Nebulizer Treatment - Skills Checklist
Form Title
Date
-
Month
-
Day
Year
Date
Skilled Nurse's Name
First Name
Last Name
Nurse's Email
example@example.com
Manager's Email
example@example.com
Competency Validation Checklist
*
Knowledgeable
Demonstrated
Instructed
Some Follow up needed
1. Washes hands
2. Explains procedure to child
3. Gathers equipment and supplies. Verifies sterile tracheostomy tube at bedside in correct size and one size smaller.
4. Verifies routine schedule for treatments and emergency indications for non-scheduled treatments.
5. Sets-up nebulizer machine according to manufactures instructions.
6. Connects plastic feeding tubing to compressor air outlet. Makes sure the tubing is firmly inserted/attached.
7. Adds prescribed medication(s) and saline into the bottom of the nebulizer cup using dropper or premeasured ampules/bottles.
8. Assembles nebulizer cup, and attaches mouthpiece or mask to nebulizer cup outlet. Attaches other end of tubing to air intake port on bottom of nebulizer cup. Makes sure the tubing is firmly inserted/attached.
9. Conducts respiratory assessment, including measurement of peak expiatory pressure using a peak flow meter, if ordered.
10. Assists child to relaxed, upright position if appropriate.
11. Begins treatment by placing nebulizer mouthpiece between the child's teeth, with mouth closed, and instructs child to hold the nebulizer cup upright until all the liquid is gone. If using a mask, places the mask over the nose and mouth of the child.
12. Verifies proper aerosol mist.
13. Instructs child to inhale and exhale slowly through the mouth, if appropriate. Gives the child the opportunity to help hold the equipment, if age appropriate.
14. Provides oxygenation/ventilation as needed.
15. Observes child's response to treatment. Monitors for unusual reactions or side effects of medications.
16. Remains with child until treatment completed, when aerosolized mist no longer present.
17. Documents indication for treatment, treatment and pateint's tolerance of treatment. Documents mediation on medication form as well.
18. Stores all medications out of the reach of children.
19. After treatment, repeats respiratory assessment and cleans supplies and equipment per manufacturer's guidelines.
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