Which inhaler needs to be given first?

  1. Hi.
    Last week I had a chance to give medications to one patient who was metal disorder i kni knwith COPD.
    At same time, he was on seretide, ventolin, and spiriva . I just had a brief idea of these inhalers that helps breathing by expanding lung capacity and relives COPD symptoms.
    I gave him spiriva first then pt used it. Then he asked me " do you really know what you are doing? I mean what meds you are giving to me?"
    So i told him that I know these medication helps your breathing by expanding your lung capacity..
    The patient said. " no I don't think you know what you are doing. You are supposed to give me ventolin first which opens my airway and expand my lung capacity and then the one you gave me helps remaining expansion. Then you need to give me other.
    OMG. I was so embarrassed and shamed myself. But I was wondering why he took spiriva first then pt said " because you gave it first!"
    OMG...although he was with mental condition, he has been on these inhalers for many years so I think he is probably right. When I finished my work, I tried to find more info through internet regarding this issue , but I couldn't find good resources. Can anyone teach me about this?
    I
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  2. 35 Comments

  3. by   subee
    Pt. logically correct. Just because someone has a mental disorder doesn't mean they're unaware of anything.
  4. by   JustBeachyNurse
    He's right. Ventolin then others. Usually steroid & spiriva at least 5 min after Ventolin
  5. by   Student Mom to Three
    I was taught to give the bronchodilator first....so that would be the Ventolin. The other important thing I remember about inhalers is to wait a full minute between "puffs" when using a bronchodilator. I had a short stint as a school nurse and administered a lot of albuterol. Was really difficult for the little ones to wait for the full minute so we ended up buying sand timers so they could watch it themselves.

    On another note- I always find it interesting when pts tell you after the fact that you did something wrong. If he was going to mention it, why not do it before hand so it can be corrected?
    Last edit by Student Mom to Three on Jul 5, '14 : Reason: spelling
  6. by   KelRN215
    I'm not sure what the patient having a "mental disorder" has to do with anything. Do you think a patient with depression or anxiety or bipolar disorder is clueless about his or her own medical conditions/history? That is laughably untrue and a borderline offensive suggestion. The bronchodilator should be given first, the patient is correct.
  7. by   T-Bird78
    Is the ventolin supposed to given daily or just PRN? I have asthma pts who swear up and down their albuterol is daily and the others are PRN, and they are wrong in that assumption. If the ventolin is supposed to be daily for the administration of the other inhalers, that's one thing, but so many people misuse their albuterol with daily use when it's not needed.
  8. by   solanim
    You guys are totally right. But don't get me wrong. I was new to geriatric psychiatric unit and i was told some patients had their own delusional ideas about their medication so gave medication as charted. When he mentioned I was doing wrong , I briefly thought about what I was told at that time. But when he explained how to give meds I thought he was right and I apologised him . And when I gave him meds with inhalers, I used medication tray to show his meds first before taking it. so he could pick the right one to use. But pt didn't pick inhaler waited until i picked wrong one. Then told me he was testing me. Anyway this time I had a big lesson.
  9. by   solanim
    I'm not sure . But this patient was on daily ventolin, spiriva, and seretide in the morning.
  10. by   klone
    Yes, as others have said, the bronchodilator is always given first, in order to open up the airway more so you can take in more of the steroid. I live in a houseful of asthmatics, so I know this routine well.
  11. by   klone
    Quote from T-Bird78
    Is the ventolin supposed to given daily or just PRN? I have asthma pts who swear up and down their albuterol is daily and the others are PRN, and they are wrong in that assumption. If the ventolin is supposed to be daily for the administration of the other inhalers, that's one thing, but so many people misuse their albuterol with daily use when it's not needed.
    Yes, I had a patient recently who was using the Ventolin BID, and Flovent PRN. NO NO NO! Other way around!
  12. by   reddgirl
    The patient is right. You give the SABA first then the LABA or steroid last. Remember they must wash out their mouth after the steroids. The SABA or Albuterol is what keeps them open and the other Meds are what maintain them. If he was having an attack, you'd give the emergency inhaler first which is his Ventolin.
  13. by   reddgirl
    Also Ventolin HFA is not given routinely. It is suppose to be ordered or given prn. If the patient is using that MDI more than twice a week then they need intervention. That means that their asthma or symptoms are not under control.
  14. by   AmyRN303
    Quote from reddgirl
    Also Ventolin HFA is not given routinely. It is suppose to be ordered or given prn. If the patient is using that MDI more than twice a week then they need intervention. That means that their asthma or symptoms are not under control.
    For asthma, yes, but this patient had COPD, so his ventolin could be a scheduled med instead of PRN.

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