Keep up the good work!

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.

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)