VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 103 Skills Lab)

SKILLS LABORATORY MODULE NO. 2

INCENTIVE SPIROMETRY

LEARNING OBJECTIVES:
By the end of the module, the student will be able to:
1. Cite the different benefits of incentive spirometry.
2. Give the two (2) types of incentive spirometers.
3. Describe the procedure in assisting & teaching a client with an incentive spirometer.
4. Explain rationale for each step of the procedure accurately.

 Important Information related to this Module:

Incentive Spirometers, also known as sustained maximal inspiration devices (SMIs) measure the flow of air
inhaled through the mouthpiece

A. Benefits of Incentive Spirometry:

 Induces the patient to take a deep breath and hold it for several seconds. This deep breath
increases lung volume, boosts alveolar inflation, and promotes venous return. This exercise also
establishes alveolar hyperinflation for a longer time than is possible with a normal deep breath,
thus preventing and reversing the alveolar collapse that causes atelectasis and pneumonitis.
 Usual indications: patients on prolonged bed rest, especially postoperative patients who may
regain normal respiratory pattern slowly due to such predisposing factors as abdominal or
thoracic surgery, advanced age, inactivity, obesity, smoking, and decreased ability to cough
effectively and expel lung secretions.

B. Types of Incentive Spirometers:

 Flow-Oriented Spirometer

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 VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 103 Skills Lab)

 _________________________

 Nursing Skill to Develop in this Module & Materials/Equipment Needed: [materials/items with an asterisk
(*) are the materials the students should bring during skills laboratory period]

 Assisting & Teaching the Client with an Incentive Spirometer:

- Stethoscope*
- Tissue*
- Alcohol swab (for disinfection of device)*
- Incentive spirometer with appropriate mouthpiece
- Kidney basin (for client’s secretions)

 Procedure Guidelines:
A. Assisting & Teaching the Client with an Incentive Spirometer
1. Explain the procedure to the patient, making sure that he understands the importance of performing
incentive spirometry regularly to maintain alveolar inflation.
2. Perform hand hygiene.
3. Help the patient into a comfortable sitting or ____________ to promote optimal lung expansion. If
you're using a flow incentive spirometer and the patient is unable to assume or maintain this position,
he can perform the procedure in any position as long as the device remains upright. Tilting a flow
incentive spirometer decreases the required patient effort and reduces the exercise's effectiveness.
4. Auscultate the patient's ______ to provide a baseline for comparison with posttreatment auscultation.
5. Instruct the patient to insert the _______ and close his lips tightly around it because a weak seal may
alter flow or volume readings.
6. Instruct the patient to exhale normally and then inhale as slowly and as deeply as possible. If he has
difficulty with this step, tell him to suck as he would through a straw but more slowly. Ask the patient

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 VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 103 Skills Lab)

to retain the entire volume of air he inhaled for ________ or, if you're using a device with a light
indicator, until the light turns off. This deep breath creates sustained transpulmonary pressure near
the end of inspiration and is sometimes called a sustained maximal inspiration.
7. Tell the patient to remove the mouthpiece from the mouth and exhale normally. Allow him to relax
and take several normal breaths before attempting another breath with the spirometer. Repeat this
sequence ___________ during every waking hour. Note tidal volumes.
8. Evaluate the patient's ability to cough effectively, and encourage him to cough after each effort
because deep lung inflation may loosen secretions and facilitate their removal. Observe any
expectorated secretions.
9. __________ the patient's lungs and compare findings with the first auscultation.
10. Place the mouthpiece in a plastic storage bag between exercises, and label it and the spirometer, if
applicable, with the patient's name to avoid inadvertent use by another patient.
11. Dispose of soiled tissues and perform hand hygiene.

 Special Considerations for Incentive Spirometry:

 Instruct patient that the mouthpiece of the incentive spirometer should be cleaned before & after use.
 If the patient is scheduled for surgery, make a preoperative assessment of his respiratory pattern and
capability to ensure the development of appropriate postoperative goals. Teach the patient how to use
the spirometer before surgery so that he can concentrate on your instructions and practice the
exercise. A preoperative evaluation will also help in establishing a postoperative therapeutic goal.
 Demonstrating first may help with client teaching. Afterwhich, perform a return-demonstration to
evaluate client learning.
 AVOID exercising at mealtime to prevent nausea. If the patient has difficulty breathing only through his
mouth, provide a noseclip to fully measure each breath. Provide paper and pencil so the patient can
note exercise times. Exercise frequency varies with condition and ability.
 Immediately after surgery, monitor the exercise frequently to ensure compliance and assess
achievement.

 References & Suggested Readings:

 Altman, G.B. (2010). Fundamental & advanced nursing skills (3rd ed.). Clifton Park, NY: Delmar Cengage
Learning.
 Nettina, S. & Mills, E.J. (2006). Lippincott manual of nursing practice (8th ed.). Philadelphia, PA:
Lippincott, Williams & Wilkins.
 Schilling-McCann, J. (2009). Lippincott’s nursing procedures (5th ed.). Philadelphia, PA: Lippincott,
Williams & Wilkins.
 Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Brunner & Suddarth’s textbook of medical-
surgical nursing (12th ed.). Philadelphia, PA: Wolter Kluwer Health/Lippincott, Williams & Wilkins.
 VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 103 Skills Lab)

 Williams, L. & Hopper, P. (2003). Understanding medical-surgical nursing (2nd ed.). Philadelphia, PA:
F.A. Davis Company.

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