Incentive Spirometry: Nursing Procedure, Patient Teaching, and Exam Points

Incentive spirometry is a simple but high-yield respiratory intervention that nurses use to prevent atelectasis and pneumonia, especially in post-operative and immobile patients. This guide covers how the device works, how to coach patients through it, and the exam traps that commonly catch students off guard.

Definition

• Incentive spirometry (IS) is a breathing device that encourages deep breathing by providing visual feedback when the patient reaches a target inspiratory volume or flow.
• Its main purpose is to prevent or treat atelectasis (collapse of alveoli), particularly in post-operative patients and those with restrictive lung conditions.

Indications

• Post-operative patients (abdominal, thoracic, cardiac surgery) — prevents atelectasis caused by shallow breathing from pain and sedation.
• Immobility or prolonged bed rest — shallow breathing leads to collapsed alveoli.
• Patients on opioids — opioids cause respiratory depression and shallow breathing.

Patients after upper abdominal or thoracic surgery are at the highest risk for atelectasis.

Types of Incentive Spirometers

• Volume-oriented: Sustained inspiration raises a piston or disc to a target volume. Provides a precise volume measurement.
• Flow-oriented: Three chambers contain balls that rise based on inspiratory flow rate. The goal is to raise all three balls.

Step-by-Step Procedure

Patient Instructions

• Sit upright with the head of the bed elevated to at least 45 degrees; hold the device vertically.
• Exhale normally, seal lips tightly around the mouthpiece, then inhale slowly and deeply.
• Raise the indicator to the target level and sustain the breath for 3–5 seconds.
• Remove the mouthpiece and exhale normally through pursed lips.
• Perform 10 breaths per session, every 1–2 hours while awake. Cough after each session to clear secretions.

Nurse Responsibilities

• Set the target goal (typically 50–75% of the patient's inspiratory capacity).
• Coach the patient during the first few sessions.
• Document the volume achieved and patient tolerance.

Patient Education

• Explain that IS helps prevent pneumonia and lung collapse after surgery.
• Teach the slow, sustained inhalation technique — fast inhalation is not effective.
• Emphasize the 3–5 second breath hold to keep alveoli open.
• Instruct the patient to cough after each session to clear secretions.
• Use the device every 1–2 hours while awake.
• Wait at least 30 minutes after eating to avoid aspiration.

Contraindications and Precautions

• Inability to follow commands — patient cannot use the device correctly.
• Severe respiratory distress — patient cannot take deep breaths.
• Hemodynamic instability — deep breathing may worsen instability.
• Untreated or suspected pneumothorax — deep breathing may worsen the condition.
• Use caution in patients with bullous emphysema.

Monitoring and Evaluation

• Assess respiratory status before and after each session.
• Administer pain medication 30–60 minutes before use if pain limits deep breathing.
• Monitor for fatigue; if the patient becomes short of breath, reduce breaths per session.
• Notify the provider if the patient cannot achieve the target volume or if SpO₂ drops during use.

Documentation

• Target volume, volume achieved, number of breaths, and duration of breath hold.
• Patient tolerance, complications, and post-session respiratory assessment.
• Teaching provided and the patient's ability to perform a return demonstration.

Common Exam Traps

• Do not instruct the patient to exhale into the device — IS measures inspiration only.
• Do not allow use while lying flat — patient must be upright (≥45 degrees).
• Do not allow fast, forceful inhalation — must be slow and deep, with a 3–5 second hold.
• Do not use IS on a patient who cannot follow commands — the device will be ineffective.

Key takeaways

• IS prevents atelectasis by encouraging sustained deep inspiration; it is essential for post-op and immobile patients.
• Position the patient upright (≥45°), inhale slowly and deeply, and hold the breath for 3–5 seconds.
• Perform 10 breaths per session, every 1–2 hours while awake, and cough afterward to clear secretions.
• Target volume is typically 50–75% of inspiratory capacity.
• Contraindicated with untreated pneumothorax, severe respiratory distress, hemodynamic instability, or inability to follow commands.
• Give pain medication 30–60 minutes before use if pain limits deep breathing.