The incentive spirometer. An often used tool in clinical and often used
incorrectly. If you've ever wondered how these things work and why we use them,
stay tuned we're going to go over that right after this. Welcome back my name's
Tammy and this is nurse minder and on this channel we do everything nursing so
if you're new here consider subscribing below so that you stay up-to-date with
the latest information. Now let's get on to the incentive spirometer. At the end
of this video you should be able to answer the question about Mr. Jones's
educational needs on his incentive spirometer. We'll come back to this. An
incentive spirometer helps to ensure that the respiratory system is in the
best possible position for maximal gas exchange. As we inhale, oxygen moves down
into the alveoli, the functional unit of the lung. Taking a closer look, we see
that there's a capillary bed that runs along the alveoli and this brings blood
supply, which is known as perfusion. Gas exchange occurs when oxygen can leave
the alveoli into the bloodstream and carbon dioxide leaves the bloodstream
into the alveoli to be expelled through exhalation. With the normal breath we
move 500 mls of air with every inhalation and exhalation. For a variety
of reasons though our patients may not be able to achieve that level and are at
increased risk for developing infection. Some of the typical patients that you
can expect to see an incentive spirometer ordered for include surgical
patients, pre-op (we do a lot of teaching with them before they go so they know
how to use this when they come back), postoperatively it's needed for a
variety of reasons: sometimes it's an anesthetic that they had during surgery
and it's cleared through the lungs, so we want them to take some deep breaths so
we can get rid of that residual anesthetic to lighten them up and to
wake them up. If they've had surgery in that thoracic or abdominal region, they
might be breathing shallow just because they have some pain (which we can use
medications), they may have some fear or anxiety but if they take too deep of a
breath are they gonna rip open those sutures. So we definitely want to get
them using the incentive spirometer, and we can teach them some splinting
techniques; which I'll show you a little bit later. Another population are those
who have reduced mobility, and that can be for a variety of reasons. Bariatric
patients, patients who have had fractures, we've got the geriatric patient
population who maybe need their aides and they can't get out of bed without our
assistance, and then we have other patients who are just too sick to get up.
So we want to make sure their lungs are still functioning at optimal
capacity. Another population could include our burn patients. If they've had
anything around the head or neck for injury there's a risk of swelling and a
risk of compromising the airway. Inhalation injuries as well are
a particular concern for us so we're going to use the incentive spirometer for them
as well. And the last one would be those who have any sort of conditions that
might impact immunity. So hematological disorders and where they're at risk for
a lung infection; and then of course we have all of our respiratory and cardiac
pathology that might impact ventilation and perfusion. There's a lot of patients
you might be using this for. It is just as important to know when not to use an
incentive spirometer, or when to question the order for an incentive spirometer.
For example our patients who have had a head injury, we would be worried about
adding to the increase in intracranial pressure and that would be a good
discussion point with your health care team. Another population includes
patients who have had surgeries to the eyes or plastic surgery. Those are areas
where we may have sensitive surgeries that would not benefit from the
additional pressure the incentive spirometer would create. In addition to
clinical pathology that might be a risk factor, we need to also consider the age
of our patient. Pediatric patients who are quite young don't have the fine
motor skills, nor can they follow the instructions to use the incentive
spirometer appropriately. So we might try an alternative strategy like a
deep breath and hold. In the geriatric population and even in our regular
population, there may be cognitive deficits that are preventing them from
understanding the instructions and implementing it. In addition, there can be
pathology that causes difficulties with those fine motor skills and that they
have a hard time struggling with the physicality of the incentive spirometer.
Let's look at the two different types. The first is a volume-oriented which
means I can dial up the desired volume I want them to inhale using the yellow
marker. As they inhale, the yellow plunger will rise with each breath and ideally if
they hit that target, there will be a yellow ball in this happy face. The
advantage to the volume-oriented incentive spirometer is that the patient
can measure their progress with each breath. Now the second type that we'll be
demonstrating today in this video is a flow-oriented incentive spirometer. This
style has a number of moveable balls that are pushed up by the force of
inhalation and suspend in air while that patient inhales. We're gonna demonstrate
that one in this video. Before we go through how to use the incentive
spirometer, we need to get our patient in the best position and sitting up is the
best position to be. It is ideal to have their back free from the mattress for
that full lung expansion, but if they can't get up you can also use the
reverse Trendelenburg. When it comes to assembling this incentive spirometer, it
often comes in two pieces and one would be the mouthpiece that we're going to
attach here, and then we're ready to go. So in instructing your patient you want
them to make sure that they just exhaled normally, and then they're gonna seal
their lips around the mouthpiece and inhale slowly and consistently so that
they're raising the balls in the flow meter at a consistent rate. Now
close, I'm not sure if you can see that, but it says six hundred, nine hundred, and
twelve hundred cc's per second. So if I can keep the white ball up for three
seconds that means I have inhaled 1,800 mls of air which is well above my tidal
volume and I'm definitely getting great recruitment in those lungs. Now let's
look at how to use it. First you want to exhale normally, put your lips around the
mouthpiece and seal, and inhale consistently and slowly, inhale, inhale,
and when you get to the top of that breath hold for three seconds and then exhale.
Take a few recovery breaths and then start the cycle again.
Now if you can't use the incentive spirometer we can use deep breathing and
coughing so let's talk about those splinting strategies. The first is to
have your patient interlock their fingers, open their palms, and press it
against their surgical incision. Apply pressure take a deep breath and cough.
The second strategy involves taking a pillow, applying pressure directly over
your wound and taking a deep breath and cough. Now let's go back to that NCLEX
question. If you're not ready for the answer pause now because here it comes.
If Mr. Jones were to say I need to tilt the incentive spirometer to reduce
effort or he's gonna breathe in as fast as he can, you need to do more teaching.
If you got those right congratulations! Well that's our lesson for today. I hope
you enjoyed it. Give a thumbs up if it was helpful. Comment below and let me
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