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Incentive Spirometry
Incentive Spirometry
Silliman University
Dumaguete City
INCENTIVE SPIROMETRY
Definition: Incentive Spirometry assists the patient in deep breathing. An incentive spirometry
(IS) is most often used following thoracic surgery to help reduce the incidence of
postoperative pulmonary atelectasis. Postoperative deep breathing and coughing had
been shown to be as effective as using an incentive spirometry when performed
frequently. The advantage of the incentive spirometry is the visual feedback to patients
about the depth of their breaths.
Types of Spirometry:
1. Flow-Oriented ISs have one or more plastic chambers with freely movable, colored balls.
At the patient inhales slowly, the balls are elevated to a premarked area (see figure 1). The
goal is to keep the ball elevated for as long as possible to ensure maximal sustained
inhalation, not to snap the balls to the top of the chamber with a rapid, very brief, low-
volume breath. Even if the very slow inspiration does not elevate the balls, this pattern may
achieve greater lung expansion. The advantage of the flow-oriented IS is the slow, steady
expansion of the lung.
2. Volume-Oriented ISs have bellows that patient must raise to predetermined volume by
inhaling slowly (see figure 2). An achievement light or counter is used to provide feedback
to the patient. Some devices have a marker that moves up as the patient inhales. The
advantage of the volume-oriented IS is that a known inspiration volume can be achieved
and measured with each breath.
Incentive Spirometry is used most often with postoperative patients. It is helpful to determine
the patient’s baseline preoperative inspiratory capacity. An inspiratory volume one half to three
quarters of baseline is an acceptable postoperative volume. Patients benefiting from incentive
spirometry include those using it preoperatively, specially before abdominal, cardiac, or
orthopedic surgery; patients with a history of smoking, pneumonia, or chronic respiratory
disease and patients with atelectasis.
Equipment:
Flow-Oriented IS or Volume-Oriented IS
1. Check physician’s order for incentive Health care institutions frequently require a
spirometry. medical order for incentive spirometry in order to
receive third-party reimbursement for the
spirometer.
2. Assess patient’s respiratory status, including Decreased chest wall movement, crackles or
symmetry of chest wall expansion, respiratory decreased lung sounds, increased respiratory rate
rate and depth, sputum production and lung or increased sputum production can indicate a
sounds. need for incentive spirometry or other respiratory
maneuvers to improve lung expansion.
3. Explain the procedure to the patient and Understanding the purpose of incentive
family. spirometry and its proper use will improve
compliance with use.
NURSING DIAGNOSIS
Nursing Diagnoses
PLANNING
3. Prepare equipment:
a. Gather the needed equipment. To identify what items must be obtained
separately.
b. Bring equipment to bedside. Set a table for To prevent delay in the performance of the
equipment. You may need to clean the procedure. Ensures ease and success of procedure.
surface of the table. For infection control.
IMPLEMENTATION
1. Identify the patient. To be sure that you are performing the procedure
to the correct patient.
2. Wash hands. Reduces transmission of microorganisms.
4. Instruct patient to place lips completely over Showing patient to correctly place mouthpiece is a
mouthpiece. reliable technique for teaching psychomotor skill
and enables patient to ask questions.
STEP RATIONALE
5. Instruct patient to inhale slowly and maintain Maintain maximal inspiration, reduces risk of
a constant flow, like pulling through a straw. progressive collapse of individual alveoli.
When maximal inspiration is reached, patient
should hold breath for 2 to 3 seconds and then
exhale slowly.
6. Have patient repeat the maneuver until Ensures correct use of the spirometer and patient’s
achieved. understanding of use.
EVALUATION
1. Observe patient’s ability to use incentive Determines patient’s ability to perform breathing
spirometry by return demonstration. exercises correctly.
2. Assess if the patient is able to achieve the Measures compliance with therapy and lung
target volume or frequency. expansion.
3. Auscultate chest during respiratory cycle. Documents lung wall expansion, identifies any
abnormal lung sounds and determines if airways
are clear.
TEACHING CONSIDERATIONS
Teach patient to examine sputum for consistency, amount and color changes.
Identify learning objectives for preparing patient to use the IS; correctly places the mouthpiece,
achieves satisfactory maximal inspiration; repeats the maneuver the required number of times;
and understands the rationale for performing incentive spirometry.
Student’s Name:
Instructor:
INCENTIVE SPIROMETRY
PERFORMANCE CHECKLIST
S US NP REMARKS
ASSESSMENT
NURSING DIAGNOSIS
PLANNING
IMPLEMENTATION
S US NP REMARKS
EVALUATION