EBA Incentive Spirometry

The AARC reviewed a total of 54 clinical trials and systemic reviews on incentive spirometry and updated the following recommendations based on the assessment, development, and evaluation (GRADE) scoring system. 1: Incentive spirometry alone is not recommended for routine alone use in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 2: It is recommended that incentive spirometry be used with deep breathing techniques, directed coughing, early mobilization, and optimal analgesia to prevent postoperative pulmonary complications. 3: It is suggested that deep breathing exercises provide the same benefit as incentive spirometry in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 4: Routine use of incentive spirometry to prevent atelectasis in patients after upper-abdominal surgery is not recommended. 5: Routine use of incentive spirometry to prevent atelectasis after coronary artery bypass graft surgery is not recommended. 6: It is suggested that a volume-oriented device be selected as an incentive spirometry device. Respir Care2011;56(10):1600 –1604. © 2011 Daedalus Enterprises]

Preoperative and postoperative incentive spirometery is aimed to prevent atelectasis, pneumonia, and to improve the airway. Upper abdominal surgery has the most complications with preoperative and post-operative respiratory problems. The incentive Spirometer cannot be used alone with this type of post operative care because it will be ineffective. The incentive spirometer prevents complications by decreasing pleural pressure, promoting increased lung expansion and better gas exchange. There is lacking evidence for exactly how frequent the incentive spirometer should be used, although some suggestions have been made in clinical trials such as: Ten breaths every one to two hours while awake, Ten breaths 5 times a day, Fifteen breaths every four hours. Assessment of the outcome shows that correct use of the incentive spirometer Decreases respiratory rate, Absence of fever, Normal pulse rate, Improvement in previously absent or diminished breath sounds, Improved radiographic findings, Improved arterial oxygenation (P_aO2, S_aO2, S_pO2), reduced F_IO2 requirement. In conclusion, incentive spirometery shows ineffective after abdominal surgery and coronary artery bypass surgery when used alone. When the incentive spirometer is indicated, it must be included with deep breathing excercises, directed coughing, early ambulation, and optimal analgesia to be affective in lowering the incidence of pulmonary complications.

 

Ruben D Restrepo, Richard Wettstein, Leo Wittnebel and Michael Tracy

Respiratory Care October 2011, 56 (10) 1600-1604; DOI: http://dx.doi.org/10.4187/respcare.01471

 

http://rc.rcjournal.com/content/56/10/1600/tab-references

Istan 9/19/2016 (Simulation)

1. Discuss 4 tasks you completed or tried to complete in simulation lab. I completed the vitals and the beginning of the assessment, the assessment was split into 3 different parts for us all to participate in. We each attempted to get a prescription order for an antibiotic. I placed a foley catheter. We all participated in getting Istan back into bed. I collected the urine specimen. We all participated in getting the room cleaned up after urine was spilled everywhere and changing bed linens.
 2. What did you learn most about the situation(s) you encountered in simulation lab? I learned where to get the correct labels, for a CBC, etc. and who I would call when Istan dies and is a DNR.
  3. What will you do differently during your next simulation experience? Try not to be so intimidated by being watched and try to think things through about what I was taught to do in each situation.
 4. While watching your peers’ simulation experience, what are 3 things you learned? That communication is key, never keep information from one another because everything is important for your coworkers to know, it's important to work together and prioritize.
  5. What 3 things did you learn in the classroom (didactic) that you put into practice during your simulation experience?  Once Istan was dying we tried to wake her up, sit her up, check pulses, put oxygen on, checked capillary refill, breath sounds. We tried to stay on top of the tasks we were given and to get them done in a reasonable amount of time and prioritize to what was most important.

Istan day 9/19/2016 (simulation)

My group for istan wound up going second after lunch. She was a 90 y.o female with urinary retention secondary to dehydration due to her doctor prescribing her an antihistamine with an anticholinergic on top of that! For the most part I think we all felt well prepared, until we walked into the door. Istan was on the floor with urine everywhere do to her urinary incontinence and catheter falling out, she said she was getting up because the nurses weren't coming when she pressed the call light or her "air horn." I lifted on her left while Nicole got her right side and Addie lifted her legs. While we were trying to transfer her to the bed the bed was not locked, so I went around to the other side and locked them. While Addie and Nicole cleaned up and prepared to change bed linens, I started to get vitals and the assessment. I found that the wrong arm band was on her so we called for a new one. We divided the assessment up into parts for each of us. After we did that Addie started to the blood draw for CBC, Nicole was trying to get the order for antibiotic, and I was preparing to insert a catheter. After searching everywhere for labels we eventually learned at the end of the day that labels could be obtained at the "nurses station." While preparing to insert the catheter, I accidentally threw the saline away instead of the lubricant. Nicole and I attempted to do some "team work" while not trying to contaminate the sterile field... but we did! We were given the run around with trying to get the order for the antibiotic, but all in all I think we did good with having individual skills and with getting them done in a reasonable amount of time. Unfortunately, as the end of the day came it was just istan's "time to go" and I think we were all very confused as to who we would call and what we would do being that she was a DNR. I ran to get oxygen, and then a while after that the simulation was over. At the end of the day I learned about what we would have done in those situations, along with many other things! Sometimes it is a lot to take in and remember, but it is a privilege to have the instructors that we do to guide us through this crazy thing called nursing school!