STEAM INHALATION

Introduction- Inhaling the warm vapors of boiling water has a number of therapeutic effects.
Steam may reduce viral load and prevent the severity of the infection.

Definition-Breathing warm and moist air produced by a vaporizer is called steam/moist

inhalation. The value of steam inhalation lies chiefly in the moisture and heat, although the
medicines used are also helpful as they are acting as respiratory antiseptics.

It is the process in which water is boiled to steam which is inhaled through nose and mouth for
therapeutic purpose.

PURPOSES-

 To relieve the inflammation and congestion of the mucous membrane of the respiratory
tract and paranasal sinuses.
 To soften thick tenacious mucous.
 To help in expectoration.
 To provide heat and moisture and to prevent the dryness of mucous membranes of lungs
and upper respiratory passages.
 To aid in the absorption of oxygen.
 To relieve spastic condition of the larynx and bronchi.
 To decrease the edema of the respiratory tract.

DRUGS USED-

1. Tr. Benzoin 5ml per 500ml of boiling water.

2. Eucalyptus 2ml per 500ml boiling water.
3. Methyl salicylate few drops per 500ml boiling water.
4. Menthol few crystals per 500ml boiling water.
5. Camphor few crystals per 500ml boiling water.

Methods for giving steam inhalation

1. By jug method
2. By steam tent
3. By electric steam inhaler
Open Jug Method-Open jug method for the inhalation is used for the infants and toddlers who
cannot inhale through the inhaler. In the open jug method, boiling water is mixed with the tap
water in proportion of five parts of boiling water to one part of tap water. The jug should be half
filled. A towel or a thick paper or discarded x-ray film can be folded around the jug to form a
funnel.

The infant should be wrapped up to the neck to restrain his extremities. The mother can be asked
to sit in the chair by holding the baby in her lap with baby’s face facing downward over the
funnel, which is wrapped around the jug of hot water. The baby’s face should be adjusted to
direct the steam towards the baby’s face. The distance between the baby’s face and level of the
water should be 30 cm (12’’ inches). As the baby cries the steam will be breathed in and out of
the baby’s respiratory passage.

Inhalation can be continued for ten minutes then; the jug should be removed, and the baby’s face
should be wiped. Baby should be made comfortable and should not be exposed for 30 minutes.

Steam Tent-When a high concentration of steam is required, a steam tent may be used. There
are different ways of making a tent. A quick and easy method is to place a screen on either sides
on the patient’s bed and stretch blankets or sheets across them thus forming a canopy. The steam
can then be directed into the tent from the spout of the kettle

Never point the spout toward the face of the patient. The steam may be given for 20-30 min at a
time and it may be repeated every 4 hrs. continuous observation is required to avoid scalding of
the patient.

Electric steam inhaler- Small electric vaporizers can be used to give steam inhalation. It
consists of a small jar with a heating element extending into the jar. The jar is filled with water.
On the top of the jar is a removable perforated cup to which is attached a small metal spout. As
the water boils, the medicated steam is directed through the spout which is inhaled by the patient.

GENERAL INSTRUCTIONS

1. The spout of the inhaler must be placed in such a way that the patient can not touch it
or put his face too near.
2. Have the water in the jug method at a moderate temperature. The temperature is
maintained between 120 to 160F [54.4 to 76.7C]. if the water is cold, it will not
generate steam. If the water is too hot, it may cause scalding of the patient.
3. Keep the patient warm and prevent draught before, during and after the inhalation.
During the treatment, the blood vessel is easily chilled when exposed to draught. This
predisposes him to a more severe and prolonged attack of inflammation and
congestion. Therefore the patient should not go into a cold atmosphere for several hrs
after the treatment. The windows and doors are closed and the fan is put off during
 the treatment to prevent draught. Ask the patient to empty the bladder to ensure that
the patient will remain on the bed for several hrs after inhalation.
4. Place a sputum cup in the reach of the patient to spit the sputum that is coughed up
during the inhalation.
5. Explain the procedure to the patient or parents before the preparation of the
inhalation, so that no time is lost to start the inhalation once the inhaler with boiling
water is taken to the bedside. If the time is lost for explanations the temperature of the
water will be reduced.

