Incentive Spirometry (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Now, let's take a look at incentive spirometry.

    00:06 This is also going to help the patient's pulmonary function or lung function here.

    00:11 Now, first, what we're going to need is an incentive spirometer.

    00:15 So, let's get familiar with this equipment really quickly.

    00:18 So, this thing is going to be your patient's bestfriend.

    00:21 This is something I'll be honest as nurses, a lot of the times we don't utilize enough in our patients or we don't encourage them to do this enough.

    00:30 So, if you take a look at this equipment here, you're going to see on this image that blue mouthpiece.

    00:36 That's the piece the patient's going to suck into.

    00:38 Then, you're going to see these little dials.

    00:41 Those are really helpful to set a patient goal.

    00:44 Now, each patient's goal's going to be a little bit different, so, you need to get a baseline first and then, set a goal for your patient.

    00:52 So, before we get started, don't forget to perform your hand hygiene and provide privacy.

    00:58 Now, this is really important to explain the procedure to the patient.

    01:02 I know we say that a lot but instructions on this is important and the importance of using their incentive spirometer is also important.

    01:11 So, we want to raise the bed to the appropriate level here, make sure the patient's at least in a semi-Fowler's to a Fowler's position and then, check their respiratory assessment, get a baseline here on your patient.

    01:23 How are they breathing? Take a listen to their lungs.

    01:26 Do you hear a little junk in there? This is a good time to encourage that incentive spirometry.

    01:32 Now, if the patient has that surgical incision like we talked about earlier maybe on their abdomen or their chest, so, since the patient's going to be breathing here, it's a good time to tell them to splint with a pillow.

    01:45 We're going to instruct the patient to exhale normally, so, we want them to let all their air out first.

    01:51 Then, we're going to have the patient put their mouth to the mouthpiece.

    01:55 Then, we want to tell them, "Take a long, slow deep breath in like this." So, notice when I did that, what we want is the patient to really open up that chest and see those lungs inflate.

    02:09 Now, once they've done that while holding on to the mouthpiece, have the patient hold their breath and those lungs expanded for at least just a few seconds if they can tolerate it.

    02:20 Now, once that's happened, you can have the patient take out the mouthpiece and exhale.

    02:25 So, what this did, this kind of set a gauge for us on the incentive.

    02:29 So, if you take a look at the image here, see those little dotted lines? There's going to be numbers on here.

    02:35 So, depending on what your patient can do, it could be as little as maybe 500 or maybe your patient has some great lungs and maybe it goes all the way to 3,000.

    02:46 So, that's a way to set the goal and then, maybe set that goal just a little bit higher to really encourage and push the patient.

    02:53 Also, do you see on the other side, there's another little gauge? Much easier for the patient to look at it, it'll say, "good, better, best" something like that.

    03:02 But regard your patient and set good goals for them to help with lung expansion.

    03:07 Now, here's the important piece. We instructed the patient to do that.

    03:11 You wanna have the patient return demonstrate.

    03:15 What I mean by this is we just taught the patient how to use this equipment, right? We want the patient to show us that they know how to perform incentive spirometry.

    03:25 Again, because they need to do this quite a bit on their own.

    03:29 So, again, make sure you provide thorough instructions on performing it and have the patient do it back for you and demonstrate so we know they understand.

    03:42 Hi, I'm here with my friend, Brandon again and we're going to talk to you about incentive spirometry.

    03:47 This is really an important technique to use anytime the patient is post-op or after surgery.

    03:54 This is going to help keep their lungs in a good, healthy condition.

    03:57 So, before we get started, don't forget to perform your hand hygiene and make sure you provide privacy for your patient and make sure again, this is really important that you explain this procedure to the patient thoroughly.

    04:10 Now, again, I've got my bed up to a working height and notice the position that Brandon's in.

    04:15 Anytime we do the incentive spirometer, it's a great idea for the patient to be at least in a semi-Fowler's to a high-Fowler's position.

    04:22 Now, if Brandon was just recovering from something that maybe had a chest or an abdominal incision, anytime we perform IS or incentive spirometry, it's a great idea to have him hold that pillow and splint like we've talked about in earlier demonstrations.

    04:39 Now, what I'm going to do is go ahead walk-through Brandon on how to perform the IS.

