COLLEGE OF NURSING

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.

Purpose: To breathe deeply and to achieve their normal inspiratory capacity.

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

Figure 1: Flow-Oriented IS Figure 2: Volume-Oriented IS

 STEP
ASSESSMENT
1. Check physician’s order for incentive
spirometry.
2. Assess patient’s respiratory status, including
symmetry of chest wall expansion, respiratory
rate and depth, sputum production and lung
sounds.
3. Explain the procedure to the patient and
family.
NURSING DIAGNOSIS
Nursing Diagnoses
Impaired gas exchange
Ineffective breathing pattern
Ineffective airway clearance
Related factors are individualized based on
patient’s condition or needs.
PLANNING
1. Identify expected outcomes following
completion of procedure:
a. Patient will demonstrate use of the IS.
b. Patient achieves target volume and number
of repetitions per hour.
c. Patient has normal breath sounds.
2. Wash hands.
3. Prepare equipment:
a. Gather the needed equipment.
b. Bring equipment to bedside. Set a table for
equipment. You may need to clean the
surface of the table.
IMPLEMENTATION
1. Identify the patient.
2. Wash hands.
3. Position patient in a semi-Fowler’s or high-
Fowler’s position.
4. Instruct patient to place lips completely over
mouthpiece.
RATIONALE
Health care institutions frequently require a
medical order for incentive spirometry in order to
receive third-party reimbursement for the
spirometer.
Decreased chest wall movement, crackles or
decreased lung sounds, increased respiratory rate
or increased sputum production can indicate a
need for incentive spirometry or other respiratory
maneuvers to improve lung expansion.
Understanding the purpose of incentive
spirometry and its proper use will improve
compliance with use.
Demonstrate learning.
Demonstrate increased lung expansion.
Reduces transmission of miicroorgamisms.
To identify what items must be obtained
separately.
To prevent delay in the performance of the
procedure. Ensures ease and success of procedure.
For infection control.
To be sure that you are performing the procedure
to the correct patient.
Reduces transmission of microorganisms.
Promote optimal lung expansion during
respiratory maneuver.
Showing patient to correctly place mouthpiece is a
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.

7. Wash hands. Reduces transmission of microorganisms.

8. Do after care of equipment. Wash the

spirometer and return to its proper place.

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.

RECORDING AND REPORTING

1. Record the lung sounds before and after

incentive spirometry, the frequency of use, the
volumes achieved and any adverse effects.

2. Report any changes in respiratory assessment

of patient’s inability to use IS.

UNEXPECTED OUTCOMES AND RELATED INTERVENTIONS

 Patient is unable to achieve spirometry target volumes and frequency independently.
- Encourage patient to attempt IS more frequently followed by rest periods.
- Teach cough-control exercises.
- Teach patient how to splint and protect incision sites.

 Patient has decreased lung expansion and/or abnormal breath sounds.

- Teach patient cough-control exercises.
- Provide assistance with suctioning if patients cannot effectively cough up their
secretions.

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:

Instructor’s Signature: Date:

INCENTIVE SPIROMETRY
PERFORMANCE CHECKLIST

S US NP REMARKS
ASSESSMENT

1. Checked physician’s order for incentive

spirometry. _____ _____ _____ ___________________

2. Assessed patient’s respiratory status, including

symmetry of chest wall expansion, respiratory
rate and depth, sputum production and lung
sounds. _____ _____ _____ ___________________

3. Explained the procedure to the patient and

family. _____ _____ _____ ___________________

NURSING DIAGNOSIS

Developed appropriate nursing diagnoses based

on assessment data. _____ _____ _____ ___________________

PLANNING

1. Identified expected outcomes following

completion of procedure: _____ _____ _____ ___________________
a. Patient will demonstrate use of the IS. _____ _____ _____ ___________________
b. Patient achieves target volume and number
of repetitions per hour. _____ _____ _____ ___________________
c. Patient has normal breath sounds. _____ _____ _____ ___________________

2. Washed hands. _____ _____ _____ ___________________

3. Prepared equipment: _____ _____ _____ ___________________

a. Gathered the needed equipment. _____ _____ _____ ___________________
b. Brought equipment to bedside. Set a table
for equipment. You may need to clean the
surface of the table. _____ _____ _____ ___________________

IMPLEMENTATION

1. Identified the patient. _____ _____ _____ ___________________

2. Washed hands. _____ _____ _____ ___________________

3. Positioned patient in a semi-Fowler’s or high-

Fowler’s position. _____ _____ _____ ___________________

4. Instructed patient to place lips completely

over mouthpiece. _____ _____ _____ ___________________
 S US NP REMARKS

5. Instructed patient to inhale slowly and

maintain a constant flow, like pulling through
a straw. When maximal inspiration is
reached, patient should hold breath for 2 to 3
seconds and then exhale slowly. _____ _____ _____ ___________________

6. Had patient repeat the maneuver until

achieved. _____ _____ _____ ___________________

7. Washed hands. _____ _____ _____ ___________________

8. Did after care of equipment. Washed the

spirometer and return to its proper place. _____ _____ _____ ___________________

EVALUATION

1. Observed patient’s ability to use incentive

spirometry by return demonstration. _____ _____ _____ ___________________

2. Assessed if the patient is able to achieve the

target volume or frequency. _____ _____ _____ ___________________

3. Auscultated chest during respiratory cycle _____ _____ _____ ___________________

RECORDING AND REPORTING

1. Recorded the lung sounds before and after

incentive spirometry, the frequency of use, the
volumes achieved and any adverse effects. _____ _____ _____ ___________________

2. Reported any changes in respiratory

assessment of patient’s inability to use IS. _____ _____ _____ ___________________

/kkav, 2009