Incentive Spirometry
The IS is a RTs favorite toy just like how RNs love the IV. In class we were taught so many steps that it would take about 10mins per patient. Do we have time for that in a hospital setting? Over course not! I found that this video goes over the basics of teaching a patient IS. However it does not go over pre- assessment, post assessment..etc..etc.. So once I got into the hospital the IS took no longer than 5mins.
1. verify patient.
2. teach IS
3. say goodbye
Its seems that #2 teaching the patient. I had a hard time explain while I was being checked off in lab. The video on youtube shows exactly how to do it correctly. I would take a notecard and write it down to help you understand better and recite the lines over and over. Tell the same exact line to all the patients. We can say the exact lines because its a procedure and nothing changes except how much the patient can take a deep breath.
Difference between lab?
We had to check vital signs before and after and do palpation, auscultation. I never did that in the hospital because of the time it would take.
My last advice to students like myself is to :
*explain the procedure without any medical terms unless you have to.
* don’t scare the patient that if they don’t do it they have a risk of getting a disease and dying
*when you tell them to breath copy exactly how to do it in front of them. (it helps them visualize)
*it is not a breathing treament its a breathing exercise. (sounds better right?)
Anyone else wants to comment and add some advice feel free and I will update this because I want to know some advice too!
November 15th, 2007 at 7:17 pm
I know time is an issue in the real world but when you’re introducing IS to a patient for the first time i think it is very important to make the time and sit through the first session of exercise.
Incentive Spirometry – consists of four basic sections. The first encompasses the items from the Preinteraction and Introductory stages of the patient therapist interaction. The second consists of those items in the Initial Assessment stage. The third, those in the Treatment and Monitoring stage and the last is the follow-up stage.
The physician’s order
Written by the physician or transcribed verbal or telephone order
Contains the date written
Specifically address initiation of respiratory care (Incentive Spirometry hourly, Hyperinflation Protocol)
Be signed by the physician or transcriber
Indication for therapy
Within patient history or progress, must be indication of risk to develop or have atelectasis
No contraindications to the therapy
Patient able to perform specific therapy if so ordered
Preparation
Spirometer
Stethoscope
Watch with second hand or digital counting of seconds
Pulse oximeter if available
Wash hands
Introduction
Address patient formally
Your name (first name only is fine)
Department in which you work (respiratory therapy)
Why you are there (what you are going to do with the patient)
Gain consent to proceed with therapy
Identify patient by arm band
Initial assessment
Baseline heart rate
Breathing rate
Pulse Ox saturation
Appearance and level of consciousness
Continued indication for therapy and lack of contraindication
Breath sounds over all lung lobes
Treatment and Monitoring
Determine target (long-term goal) Inspiratory Capacity (Pre-op or calculate predicted value)
Establish goal with first few Inspiratory Capacity inhalations
Communicate goal to patient
Observe that vitals do not change dramatically and that dizziness does not occur
Evaluate patient ability to reach goal - modify up or down if indicated
Emphasize end-inspiratory breath hold when comfortable with goal
Emphasize normal breaths between deep inhalations
Instruct to take 8 – 10 breaths to IC with hold every hour while awake
Have patient repeat their understanding of what they are to do
Follow-up
Evaluate breath sounds for changes
Evaluate for changes in other vital signs
Explain what the person should expect – when will someone check back?
Ask person if they have questions
Answer any questions
Wash hands
Document what you did
Requirements for documentation
Date and time
Type of therapy performed
Effects of the therapy
Adverse reactions (none if there were none) and what you did about those unwanted effects
Signature, including initials for status (RTS, Respiratory Therapy Student)
November 15th, 2007 at 11:48 pm
Good job on the comment right up! I will update it soon!
November 19th, 2007 at 9:55 pm
You about have it right. You will also find some elderly patients unable to do IS. Then what do you do?
IMO, don’t be afraid give up on the IS and have them simply take a deep breath with a breath hold. I find that many times that a patient does much better with this than with the IS, and it works just as well if not better. Keep in mind that the IS is a tool for the patient and you to use.
It’s not so important that they can use the IS. It’s more important that they can take a deep breath with breath hold.
December 15th, 2007 at 7:49 pm
very interesting, but I don’t agree with you
Idetrorce
August 15th, 2008 at 11:16 am
Your blog is interesting!
Keep up the good work!