    04:45 Okay, Brandon, so, I'm going to have you hold on to this and before we get too far, notice with the IS, you've got your mouthpiece on here.

    04:53 You've also got a goal where you want the patient to reach.

    04:57 Nice thing is well while Brandon's holding that, you'll see there's calibration here from 500 to 1,000, all the way up to 5,000.

    05:06 Now, each patient, their goal is going to be different depending on their respiratory capacity.

    05:12 Also, I want you to note, see this little piece here, this is really great because you can move this around and set your patient's goal for them so they can visibly see that.

    05:22 There's also a meter here as well that's a little bit more patient-friendly and also nice to use.

    05:28 But most of the time as nurses when we document, we want the exact number, so, we're going to set this here.

    05:38 So, we've tested it and gotten a baseline earlier with Brandon, so, I'm going to set this about 2,500 and see if he can reach that.

    05:46 So, now, I'm going to talk him through on how we're going to do that.

    05:49 So, now, Brandon, if you would, go ahead and give me a good exhalation normally as you would.

    05:53 Now, once you do that, you can go ahead and put the mouthpiece in your mouth.

    05:58 Now, I want you to take a long dep breath in and don't be afraid to try to hit that goal.

    06:05 Perfect, that was great. Now, you can take out that mouthpiece and just exhale normally.

    06:11 Now, Brandon can hold his breath during the time he inhaled, that's great.

    06:15 Sometimes, people can tolerate it and sometimes, they can't.

    06:18 But again, as you noticed, Brandon surpassed where he needed to be, so, we probably need to move up his goal a little bit more.

    06:26 Now, this is a great time to repeat it as ordered by the physician. That's really important.

    06:31 However, I like to tell patients again that sometimes if you're just in the hospital, make sure that you like watch the commercials for example, when you see those on TV, it's a great time to do the incentive spirometer.

    06:45 So, again, let's go back. We set that gauge at about 2,500 for Brandon.

    06:50 We really could move that up probably about 3,000 because this was the gauge where that incentive spirometer of where Brandon hit on how much volume of inspired air he could do.

    07:01 Now, once we've walked Brandon through this, it's important that I have Brandon do this back again and talk me through how that's to be performed.

    07:10 I want to make sure he can do this independently because if I'm not in the room, he can do this while watching TV commercials or when we go home and he discharges from the hospital, he needs to take this as well to keep his respiratory condition as stable as possible and we don't want any respiratory complication after our surgery.

    07:35 Now, after we're done with this, reassess the patient's respiratory status.

    07:39 Then, we can return that bed to the lowest position, make sure those side rails are up, perform our hand hygiene and document the procedure.

    07:48 Now, before we leave this skill, here's a really nice tip I like to tell my patients, "Hey, anytime you're in the room post-surgery, you're watching TV, if you see some commercials come on, that's the time to do the incentive spirometer." Also know that after surgery, we really encourage the patient to take this device home and do the same thing at home. I can tell you as long as the patient can tolerate it, it's never going to be a bad thing for the patient.

    08:15 It's going to help keep junk out of their lungs. It's going to prevent pneumonia.

    08:19 It's going to make sure that patient keeps a solid respiratory status throughout their post-op experience.

    08:31 Now, after we're done and Brandon's done that, keep an eye on his respiratory status.

    08:35 Also, make sure his beds in the lowest position and that side rail's up.

    08:40 And then, we can perform our hand hygiene and document.

    About the Lecture

    The lecture Incentive Spirometry (Nursing) by Samantha Rhea, MSN, RN is from the course Postoperative Care (Nursing).

    Included Quiz Questions

    1. Pulmonary function
    2. Abdominal pain
    3. Chest pain
    4. Coughing
    1. Hand hygiene
    2. Explain the procedure to the patient
    3. Raise the bed
    4. Perform a respiratory assessment
    1. 5 seconds
    2. 3 seconds
    3. 7 seconds
    4. 4 seconds
    1. Have the patient demonstrate incentive spirometry back to the nurse
    2. Providing a printout to the patient on how to perform the procedure
    3. After explaining the procedure, instruct the patient to perform the procedure as much as possible
    4. Teach the patient how to use the incentive spirometry equipment

    Author of lecture Incentive Spirometry (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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