The nurse is teaching a postoperative client how to use an incentive spirometer

This is an NCLEX review on the incentive spirometer. In this review I will cover the most important material you need to know about the incentive spirometer for the NCLEX exam and give you a practice NCLEX style question at the end.

An incentive spirometer is a device used to help improve lung function and prevent atelectasis. Atelectasis is where the lung or part of it, has collapsed and the alveoli sacs are unable to perform gas exchange. This is a very common complication for patients after surgery.

An incentive spirometer encourages the patient to regularly deep breath which helps keep the alveoli sacs open. The alveoli sacs are responsible for gas exchange and if they become affected, gas exchanged will be significantly decreased.

What do you need to know for the NCLEX exam about the Incentive Spirometer?

• How to properly use it (exams LOVE to give you a scenario and ask which of the following is the correct or incorrect way to use an incentive spirometer)***most common
• The nurse’s role with the incentive spirometer
• What type of patients benefit from using an incentive spirometer
• How an incentive spirometer works and why it is used

Video NCLEX Lecture on the Incentive Spirometer

What Type of Patients Benefit from an Incentive Spirometer?

• Pre-opt and post-opt patients
• Patients with breathing disorders: COPD (strengthen lung function)
• Patients with respiratory illnesses: Pneumonia (helps keep lungs healthy while sick and move fluid/pus affecting the alveoli sac)

How often should a patient use and incentive spirometer? 10 times every 1 to 2 hours while awake

Nurse’s role with an Incentive Spirometer:

• Educate patient how to use it and the importance of using it regularly
• Observing and encouraging patient to use it often
• Monitoring lung sounds for improvement: For example, if the patient has atelectasis the lungs will sound diminished or bronchial breath sounds may be heard in the peripheral lung fields, or crackles. LISTEN TO ABNORMAL LUNG SOUNDS

Wrong Ways to use an Incentive Spirometer?

• Blowing into the device (most devices will not work if this is done)
• Rapidly inhaling and exhaling off of the device
• Inhaling too fast or too slow off of the device and not allowing the piston to completely fall to baseline before repeating
• Not using it often (less than 2 -3 times per day)
• Not using the device in sets of 10

Steps on How to Use an Incentive Spirometer

1. Attach the flexible tubing to port
2. Set goal for patient with the yellow marker
3. Have patient sit-up and exhale completely
4. Seal lips around mouthpiece tightly
5. Have patient inhale deeply and slowly…making sure to keep yellow indicator within normal range (not too fast or too slow)…Piston will rise
6. Patient needs to keep inhaling as deep as possible. …until unable to hold breath any longer and then hold breath for 6 seconds
7. Exhale slowly and allow piston to fall before repeating again

NCLEX style question about an Incentive Spirometer:

You are providing pre-opt teaching to a patient who will be having abdominal surgery. After discussing with the patient how to use an incentive spirometer, you ask the patient to demonstrate how to use the device. Which action by the patient demonstrates that the patient understood your education about how to use the device?

A.      The patient inhales quickly and rapidly off of the device.

B.      The patient inhales and then exhales into the mouthpiece.

C.      The patient inhales slowly until unable and holds breath for 6 seconds and then exhales.

D.      The patient slowly inhales and exhales multiple times and then holds breath for 2 seconds.

Answer: C….this option is the only correct explanation of how to correctly use an incentive spirometer.

A is wrong because the patient should SLOWLY inhale from the device not quickly and rapidly.

B is wrong because the patient never exhales into the mouthpiece.

D is wrong because the patient should inhale and exhale one time each time (not multiple) and hold breath for 6 seconds…not two.

More NCLEX reviews

References

1. How Is Atelectasis Treated? – NHLBI, NIH. (2012). Nhlbi.nih.gov. Retrieved 26 October 2016, from https://www.nhlbi.nih.gov/health/health-topics/topics/atl/treatment

This information will help you learn how to use and clean your incentive spirometer (in-SEN-tiv spy-rah-MEE-ter). It also answers some common questions about it.

About Your Incentive Spirometer

An incentive spirometer is a device that will expand your lungs by helping you breathe more deeply and fully. It measures how much air you can breathe into your lungs.

Using an incentive spirometer:

• Helps you practice taking slow, deep breaths.
• Exercises your lungs and makes them stronger as you heal from surgery.
• Helps clear out mucus that builds up in your lungs.
• Lowers your risk of getting a lung infection as you heal from surgery.

The parts of your incentive spirometer are labeled in Figure 1.

Figure 1. Incentive Spirometer

It’s very important to use your incentive spirometer after your surgery. It’s also important to do your deep breathing and coughing exercises. This will help loosen and bring up any mucus in your lungs. Keeping your lungs active during your recovery will help prevent lung infections, such as pneumonia (noo-MOH-nyuh).

If you have an active respiratory infection, do not use your incentive spirometer around other people. A respiratory infection is an infection in your nose, throat, or lungs, such as pneumonia or COVID-19. This kind of infection can spread from person to person through the air. It can spread to someone near you when you’re using your spirometer to breathe in and out.

Here is a video that shows how to use your incentive spirometer:

Setting up your incentive spirometer

Before you use your incentive spirometer for the first time, you will need to set it up. First, take the flexible (bendable) tubing out of the bag and stretch it out. Then, connect the tubing to the outlet on the right side of the base (see Figure 1). The mouthpiece is attached to the other end of the tubing.

Using your incentive spirometer

When using your incentive spirometer, make sure to breathe through your mouth. If you breathe through your nose, your spirometer will not work right. You can hold your nose if you have trouble.

