ch 39 incentive spirometry Flashcards
what is the purpose of IS
guide the patient to take a sustained maximal inspiratory effort resulting in a decrease in Ppl and maintain the patency of airways at risk for closure
what are IS devices designed for
mimic natural sighing by encouraging patients to take slow, deep breaths
how can IS can be performed
using devices that provide visual cues to patients when the desired inspiration flow or volume has been achieved
what should patients respiratory rate be to do IS
should be less than 25 breaths/min
what should patients vital capacity be for IS
should be more than 10 mL/kg of body weight
what type of attitudes should a patient have for IS
cooperative and motivated patient
what is the true benefit of IS
best achieved by repeated use and proper technique
what is the basic maneuver of IS
sustained maximal inspiration (SMI)
what is SMI
slow, deep inhalation from the functional residual capacity up to the total lung capacity, followed by a 5 second lung stretch
during the inspiratory phase of spontaneous breathing what happens
the decrease in Ppl caused by the breath is transmitted to the alveoli
lower the head of the bed what happens to vital capacity
vital capacity gets smaller, and the patient feels the pressure of their abdominal contents into their rib cage
what is the inspired volume goal set on
the basis of predicted values or observation of initial performance
what is the primary indication for IS
treat existing atelectasis
what are the 3 indications for IS
- presence of pulmonary atelectasis
- presence of conditions predisposing to atelectasis
- presence of a restrictive lung defect associated with quadriplegia or dysfunctional diaphragm
what are the 4 contraindications for IS
- patient can’t be instructed or supervised to ensure appropriate use of device
- patient can’t cooperate or understand
- patient can’t take a deep breath in
- presence of an open tracheal stoma requires additional equipment
What are some hazards and complications (5)
- hyperventilation and respiratory alkalosis
- discomfort secondary to inadequate pain control
- pulmonary barotrauma
- exacerbation of bronchospasm
- fatigue
what are the 3 assessment of needs for IS
- surgery with upper abdomen/thorax
- conditions that could lead to atelectasis – immobility, poor pain control, and abdominal binders
- presence of neuromuscular disease involving respiratory musculature
what is the assessment of outcome (7) not all are listed
- absence or improvement of atelectasis
- decreased respiratory rate
- resolution of fever
- normal pulse rate
- normal breath sounds
- normal chest x-ray
- return of FRC/VC to preoperative values
what is the most common problem when a patient performs IS too rapidly
acute respiratory alkalosis
what are the most frequently reported symptoms associated with respiratory alkalosis
dizziness and numbness
IS devices can be categorized into what 2 categories
volume oriented
flow oriented
flow-oriented devices measure and virtually indicate what
the degree of inspiratory flow
both flow oriented and volume oriented devices attempt to attempt what goal for the patient
sustained maximal inspiratory effort to prevent or correct atelectasis
what 3 phases does the successful application of IS include
- planning
- implementation
- follow-up
planning for IS should focus on what
selecting explicit therapeutic outcomes
what is critical when planning
getting the baseline patient assessment
what patients should be pre-assessed
patients scheduled for upper abdominal or thoracic surgery
why is pre-assessment of patients essential (3)
- helps determine patients who are at high risk for postoperative complications
- allows for determination of baseline lung volumes and capacities
- provides an opportunity to orient high-risk patients to the procedure before undergoing surgery
what type of goal should the RT set for IS
an initial goal that is attainable to the patient yet requires a moderate effort
what should the patient be instructed to do
inspire slowly and deeply to maximize the distribution of ventilation
what should the RT observe the patient perform
initial inspiratory maneuvers and ensure the patient uses the correct technique
what should the RT instruct the patient to do sustain
sustain maximal inspiratory effort for 5 to 10 seconds
what is the correct technique when performing IS breathing
diaphragmatic breathing at slow to moderate inspiratory flows
what is a typical rest period for early postoperative stages for IS
30 sec to 1 minute
why is the rest period important
helps avoid a common tendency by some patients to repeat the maneuver at rapid rates, causing respiratory alkalosis
what is the inspiratory goal
intermittent, maximal inspirations
what is a healthy individuals average sigh per hour
6
an IS regimen should aim to ensure a minimum of ____ to ____ SMI maneuvers each hour
5 to 10
what does SMI stand for
sustained maximal inhalation
TLC
total lung capacity
TV stand for and average
tidal volume
500 mL
IRV
inspiratory reserve volume
IC and calculation
inspiratory capacity
IRV + TV = IC
VC and formula
vital capacity
(maximal inhalation to maximal exhalation)
IRV + TV + ERV = VC
ERV
expiratory reserve volume
FRC and calculation
functional residual capacity
ERV + RV = FRC
RV
residual volume
TLC average
6000 mL
TLC calculation
IRV + TV + ERV + RV =TLC
emphysemitis bleb
weak spot on lung
what do you not what to do with a emphysemitis bleb
over pressurize the lung
what is vital to ensuring the achievement of goals
assessing the patients performance
how should you assess the patients performance
RT should make return visits to monitor treatment until the correct technique and appropriate effort are achieved
what can happen after the patient has demonstrated mastery of technique
IS may be performed with minimal supervision
what must be maintained at all times regarding the patients progress
all records of progress pertaining to the patients clinical status must be maintained throughout the course of treatment
what is the results of assessing a patient
helps guide the RT/physician in revising the respiratory care plan or terminating treatment after the goals are achieved
