incentive spirometry for nursing students

1. Incentive spirometry:
Pratiksha ghimire
LMC

2. GLOSSARY:
 Tidal Volume (VT): The amount of air that moves in or
out of the lungs with each respiratory cycle. It
measures around 500 mL in an average healthy adult
male and approximately 400 mL in a healthy female.

3.  Vital capacity(VC): It is the total amount of air exhaled
after maximal inhalation
 Lung capacity or total lung capacity (TLC): It is the
volume of air in the lungs upon the maximum effort of
inspiration.
 Inspiratory reserve volume: The extra volume of air that
can be inspired with maximal effort after reaching the
end of a normal, quiet inspiration

4.  EXPIRATORY RESERVE VOLUME: The extra volume of
air that can be expired with maximum effort beyond the
level reached at the end of a normal, quiet expiration
 Residual volume (RV) : It is the volume of air remaining
in the lungs after maximum forceful expiration. In other
words, it is the volume of air that cannot be expelled
from the lungs, thus causing the alveoli to remain open
at all times.

5.  Functional residual capacity (FRC): It is the volume
remaining in the lungs after a normal, passive
exhalation.

9. Definition:
 Incentive spirometry, also referred to as
sustained maximal inspiration (SMI)
 Intensive spirometry is designed to mimic
natural sighing or yawing by encouraging the
patient to take long, slow, deep breaths.

10. Contd:
 This is accomplished by using a device that
provides patients with visual or other positive
feedback when they inhale at the
predetermined flowrate or volume and sustain
the inflation for at least 5 seconds.

12. Indication:
 Pre-operative screening of patients at risk of
postoperative complications
 Pulmonary atelectasis
 Abdominal or thoracic surgery
 Prolonged bed rest

13. Contd:
 Surgery in patients with COPD
 Presence thoracic or Abdominal binders
 Patients with inspiratory capacity less than 2.5 litres.
( normal value 3500ml)
 Patients with neuromuscular disease or spinal cord
injury
 In patient with coronary artery bypass graft surgery
( CABG)

14. HOW TO USE :
 Breathe in through your mouth as slowly and deeply as
you can, causing the piston or ball to rise toward the
top of the chamber.
 Hold your breath for 3–5 seconds or as long as
possible.
 If the spirometer has a goal indicator, use this to
guide your breathing. If the indicator goes above the
marked areas, slow your breathing down.
 Remove the mouthpiece from your mouth.

15.  Breathe out normally. The piston or ball will return to
the bottom of the chamber.
 Rest for a few seconds, then repeat the steps 10 or
more times.
 Go slowly. Take some regular breaths between deep
breaths to prevent lightheadedness.
 Do this every 1–2 hours when you’re awake.
 After each set of 10 deep breaths, cough a few times to
clear your lungs.

16. Frequency
 During the first 3 post operative days, try to do this
every hour.
 Clean the mouth piece of spirometer when finished.

17. How to measure
 The main column of your incentive spirometer has a
grid with numbers. These numbers are usually
expressed in millimeters and measure the total volume
of your breath.
 The piston in the main chamber of the spirometer rises
upward along the grid as you breathe in. The deeper
your breath, the higher the piston rises. Next to the
main chamber is an indicator that your doctor can set
as a target.

18.  There’s a smaller chamber on your spirometer
that measures, the speed of your breath. This chamber
contains a ball or piston that bobs up and down as the
speed of your breath changes.
 The ball will go to the top of the chamber if you’re
breathing in too quickly and will go to the bottom if
you’re breathing too slowly.
 Many spirometers have a line on this chamber to
indicate the optimal speed.

20. Hazards and complications:
 Ineffective unless performed as instructed
 Hyper ventilation or respiratory alkalosis
 Hypoxemia secondary to interruption of
prescribes oxygen therapy
 Fatigue
 Infection if not properly stored.

21. Contraindication:
 Patient who cannot be instructed or supervised to
assure appropriate use of the device.
 Patient who does not cooperate.
 Very young patient and other with development delays.
 Sedated or comatose.
 Pt unable to generate adequate inspiration with
capacity <10ml/kg or an inspiratory capacity < 33% of
predicted normal.