If you feel dizzy or lightheaded (like you’re going to faint) at any time, stop and rest. Try again at a later time.

Follow these steps to use your incentive spirometer. Repeat these steps each hour you’re awake.

1. Sit upright on the edge of your bed or in a chair. Hold the incentive spirometer at eye level.
   • If you had surgery on your chest or abdomen (belly), it may help to splint your incision (surgical cut). To do this, hold a pillow against your incision. This will keep your muscles from moving as much while you’re using the spirometer. It will also help ease pain at your incision.
2. Before you use the spirometer, breathe out (exhale) slowly and fully through your mouth.
3. Put the mouthpiece in your mouth and close your lips tightly around it. Make sure you do not block the mouthpiece with your tongue.
4. Breathe in (inhale) slowly through your mouth as deeply as you can. You will see the piston slowly rise inside the spirometer. The deeper you breathe in, the higher the piston will rise.
5. Try to get the piston to rise as high as you can. As the piston rises, the coaching indicator on the right side of the spirometer should also rise. It should stay between the 2 arrows (see Figure 1).
   • The coaching indicator measures the speed of your breath. If it does not stay between the arrows, you’re breathing in either too fast or too slow.
     • If the indicator rises above the higher arrow, you’re breathing in too fast. Try to breathe in slower.
     • If the indicator stays below the lower arrow, you’re breathing in too slow. Try to breathe in faster.
6. When you get the piston to rise as high as you can, hold your breath for at least 5 seconds. You will see the piston slowly fall to the bottom of the spirometer.
7. Once the piston reaches the bottom of the spirometer, breathe out slowly and fully through your mouth. If you want, you can take the mouthpiece out of your mouth first and then breathe out.
8. Rest for a few seconds. If you took the mouthpiece out of your mouth, put it back in when you’re ready to start again.
9. Repeat steps 1 to 8 at least 10 times. Try to get the piston to the same level with each breath. After you have done the exercise 10 times, go on to step 10.
10. Try to cough a few times. As you’re coughing, hold a pillow against your incision, as needed. Coughing will help loosen and bring up any mucus in your lungs.
11. Use the marker on the left side of the spirometer to mark how high the piston rises (see Figure 1). Look at the very top of the piston, not the bottom. The number you see at the top is the highest number the piston reached. Put the marker there. This is how high you should try to get the piston the next time you use your spirometer.
    • Write down the highest number the piston reached. This can help you change your goals and track your progress over time.

Use your incentive spirometer 10 times each hour you’re awake.

Cover the mouthpiece of your incentive spirometer when you’re not using it.

How To Clean Your Incentive Spirometer

Follow these steps to clean the flexible tubing with the mouthpiece from your incentive spirometer. Clean it after each use, or as often as needed.

1. Remove the flexible tubing with the mouthpiece from the outlet on the right side of the base.
2. Wash it in a sink with mild soap and warm water. Do not use bleach, dish or laundry soap, or hot water.
3. Rinse it in cool, clean water.
4. Gently shake it to get rid of extra water.
5. Place the flexible tubing with the mouthpiece on a cloth towel or paper towel. Let it air dry in a cool place away from heat or direct sunlight. Make sure it’s fully dry before reconnecting it to the spirometer.

Commonly Asked Questions

How often should I use my incentive spirometer?

How often you will need to use your incentive spirometer is different for everyone. It depends on the type of surgery you had and your recovery process.

Most people are able to use their incentive spirometer at least 10 times each hour they’re awake. Your healthcare provider will tell you how often to use your spirometer. Follow their instructions.

How long after my surgery will I need to use my incentive spirometer?

The length of time you will need to use your incentive spirometer is different for everyone. It depends on the type of surgery you had and your recovery process.

Your healthcare provider will tell you how long you need to use your spirometer for. Follow their instructions.

What do the numbers on my incentive spirometer measure?

The large column of your incentive spirometer has numbers on it (see Figure 1). These numbers measure the volume of your breath in milliliters (mL) or cubic centimeters (cc). The volume of your breath is how much air you can breathe into your lungs (inhale).

For example, if the piston rises to 1500, it means you can inhale 1500 mL or cc of air. The higher the number, the more air you’re able to inhale, and the better your lungs are working.

What number I should aim for?

The number you should aim for depends on your age, height, and sex. It also depends on the type of surgery you had and your recovery process. Your healthcare provider will look at these things when setting a goal for you. They will tell you what number to aim for.

Most people start with a goal of 500 mL or cc. Your healthcare provider may change your goal and have you aim for higher numbers as you heal from surgery.

The package your incentive spirometer came in should also have a chart. You can use the chart to set your goal based on your age, height, and sex.

What does the coaching indicator on my incentive spirometer measure?

The coaching indicator on your incentive spirometer measures the speed of your breath. As the speed of your breath changes, the indicator moves up and down.

Use the indicator to guide your breathing. If the indicator rises above the higher arrow, it means you’re breathing in too fast. If the indicator stays below the lower arrow, it means you’re breathing in too slow.

Aim to keep the indicator between the 2 arrows (see Figure 1). This means your breath is steady and controlled.

When To Call Your Healthcare Provider

Call your healthcare provider if you have any of these when using your incentive spirometer:

• Dizziness or feeling like you’re going to faint (pass out).
• Pain in your lungs or chest.
• Pain when you take deep breaths.
• Trouble breathing.
• Coughing up blood.
• Fluid or blood coming from your incision site (surgical cut) when you cough.
• Trouble using your spirometer for any reason.