• Attempt to provide the student with as much privacy as possible, given the urgency of the situation


  • 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

procedure download skill competency

  1. Position student
  2. Explain the procedure to the student at his/her level of understanding
  3. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  4. Review IHP and/or healthcare provider’s orders
  5. Check for authorization forms/records
    1. Medication Administration Form
    2. Medical provider
    3. Parent/guardian
  6. Check for the Five Rights
    1. Right student
    2. Correct time
    3. The medicine container matches authorization forms and medication administration record
    4. The dose on mediation container matches authorization form and records
    5. The medication is in the correct route as identified on medication container, authorization forms and medication record
  7. Ensure the medication has not expired
  8. Wash hands
  9. 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
  10. Follow the directions for the specific brand of nebulizer machine and cup
  11. Unscrew top of nebulizer cup
  12. Add medication into the bottom half of the nebulizer cup
  13. Screw the top of the cup back on
  14. Attach the tubing from the cup to the nebulizer machine and the cup onto the facemask or mouthpiece
  15. 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
  16. Instruct the student to take relatively normal slow deep breaths
  17. Keep the nebulizer cup in an upright position
  18. The cup may require some tapping on the sides toward the end of the treatment to optimize the completion of the dose
  19. The treatment is complete when there is no more mist from the cup (usually 10–15 minutes)
  20. Turn off the machine
  21. Remove the mask or mouthpiece
  22. Rinse nebulizer cup, mouthpiece  or mask under warm water
  23. Shake off excess water
  24. Place on paper towel to dry
  25. Reassess respiratory status
  26. Wash hands
  27. Document assessment, intervention and outcome in student’s healthcare record
  28. Update parents/guardian and healthcare provider, if needed

Cleaning and storing:

  1. Take the nebulizer apart
  2. Set tubing aside
  3. Do not soak, wash or rinse tubing
    • Replace it if it becomes cloudy, discolored or wet inside
  4. Wash the medicine cup and mask with warm, soapy water
  5. Rinse the medicine cup and mask in warm water
  6. Let all pieces air dry on a paper towel
  7. When dry, put pieces in a plastic bag or container

Disinfect weekly

  1. Soak medicine cup and mask in half strength vinegar for at least 10 minutes or overnight
  2. Rinse with water
  3. Let all pieces air dry on a paper towel
  4. When dry, put pieces in a plastic bag or container

Care of the machine

  1. Wipe with a damp cloth
  2. Check the filter monthly
    • Change it every six months or sooner if discolored
  3. The machine should be serviced every five years


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


Children’s Hospital of Wisconsin.  Nebulizer Treatments.

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:

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