Atomization is done every day, in the end with the mouth or the nose?
How nurses correctly teach patients to use oxygen atomizing inhalers at work directly affects the patient's treatment effect. Therefore, in nursing work, patients should focus on instructing patients on how to use them, so as to avoid improper use, resulting in no treatment effect or side effects. {1}
Uncle Wang, male, 45 years old, was admitted to hospital due to maxillary cyst and underwent excision of maxillary cyst under general anesthesia. After surgery, he was given anti-infection, symptomatic treatment with fluid replacement, 0.9% sodium chloride injection + budesonide suspension When 2ml of oxygen is inhaled by atomization, the patient coughs continuously during the process of inhalation and atomization. How to correctly guide the patient in oxygen atomization inhalation? In the end use the mouth or nose to inhale?
- Atomized body position
① Position selection, try to choose a sitting position, move the diaphragm down, and use gravity to make the atomization go deep into the bronchioles and alveoli. Breathe deeply into the bronchioles and into the alveoli.
②Choose the position of unconsciousness and weakness in breathing, lying on the side, raising the head of the bed 30 degrees, so that the diaphragm is moved down to increase the gas exchange capacity, improve the depth of breathing, and facilitate the settlement of droplets in the terminal bronchioles.
- How to choose the amount of atomization
Correctly adjust the amount of atomization,
①Generally speaking, it is 1~4L/min for adults
②Children should not exceed 1L/min. Due to the imperfect development of the throat tissue of young children, the buffering effect of the throat cavity and nose hair is small, and a large amount of atomized inhalation can easily lead to hypoxia.
③ For patients with chronic obstructive pulmonary emphysema, the inhalation method of gradually adjusting the atomization volume should be adopted during atomization, starting from a small atomization volume and low concentration, inhaling 1L/min and then gradually increasing the atomization volume to 4L/min. min. {2}
- Nose or oral cavity
Aerosol inhalation achieves therapeutic effect through aerosol deposition mechanism.
When passing through the nasal cavity, many large-diameter particles adhere to the inner wall of the nasal cavity in the turbulent flow formed by the nasal cavity. Atomization is to administer medicine through the lower airway to avoid waste of medicinal liquid.
The caliber of the nasal cavity is smaller than that of the oral cavity, the mucosal turbinates are curved, and the ions are more likely to settle when passing through. The amount of wasted drug in the nasal cavity increases, the number of ions reaching the alveoli or small airways decreases, and the therapeutic effect that is not applied is achieved.
The inhalation of aerosol through the mouth is more appropriate than the nasal cavity. Like smoking, the mouth is inhaled and the nose is exhaled.
- Operation process:
Mouth-to-mouth/mask-type nebulizer adopts deep inhalation through the mouth and exhalation through the nose
Properly and firmly connect, adjust the oxygen flow first, and then connect the atomizing pipe and mask
The oxygen flow rate is gently rotated in the heart, and the general oxygen flow rate is 1~4L/min
Check whether the oxygen inhalation device is leaking, whether the atomization tank is tightly connected, and the atomizer is kept vertical to the ground.
Rinse your mouth after atomization and tap your back.
After the above, the patients were instructed to do oxygen atomization inhalation, the symptoms of choking cough were significantly relieved, and the treatment purpose was achieved.
At present, the nebulizer has been used for special use in clinical practice. Inhalation disinfection and storage of the nebulizer are extremely important. If the disinfection is not thorough or the storage is improper, the contamination and bacteria can lead to lower respiratory tract infections. {2}
No attention was paid to disinfection, and the patients were washed and stored by themselves. The patients had no strong awareness of disinfection. They simply washed and placed them at will. During the test, it was found that the number of bacteria in the self-treated aerosol inhalers seriously exceeded the standard. {3}
Item preparation: Disposable round bowl plastic fresh-keeping box with a capacity of 1000ml water + one chlorine-containing disinfection effervescent tablet (500mg effective chlorine)
Operation method: write the patient's bed number, name and hospital number with a marker on the outside of the disposable crisper box. After atomizing inhalation, rinse the atomizing inhaler with clean water, then soak it in a disposable fresh-keeping box corresponding to the patient for 30 minutes. After 30 minutes, rinse it with clean water, control the moisture, put it in a sterile cloth bag, and hang it on the patient's bedside for use. Bags are changed every other day. {3}{4}
Through testing and standardizing disinfection and storage methods, the disinfection pass rate of atomizing inhalers has been increased to >98%.
Disinfection of the atomizer reassures the patient, and also gives the patient a good habit of careful disinfection, which achieves the purpose of disinfection and is an easy operation. Convenient and effective disinfection and preservation methods.
references:
Talking about the misunderstanding of clinical use of nebulizer in Chinese and foreign medical care, 2009-12
Selection of disinfection and preservation methods for oral nebulizers PLA Nursing Journal, 2009, 22
Improvement of disinfection and preservation of atomizing inhalers Chinese Journal of Hospital Infectious Diseases, 2010-18
The application of disposable fresh-keeping boxes in the independent disinfection of pneumatic atomizers Tianjin Nursing 2017-01