USING A NELSON’S INHALER

Preliminary Assessment

1. Check the patient’s name, bed number and other identification

2. Check the diagnosis and the general condition of the patient.
3. Check the physician’s orders to see the specific precaution for the patient’s
movement and positioning.
4. Assess the patient’s ability for self care, his ability to move and to maintain the
desired position.
5. Assess the level of consciousness and the ability to follow instructions.
6. Check the articles available in the patient’s unit..

Preparation of articles

Articles
Nelson’s inhaler with a mouth piece tightly fit to To use as a vaporizer.
the neck of the inhaler.
Bowel or basin large enough to hold the inhaler.
A flannel piece or a towel.
Face towel
Bath blanket or bath towel
Tr. benzoin or any other inhalant ordered
Teaspoon or a minim glass.
Kettle with boiling water.
Gauze piece in a container.
Cotton swabs in a container.
Kidney tray and paper bag.
Rationale
To place the inhaler safety.
To wrap around the inhaler to prevent the
heat loss.
To wipe the face of the patient.
To put over the patient’s head and the jug to
prevent the loss of steam.
Used as a respiratory antiseptic.
To measure the inhalant.
To wrap around the mouth pieces.
To plug the spout.
To receive the wastes.
 Preparation of the patient-

1. Explain procedure to the patient.

2. Make the patient to understand that he has to remain in the bed one to two hrs more after
inhalation.
3. Ask patient to for to toilet and empty the bladder and bowel if necessary.
4. Place the patient in a fowler’s position with a cardiac table in front.
5. Close the doors and windows and put off the fan to prevent the draught.
6. Place the sputum cup in a convenient place within the easy reach of patient.
7. Provide a face towel to the patient to wipe the sweating from face during inhalation.

PROCEDURE -

S. no Steps Rationale

1 Warm the inhaler by pouring a little hot
water into the inhaler and emptying it
after one minute.
2 Pour the required amount of inhalant into
the inhaler and fill to a level below the
spout with boiling water. The water
should remain just below the spout.
3 Place sterile mouthpiece and close the
inhaler tightly. See that the mouthpiece is
in the opposite direction to the spout.
4 Cover the mouth piece with a gauze
piece and plug the spout with a cotton
ball.
5 Place a towel around the inhaler and
position it in the bowl.
Reduces loss of heat from inhaler during procedure.
If the inhaler is filled up to the level of spout there is possibility
of drawing water into the mouth when inhaling and cause
scalds. If the spout is filled with water it will not act as an air
inlet.
This arrangement keeps the spout away from the patient when
inhalations are taken in.
Covering the mouthpiece with a gauze piece will prevent burns
of the lips. Cotton ball in the spout will prevent escape of
steam.
Insulates the inhaler and prevents heat loss.

6 Take it to the patient without losing time. To prevent cooling of water.

7 Place the apparatus conveniently in front Keeping the spout opposite to the patient reduces the chances of
of the patient on cardiac table with spout burns. Removing the cotton plug helps to open spout, so that it
opposite to the patient. Remove the can act as an inlet for air.
cotton plug and discard it into the kidney
tray.
8 Instruct the child to place lips on the Directing the steam out through the nostrils relieve the
mouthpiece and take deep breath. After congestion of the mucous membranes of the nostrils.
removing the lips from the mouthpiece,
breathe out air through nose.
9 Continue the treatment for 15 to 20 Helps in effectiveness of the procedures
minutes as long as patient gets the
vapours. Observe the child during
procedure.
10 Remove inhaler from the patient after the Enhances comfort of the patient.
stated time, wipe off perspiration from
the patient’s face.
11 Give chest physiotherapy and encourage
patient to bring out sputum by coughing.

12 Instruct the patient to remain in the bed Reduces chance of dizziness and effect of sudden temperature
for 1 to 2 hours. variation.

After care:

 Take articles to the utility room, empty the inhaler, clean the inside with alcohol
to remove Tr.benzoin. Wash it with warm soapy water and then rinse with clean
water .
 clean the ounce glass with alcohol swab followed by soapy water.
 Remove the gauze covering the mouthpiece and wash the mouthpiece with soap
and water and send for autoclaving.
 Dry the articles and replace them. Wash hands.

