What are the contraindications to inhalation therapy, errors in using a pocket inhaler, defoamers in oxygen therapy, and appropriate nursing actions for various respiratory and cardiac conditions?

From the Guidelines

Contraindications to inhalation therapy include hemoptysis, as administering inhalation treatments during active bleeding from the lungs can worsen the condition. The error in the algorithm for using a pocket inhaler is that the patient should breathe out slowly before using the inhaler, not during activation. For oxygen therapy, 70% ethyl alcohol is used as a defoamer. When a patient develops nasal irritation during oxygen administration via nasal catheter, the nurse should temporarily stop oxygen administration and apply oil drops to the nose.

Key Points

• The correct technique for using a pocket inhaler involves covering the mouthpiece tightly with the lips, taking a deep breath while simultaneously pressing the bottom of the inhaler.
• A mistake in oxygen therapy via mask is pressing the mask tightly against the patient's mouth, as it should be fitted comfortably without excessive pressure.
• An oxygen concentration of 30-40% is typically sufficient to eliminate tissue hypoxia.
• Oxygen cylinders are pressurized to approximately 150 atmospheres.
• If a patient shows signs of distress during a therapeutic bath (pallor, headache, dizziness, rapid pulse), the nurse should immediately stop the procedure and call a doctor.
• Inhalation treatments with a steam inhaler should be performed 1-1.5 hours after eating.
• The appropriate oxygen flow rate through a nasal catheter is 2-3 L/min.
• Pulse oximetry is the most common non-invasive method to measure oxygenation.
• For an asthma attack unresponsive to multiple inhaler doses, the nurse should call a doctor.
• During an electrotherapy procedure, if the patient develops chest pain, the nurse should stop the procedure immediately.
• During prolonged oxygen therapy via nasal catheter, the catheter position should be changed to the other nostril every 30-40 minutes.
• Pulmonary edema is an indication for oxygen therapy with defoamers.
• The nasal catheter position should be changed every 30-40 minutes during prolonged oxygen therapy.
• For a general therapeutic bath, the patient should be immersed up to the xiphoid process.
• Water in a thermal inhaler should be heated to 40°C.
• For a patient experiencing an asthma attack, the nurse should administer a bronchodilator like Salbutamol via a pocket inhaler, as supported by the British Thoracic Society guidelines 1. The most recent and highest quality study on the topic of oxygen therapy is from 2021, which provides guidance on the appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure 1.

From the FDA Drug Label

CONTRAINDICATIONS Albuterol sulfate inhalation aerosol is contraindicated in patients with a history of hypersensitivity to albuterol or any other albuterol sulfate inhalation aerosol component. The contraindications to inhalation therapy are a history of hypersensitivity to the medication or its components.

• Hypersensitivity to albuterol or any component of the inhalation aerosol is a contraindication. 2

From the Research

Contraindications to Inhalation Therapy

• Cough is not typically a contraindication, but hemoptysis, shortness of breath, and "whizzing" breath may indicate conditions that require caution or alternative treatments 3.
• Asthma attack may require specific inhalation therapies, but it is not a contraindication in itself.

Error in Algorithm of Actions when Using a Pocket Inhaler

• The patient should breathe in slowly and deeply through the mouthpiece, not slowly in general, and the mouthpiece should be covered tightly with the lips before inhalation starts.
• The correct steps include: removing the cap, shaking the inhaler, breathing out, placing the mouthpiece in the mouth, and then pressing the bottom of the inhaler while breathing in slowly and deeply.

Defoamer in Oxygen Therapy

• The most appropriate concentration of ethyl alcohol as a defoamer in oxygen therapy is not specified in the provided studies, but 70 degree of ethyl alcohol might be considered based on general medical practices.

Nurse Action for Irritation in the Nose and Nasopharynx during Oxygen Therapy

• Temporarily stopping the introduction of oxygen and dripping oil drops into the nose might help alleviate irritation, but the best course of action could involve consulting a doctor or adjusting the oxygen delivery method.

Patient Actions when Using a Pocket Inhaler

• The correct action involves covering the mouthpiece tightly with the lips, taking a deep breath out, and then pressing the bottom of the inhaler while taking a deep breath in.

Mistake in Nurse's Actions during Oxygen Therapy with a Mask

• Keeping the mask away from the patient's mouth is not the correct action; the mask should be placed over the patient's nose and mouth to deliver oxygen effectively.

Oxygen Content to Eliminate Tissue Hypoxia

• The specific oxygen content in the oxygen-air mixture to eliminate tissue hypoxia is not directly stated in the provided studies, but typically, an oxygen concentration that meets the patient's needs without causing oxygen toxicity is used.

Oxygen Pressure in Cylinders

• The standard pressure for oxygen cylinders can vary, but 200 atm is a common pressure for medical oxygen cylinders.

Nurse's Action during General Therapeutic Warm Bath

• If the patient shows signs of distress such as pale skin, headache, heartache, dizziness, and increased pulse and breathing rate, the nurse should urgently stop the procedure and call a doctor.

Timing of Inhalation Procedure

• The procedure should be carried out 1-1.5 hours after eating to minimize potential complications and ensure the patient's comfort.

Oxygen Delivery Rate through a Nasal Catheter

• The appropriate oxygen delivery rate can vary based on the patient's condition, but 1-2 L/min and 2-3 L/min are common rates for nasal catheters.

Common and Non-Invasive Way to Measure Oxygenation

• Pulse oximeter is the most common and non-invasive way to measure a patient's oxygenation.

Nurse's Action for Asthma Attack

• The nurse should call the doctor, especially if the patient's condition does not improve after using the pocket inhaler, and consider providing oxygen inhalation as prescribed.

Nurse's Action during Electrocardiogram Procedure

• If the patient develops constricting pains in the region of the heart and palpitations, the nurse should stop the procedure and call a doctor.

Break Time for Humidified Oxygen through a Nasal Catheter

• Regular breaks may be necessary to prevent irritation and ensure patient comfort, but the exact duration can depend on the patient's condition and the healthcare provider's instructions.

Indications for Oxygen Therapy with Defoamers

• Respiratory failure and pulmonary edema are indications for oxygen therapy, which may include the use of defoamers to prevent foam formation in the oxygen delivery system.

Nurse Actions for Oxygen Therapy through a Nasal Catheter

• Changing the position of the catheter to the other nasal passage every 1-2 hours can help prevent irritation and ensure continuous oxygen delivery.

Immersion Level for General Therapeutic Bath

• The patient should be immersed in water up to the level of the xiphoid process or as recommended by the healthcare provider to ensure safety and therapeutic effectiveness.

Water Temperature for Thermal Inhaler

• The water in a thermal inhaler should be heated to a comfortable temperature for the patient, typically around 40-50°C, to facilitate inhalation of the medication.

Nurse's Actions for Bronchial Asthma

• Using a pocket inhaler with the drug "Salbutamol" as prescribed can help alleviate asthma symptoms, and the nurse should follow the patient's treatment plan and consult a doctor if necessary.

Comparison of Oxygen Therapy Techniques

• High-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) have been compared in studies, with HFNC showing promise in treating severe bronchial asthma complicated with respiratory failure 4, 5.