after performing hand hygiene and ensuring privacy introduce yourself to the patient good morning my name is Laurie I'll be your nurse for today then identify the patient using to identify errs ask the patient if she has any allergies a metered dose inhaler or MDI is a small handheld device that delivers a measured dose of medication to the Airways with each puff a propellant in the canister disperses the drug in the form of an aerosol spray or mist compare the label of the MDI medication with the information in the medication administration record or ma are twice and do a third check at the bedside also check the expiration date of the medication as you proceed keep in mind the six rights of medication administration for a quick review see the video skill ensuring the six rights of medication administration next assess the patient's respirations and breath sounds ask the patient about her subjective symptoms such as shortness of breath discuss the purpose of the medication and explain what you mean by a metered dose caution her not to use the inhaler more often than her healthcare provider has specified and to be alert for possible side effects to teach the patient to use an inhaler without a spacer device demonstrate the steps for her shake the inhaler five or six times and remove the mouthpiece cover show the patient how to hold the inhaler in her dominant hand she can position it in one of two ways I want you to practice putting this all together push it in till you feel it snap tilt your head back the first option is for her to place the inhaler in her mouth with the opening toward the back of the throat and the lips close tightly around it this is the best way to deliver the medication when a spacer device is not being used the second option is for her to hold the device 2 to 4 centimeters in front of her mouth open wide and point the inhaler toward the back of the throat in either position make sure the patient's thumb is at the mouthpiece and her index and middle fingers are on top instruct her to tip her head back slightly and inhale slowly and deeply for 3 to 5 seconds while depressing the medication cannister completely ask her to hold this inhalation for about 10 seconds then have her remove the inhaler from her mouth and exhale slowly through her nose or through pursed lips if a spacer device is to be used with the inhaler begin your demonstration by removing both mouthpiece covers insert the inhaler into the end of the spacer device and shake it 5 or 6 times have the patient place the mouthpiece of the spacer in his mouth and close his lips around it tell him not to insert the mouthpiece beyond its raised area and to avoid covering the small exhalation slots with his lips now instruct him to breathe normally through the mouthpiece of the spacer when he's ready have him depressed the medication canister to release one puff into the spacer breathe in slowly and fully for 5 seconds and then hold his breath for 10 seconds when using a metered dose inhaler with or without a spacer tell the patient to wait 20 to 30 seconds between inhalations of the same medication and 2 to 5 minutes between inhalations of different medications when two different medications are given a bronchodilator should be administered before a steroid medication remind the patient not to use the inhaler again until it's time for his next dose mr. Reynolds after you're finished using your inhaler about two minutes later you're gonna want to rinse out your mouth with some warm water swish it around and spit it back out explain that he should rinse his mouth with warm water and spit it out about two minutes after administering the medication finally demonstrate how to clean the inhaler and take the canister out and make sure that this does not get into the water are they gonna run some warm water inside to clean it out and let tap the water out of it and let it set to dry don't forget to perform hand hygiene when you're finished okay mr. Reynolds now I'm going to show you how to mark your canister for the month show your patient how to keep track of how many doses he's used by noting the first day of use on the canister and calculating the number of doses he uses per day you're gonna put a date right here on your canister so that you know what the first day is that you started using this canister your doctor has ordered two puffs three times a day which is equals six there are 200 puffs in each canister divided two hundred by six thirty three days as part of your follow-up care assess the patient's respiration and breath sounds comparing them with the assessment you made before giving the medication include patient teaching and encourage your patient to demonstrate self administration of his medication using the MDI observe his technique and offer reinforcement as necessary remember to document the medication in the M AR after administration and not before note and report the patient's response and expected or unexpected outcomes