RECORDING AND REPORTING:

Record the procedure in nurse’s record with date, time, Purpose and patient’s response to
the procedure.

Special points-

 When a wide-mouthed vessel is used for inhalation, patient’s head and inhaler
may be covered using a sheet or blanket to help increase the concentration of
steam.
 During inhalation if patient stops for a while for coughing or expectorating
sputum, the spout may be closed with cotton ball to prevent escape of steam
 NEBULIZATION

Introduction- The nebulizer is a mechanical pump that produces a fine mist in which the drug is
dispersed via an appropriate nebulizer-compatible face mask. This fine mist is inhaled deep into
the lungs for maximum effect.

Definition-Nebulization is the process of delivering medication by a fine mist that is inhaled

directly into the lungs.

Purposes-

 To administer medications directly into respiratory tract for sputum expectoration.

 To reduce difficulty in bringing out thick tenacious respiratory secretions.
 To increase vital capacity.
 To relieve dyspnea.

Articles-

1. Air compressor
2. Connecting tube
3. Nebulizer
4. Medication and saline solution
5. Sterile water
6. Cotton balls
7. Face mask
8. Sputum cup with disinfectant
9. Disposable tissues
10. Kidney tray

Steps of Procedures-

PREPROCEDURAL STEPS-
Nursing action Rationale
1 Identify patient and check physician’s order and nursing Ensure that right procedure is done for right
care plan patient.
2 Assemble the articles and bring them near bedside Ensures smooth orderly procedure
3 Explain the procedure to the child and/or to the family. Proper explanation of the procedure helps
to ensure patient's cooperation and
effectiveness of the treatment
4 Place the child in a comfortable, upright position. This ensure maximal distribution and
deposition of aerosolized particles to base of
lungs
5 Wash hands It reduce transmission of micro-organism
6 Clean the mask with normal saline swabs and dry it and It reduce transmission of micro-organism
 clean the tubings with spirit swabs.
7 Add the prescribed amount of medication and saline or For effective nebulization
sterile water to the nebulizer.
8 Clean the nostrils if dirty To clear the nasal passage of mucous and secretions
9 Connect the tubing to the compressor and turn on the
pump. A fine mist from the device should be visible.
INTRAPROCEDURAL STEPS
10 Place mask on patient’s face to cover his mouth and nose
and instruct him to inhale deeply and slowly through
mouth, hold breath and then exhale several times.
11 Observe expansion of chest to ascertain that patient is
taking deep breaths.
12 Instruct the child to breath slowly and deeply until all the
medication is nebulized.
13 Monitor child’s oxygen saturation level throughout the
procedure
POST PROCEDURAL STEPS
14 On completion of the treatment encourage the patient to
cough after several deep breath.
15 Observe patient for any adverse reaction to the treatment.
16 Record medication used and description of secretion
expectorated.
17 Disassemble and clear nebulizer after each use. Keep the
equipment in patient’s room. The tubing is changed every
24 hours.
18 Wash hands.
that can block even distribution of medication.
To ensure proper working of the nebulizer
This encourages optimal dispersion of the
medication.
This will ensure that medication is deposited
below the level of oropharynx.
Medication will usually be nebulized within
15 minutes.
The medication may dilate airways
facilitating expectoration of secretions.
Patient may develop bronchospasms due to
inhalation of aerosol. The fluid may also
cause dried and retained secretion in
airways, leading to narrowing of airway.
Proper cleaning, sterilization and storage of
equipment prevents organism from entering
the lungs.
To prevent cross infection

Special consideration-

If indicated provide nebulization using oxygen source.

REFERENCE:

 Annamma Jacob (2011), Clinical Nursing Procedures: The Art Of Nursing Practice,
Second Edition, Jaypee Brothers Medical Publishers Ltd, Page No. 233-235
 Sandhya Ghai, National Institute of Nursing Education (NINE) Clinical Nursing
Procedures, First Edition, CBS Publishers, Chandigarh, Page No. 826-828
 Soumya Kurian (2016) “Textbook Of Pediatric Nursing” First Edition, EMMESS
Medical Publishers, Bangalore, Page No. 64-66