Meter Dose Inhaler Skills - Checklist - 21-6

Student _______________________________________________________
Date __________________________
Instructor _____________________________________________________
Date __________________________
PERFORMANCE CHECKLIST SKILL 21-6 USING METERED-DOSE INHALERS
NP
Comments
1. Checked accuracy and completeness of each

MAR against medication order, clarified incomplete or unclear orders with health care provider.
____
____
____
___________________________
2. Reviewed pertinent information related to

medication.
____
____
____
___________________________
3. Assessed patients medical history, history of

allergies, and medication history.
____
____
____
___________________________
4. Assessed respiratory pattern, auscultated breath

sounds.
____
____
____
___________________________
5. Assessed patients ability to hold, manipulate,

and depress canister and inhaler.
____
____
____
___________________________
6. Assessed patients readiness and ability to learn.
____
____
____
___________________________
7. Assessed patients knowledge and understanding of disease and purpose and action of medications.
____
____
____
___________________________
1. Identified expected outcomes.
____
____
____
___________________________
2. Explained procedure to patient, explained specifics if patient wished to self-administer drug.
____
____
____
___________________________
1. Prepared medications for inhalation, checked

label of medication against MAR twice, checked
expiration date.
____
____
____
___________________________
2. Took medication(s) to patient at correct time,

applied the six rights of medication administration.
____
____
____
___________________________
3. Identified patient using two identifiers.
____
____
____
___________________________
4. Compared MAR with medication labels at

patients bedside, asked patient if he or she had
allergies.
____
____
____
___________________________
5. Discussed purpose of each medication, action,

and possible adverse effects; allowed patient to
ask any questions; explained what a metereddose is and how to administer it, warned about
overuse and side effects.
____
____
____
___________________________
ASSESSMENT
PLANNING
IMPLEMENTATION
Copyright 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Copyright 2014, 2010 by Mosby, an imprint of Elsevier Inc.
271
NP
Comments
____
____
____
___________________________
a. Removed mouthpiece cover from inhaler

after inserting MDI canister into holder.
____
____
____
___________________________
b. Shook inhaler well for 2 to 5 seconds.
____
____
____
___________________________
c. Held inhaler in dominant hand.
____
____
____
___________________________
d. Instructed patient to position inhaler properly.
____
____
____
___________________________
e. Had patient take deep breath and exhale

completely.
____
____
____
___________________________
f. Had patient hold inhaler in three-point or

bilateral hand position when positioned
properly.
____
____
____
___________________________
g. Instructed patient to tilt head back and inhale

slowly and deeply through mouth for 3 to 5
seconds while depressing canister fully.
____
____
____
___________________________
h. Had patient hold breath for about 10

seconds.
____
____
____
___________________________
i. Removed MDI from mouth before exhaling.
____
____
____
___________________________
a. Removed mouthpiece cover from MDI and

mouthpiece of spacer device.
____
____
____
___________________________
b. Shook inhaler well for 2 to 5 seconds.
____
____
____
___________________________
c. Inserted MDI into end of spacer device.
____
____
____
___________________________
d. Instructed patient to place spacer mouthpiece

in mouth and close lips, avoided covering
exhalation slots with lips.
____
____
____
___________________________
e. Had patient breathe normally through

mouthpiece.
____
____
____
___________________________
f. Instructed patient to spray one puff into

spacer device.
____
____
____
___________________________
g. Had patient breathe in slowly and fully.
____
____
____
___________________________
h. Instructed patient to hold breath for 10

seconds.
____
____
____
___________________________
9. Instructed patient to wait appropriate length

between inhalations.
____
____
____
___________________________
6. Allowed adequate time for patient to manipulate equipment, explained and demonstrated
how canister fits into inhaler.
7. Explained steps for administering MDI without
spacer:
8. Explained steps to administer MDI using a

