a long way in improving patients skills of inhalation and hence efficacy of treatment .
We conclude that substantial errors were made by patients using MDI as the inhalation device .Teaching proper technique will not only improve patients compliance but also will lead to better disease control and lesser cost and stress on emergency medical services .Though it is the primary responsibility of the physician prescribing the inhaler to provide patient with proper instructions for using the device but the responsibility could also be branched among the health care team like pharmacists who could play a vital role in teaching and reinforcing the technique as has been found in our study .Careful follow up of these patients is necessary and if still patient has faulty technique then change of prescription could also be considered.
Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,
An audit of patient records completed in 2005, revealed a low incidence of respiratory rate recording. An initial audit completed revealed that only 7% of 341 patients had a respiratory rate recording (Butler-Williams 2005). Due to this worrying outcome, the priority was to implement appropriate training to raise respiratory rate significance. Due to the audit being completed hospital wide and with no prior warning, it is an accurate indicator of an overall attitude of practice towards the recording of respiratory rate. Various studies have been conducted in order to gain an understanding as to why this precious sign is so often ignored. Jacqueline Hogan explored the paucity of patient monitoring on acute wards, completing qualitative research using focus groups in 2004. Four major themes were identified, firstly the issue of the nursing workload. Many participants acknowledged the expansion of the nurse’s role and with this added responsibility, the need for delegation of activities such as patient observations. Observations are often delegated to junior staff members such as healthcare assistants and student nurses. Although many nurses admitted to delegating this vital activity, 73% of nurses did not consider healthcare assistants possessed the required knowledge to interpret observational results. With this lack of knowledge comes the absence of appreciation for the completion of such vital signs, and
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
...r illness causes them (). Service users expect respect and sensitivitiy as well as competent treatment and practical support. Nurses must be willing to engage with patients with effective therapeutic communication as well as demonstrating the 6 C’s (). It is evident that nutritional and fluid intake is important for COPD sufferers. It is a long term condition, so enabling people with the condition to self manage and to be educated about the importance of their health choices (By implementing a nursing model or theory and following the cycle of ASPIRE, it would seem impossible for the primary carer to not treat Mr B holistically. Every aspect of his life is affected by his COPD and by evaluating and backing up the care plan with evidence based practice, being in partnership with Mr B every step of the way, he would be able to get the help he needs.
Generally, T_low set closer to terminate at 50% - 70% of the peak expiratory flow rate (T-PEFR). 8 Many studies have advocated setting of T_low according to the peak expiratory flow termination.9 Inappropriate mechanical ventilation setting can lead to ventilation-induce lung injury (VILI). Dr. Kollisch-Singule and colleagues discussed a study where they hypothesized that lung injury can be reduced by modifying specific components of ventilation waveforms.9 In their study, control mandatory ventilation (CMV) was compare to APRV in analyzing the effect of mechanical breath on the lung units for both ventilation modes. During APRV when expiratory time was adjusted to regulate peak expiratory flow rate termination point to 75% , the gas distribution to the terminal airways was almost similar to that of the normal lung. Whereas, in CMV and APRV smaller percentage of peak expiratory flow termination, the gas distribution to the terminal airways was lower and increase "conduction airway micro-strain". The finding indicated that APRV with 75% of peak expiratory flow termination is the optimal setting to achieve lung protective goals.
HENDERSON, Y (1998) A practical approach to breathing control in primary care. Nursing Standard (JULY) 22 (44) p41
...iple treatments to regain their own ability to breathe. In building the device, the inventors examined other methods of treatment for people who were unable to breathe. The doctors discovered that manually attempting to force the patient into breathing did not provide enough air, but all mechanical methods until this point forced too much air in too quickly, causing damage to other important organs. One of the goals for the design was to be able to put almost any person in it successfully.
Every day there is a constant trust adhered to many different people in the profession of Nursing—the decision of what will help patients in terms of medicine, and the confidence to make these decisions. One false act or one slight misdiagnoses of medication to a patient could be the prime factor in whether the patient lives or dies. Nurses in hospitals across the country are spread thin, and thus makes the probability of mistakes higher. If a medicinal dose is off by even one decimal a patient could die, so the only real answer is for nurses to not be afraid to ask for assistance, always follow procedure and voice opinion is they feel something is wrong.
Through this opportunity, I have become aware of legal, ethical and professional regulations of the nurse prescribing. I have gained a comprehensive knowledge of pharmacology, especially on the medications to achieve the competencies essential for a successful nurse prescriber. The development process has enlightened me with the gravity of my new role, and the accountability and responsibility which accompanies it. Through the innovation of the nurse prescribing process, the professional boundaries of nurses are being redefined for the benefit of both patient and nurse. The structured reflective practice has the potential to develop staff and improve the implementation of professional standards. Reflection can help to make sense of complicated and difficult situations, as well as learn from the experiences. Thus, a healthcare staff can identify educational needs, workload stressors, highlight barriers to development and provide evidence of continuing professional development. In addition, staff could become increasingly more motivated to empower performance and patient care. Healthcare providers have an ethical obligation to inform patients about their on-going plan of care, including if a medical error has occurred. Current thinking in nursing advocates the need for education in the ways of autonomy, critical thinking, and sensitivity to others. Good communication encourages collaboration and helps prevent medication errors. Many potential and actual medical errors fall within the sphere of nursing practice. Thus, nurses have an ethical obligation to help prevent and manage medical
Inhalant use refers to breathing in the vapors a substance gives off. The sole purpose is to get high. Surprisingly, these inhalants are legal. Things like markers and even cooking spray can be found in any local grocery store. It’s uses like huffing that cause these items to be misused. Inhalant use is not something that only a few people pick up on either. By the time a person reaches 8th grade, one in five will have used inhalants. Statistics show that young, white males have the highest usage rates. Hispanic and American Indian populations are close behind.
Ruppert, S, D., Shiao, S, K., Tolentino-DelosReyes, A. F.,(2007). Evidence- Based Practice. Use of the Ventilator Bundle to prevent Ventilator associated pneumonia (3rd ed). American Journal of Critical Care.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient's failin...
On my first day of week three clinical at 0830, client W and I were on our way to the dinning room and client B asked me to put his jacket on, so I told client W that I would meet him in the dinning room. After I helped Client B, I was on my way to the dinning room and nurse A told me that client W was experiencing difficulty breathing and we needed to give him his 0900 inhalers earlier. He was having audible wheezing and rapid respiratory rate. Therefore, we had to give client W his inhalers, SalbutaMOL Sulfate, which is a bronchodilator to allow the alveoli in the lung to open so th...
Nurses have both learning and teaching responsibilities. Continuing education for nurses is very important in order to maintain their knowledge and skills among the health care development. If it is true, that the ability of teaching is a complex process, one fundamental part of this process is the ability of the learner to receive information, process the information and carry out in practice. Learning, is a change in human ability or capability of willing to learn and act on the learning (Blais, Hayes, Kozier, & Erb, 2006); is a transformation of behaviors, existing knowledge, ability and values to change an area of need to become better as individual. When teaching how to use the EpiPen, the following components are applied and planned: detailed assessment of the learner, learner objectives, defined topic and outline for the learner, materials and teaching methods, teaching sessions with focus on an interpersonal process recording, and finally an evaluation of the teaching plan provided by return demonstration.
...ering to medication antibiotics which fight off infections, bronchodialators used to decrease dyspnea relieve broncho spasms , and pulmonary rehabilitation help betters their condition. The nurse expects the patient to be able to perform suitable activities without complication, avoid irritants that can worsen the disease (contaminated air) and reduce pulmonary infection by abiding to medications.