SN provided skilled teaching on proper use of the metered‑dose inhaler (MDI). SN demonstrated correct technique, including shaking the inhaler prior to use, exhaling fully before inhalation, sealing lips around the mouthpiece, activating the inhaler once while taking a slow, deep breath, and holding the breath for approximately 5–10 seconds to allow medication to reach the lungs. SN instructed patient to exhale slowly afterward and to wait the prescribed interval before a second puff if ordered.

SN reviewed the importance of rinsing the mouth and spitting after use of a steroid inhaler to reduce risk of oral irritation and infection (thrush). Education provided on taking inhaler exactly as prescribed, not skipping doses, and monitoring for increased shortness of breath, wheezing, chest tightness, or increased rescue inhaler use, with instructions to notify the healthcare provider or call 911 for severe or worsening respiratory symptoms.

Teach‑back used to verify learning. Patient was asked to verbalize and demonstrate the steps of inhaler use. Patient correctly:

• Shook the inhaler prior to use
• Exhaled fully before inhalation
• Pressed the inhaler while taking a slow, deep breath
• Held her breath for 5–10 seconds
• Rinsed her mouth after “steroid inhaler” use

Patient was able to demonstrate inhaler technique with minimal corrective cues and verbalized understanding of when and how often to use the inhaler and when to contact the provider. Ongoing reinforcement is needed to support correct technique and adherence. Skilled nursing remains medically necessary to provide respiratory assessment, reinforce inhaler technique, monitor response to therapy, and coordinate with the prescribing provider as needed.