Considerations:
- Attempt to provide the student with as much privacy as possible, given the urgency of the situation
Supplies:
- Medication
- Nebulizer machine (air compressor)
- Connecting tubing
- Facemask, or a mouthpiece held in the mouth
- Individualized Health Plan (IHP) and/or Healthcare provider’s orders
- Position student
- Explain the procedure to the student at his/her level of understanding
- Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
- Review IHP and/or healthcare provider’s orders
- Check for authorization forms/records
- Medication Administration Form
- Medical provider
- Parent/guardian
- Check for the Five Rights
- Right student
- Correct time
- The medicine container matches authorization forms and medication administration record
- The dose on mediation container matches authorization form and records
- The medication is in the correct route as identified on medication container, authorization forms and medication record
- Ensure the medication has not expired
- Wash hands
- Set up and plug in the nebulizer machine in a location where the power source is close to a comfortable location for the medication to be administered
- Follow the directions for the specific brand of nebulizer machine and cup
- Unscrew top of nebulizer cup
- Add medication into the bottom half of the nebulizer cup
- Screw the top of the cup back on
- Attach the tubing from the cup to the nebulizer machine and the cup onto the facemask or mouthpiece
- Place either the facemask on the student or the mouthpiece in his or her mouth and turn on the machine
- A mist of medication should rapidly appear
- Instruct the student to take relatively normal slow deep breaths
- Keep the nebulizer cup in an upright position
- The cup may require some tapping on the sides toward the end of the treatment to optimize the completion of the dose
- The treatment is complete when there is no more mist from the cup (usually 10–15 minutes)
- Turn off the machine
- Remove the mask or mouthpiece
- Rinse nebulizer cup, mouthpiece or mask under warm water
- Shake off excess water
- Place on paper towel to dry
- Reassess respiratory status
- Wash hands
- Document assessment, intervention and outcome in student’s healthcare record
- Update parents/guardian and healthcare provider, if needed
Cleaning and storing:
- Take the nebulizer apart
- Set tubing aside
- Do not soak, wash or rinse tubing
- Replace it if it becomes cloudy, discolored or wet inside
- Wash the medicine cup and mask with warm, soapy water
- Rinse the medicine cup and mask in warm water
- Let all pieces air dry on a paper towel
- When dry, put pieces in a plastic bag or container
Disinfect weekly
- Soak medicine cup and mask in half strength vinegar for at least 10 minutes or overnight
- Rinse with water
- Let all pieces air dry on a paper towel
- When dry, put pieces in a plastic bag or container
Care of the machine
- Wipe with a damp cloth
- Check the filter monthly
- Change it every six months or sooner if discolored
- The machine should be serviced every five years
Resources:
American School Health Association: Asthma Control Webinar
Asthma and Allergy Foundation of America: Success of the Asthma Management and Education Online Program
Asthma and Allergy Foundation of America: Validated Programs for Children, Parents and Caregivers
Children’s Hospital: University of Missouri Health Care: School Nurse Online Module
Merck Childhood Asthma Network and The National Association of School Nurses: The Evolving Role of the School Nurse in Treating and Managing Childhood Asthma – At School and Home
National Heart, Lung and Blood Institute: Asthma Basics for Schools
National Heart, Lung and Blood Institute: Management of Asthma Exacerbations: School Treatment Steps to Follow for an Asthma Episode in the School Setting When a Nurse is Not Available
National Heart, Lung and Blood Institute: Management of Asthma Exacerbations: School Treatment Suggested Emergency Nursing Protocol for Students with Asthma Who Don’t Have a Personal Asthma Action Plan
National Heart, Lung and Blood Institute: Asthma Action Plan
References:
Children’s Hospital of Wisconsin. Nebulizer Treatments. http://www.chw.org/medical-care/asthma/asthma-treatment/nebulizer-treatments/
Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf
Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J. (1997). Children and Youth Assisted by Medical Technology in Educational Settings. Guidelines for Care. Second Edition. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624
Acknowledgment of Reviewers:
Marcia Creasy, BSN, RN
Retired School Nurse
Mary Kay Kempken, RN, BSN, NCSN
School Nurse
Randall Consolidated School
Page last updated: October 23, 2015