spacer.
272
NP
Comments
10. Instructed patient to not repeat inhalation

before next scheduled.
____
____
____
___________________________
11. Warned patient they may feel gagging sensation.
____
____
____
___________________________
12. Instructed patient to rinse and spit with warm

water 2 minutes after dose.
____
____
____
___________________________
13. Instructed patient in daily cleaning of inhaler.
____
____
____
___________________________
14. Asked if patient had any questions.
____
____
____
___________________________
15. Assisted patient to comfortable position, performed hand hygiene.
____
____
____
___________________________
1. Had patient explain and demonstrate steps in

use and cleaning of inhaler.
____
____
____
___________________________
2. Asked patient to explain drug schedule and

dose or medication.
____
____
____
___________________________
3. Asked patient to describe side effects of medication and criteria for calling health care provider.
____
____
____
___________________________
4. Assessed patients respirations, breath sounds,

and peak flow measures after medication
administration if ordered.
____
____
____
___________________________
5. Identified unexpected outcomes.
____
____
____
___________________________
1. Recorded drug, dose, route, number of inhalations, and time on MAR; included initials or
signature; recorded patient teaching and validation of understanding in nurses notes.
____
____
____
_________________________
2. Recorded patients response to MDI, side effects,

and patients ability to use MDI.
____
____
____
_________________________
3. Reported adverse effects/patient response/

withheld drugs to nurse in charge or health care
provider.
____
____
____
_________________________
EVALUATION
RECORDING AND REPORTING
273

Meter Dose Inhaler Skills - Checklist - 21-6

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Student _______________________________________________________

PERFORMANCE CHECKLIST SKILL 21-6 USING METERED-DOSE INHALERS

1. Checked accuracy and completeness of each

2. Reviewed pertinent information related to

3. Assessed patients medical history, history of

4. Assessed respiratory pattern, auscultated breath

5. Assessed patients ability to hold, manipulate,

6. Assessed patients readiness and ability to learn.

1. Identified expected outcomes.

2. Explained procedure to patient, explained specifics if patient wished to self-administer drug.

1. Prepared medications for inhalation, checked

2. Took medication(s) to patient at correct time,

3. Identified patient using two identifiers.

4. Compared MAR with medication labels at

5. Discussed purpose of each medication, action,

Copyright 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Copyright 2014, 2010 by Mosby, an imprint of Elsevier Inc.

a. Removed mouthpiece cover from inhaler

b. Shook inhaler well for 2 to 5 seconds.

c. Held inhaler in dominant hand.

d. Instructed patient to position inhaler properly.

e. Had patient take deep breath and exhale

f. Had patient hold inhaler in three-point or

g. Instructed patient to tilt head back and inhale

h. Had patient hold breath for about 10

i. Removed MDI from mouth before exhaling.

a. Removed mouthpiece cover from MDI and

b. Shook inhaler well for 2 to 5 seconds.

c. Inserted MDI into end of spacer device.

d. Instructed patient to place spacer mouthpiece

e. Had patient breathe normally through

f. Instructed patient to spray one puff into

g. Had patient breathe in slowly and fully.

h. Instructed patient to hold breath for 10

9. Instructed patient to wait appropriate length

8. Explained steps to administer MDI using a

Copyright 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Copyright 2014, 2010 by Mosby, an imprint of Elsevier Inc.

10. Instructed patient to not repeat inhalation

11. Warned patient they may feel gagging sensation.

12. Instructed patient to rinse and spit with warm

13. Instructed patient in daily cleaning of inhaler.

14. Asked if patient had any questions.

15. Assisted patient to comfortable position, performed hand hygiene.

1. Had patient explain and demonstrate steps in

2. Asked patient to explain drug schedule and

4. Assessed patients respirations, breath sounds,

5. Identified unexpected outcomes.

2. Recorded patients response to MDI, side effects,

3. Reported adverse effects/patient response/

RECORDING AND REPORTING

Copyright 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Copyright 2014, 2010 by Mosby, an imprint of Elsevier Inc.

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