Steps

Rationale/Points of Emphasis

1 Collect equipment. Assemble device per manufac turer’s instructions and label it with child’s name.

Ensuring that the device is used only by the child whose name appears on the device prevents nosocomial transmission of respiratory infections.

2 Perform hand hygiene.

Reduces transmission of microorganisms.

3 Assess the child’s comfort level, and use pain management interventions as needed.

Appropriately managing the child’s pain level enhances the child’s ability to follow directions and participate in the procedure with more effective inspirations. IS is contraindicated in children unable to deep breathe due to excessive pain.

4 Raise the bed to a comfortable working level, and lower the side rails, if appropriate.

Decreases the potential for back injury.

5 Position child in a semi-Fowler or a high-Fowler position.

Allows for maximum lung expansion.

6 Demonstrate the breathing techniques the child should use to perform the procedure (see steps 8 and 9). Review techniques for deep breathing and directed coughing.

Prepares child for participation in the activity. Deep breathing has been shown to have the same benefit as IS in the preoperative and postoperative setting to prevent pulmonary complications. IS in combination with deep breathing, directed coughing, early mobilization and optimal analgesia have demonstrated the most success in preventing pulmonary complications.

7 If child has an abdominal incision, have the child splint the abdomen with a pillow or bath blanket.

Allows for support and comfort of incision area while simultaneously allowing for maximum expansion of chest and lungs.

KidKare The child can also be encouraged to hold a favorite stuffed animal in place to splint the abdomen.

8 Have the child exhale normally and then direct the child to place the mouthpiece of the device in his or her mouth, sealing the lips around the mouthpiece.

Effectiveness of the incentive spirometer is enhanced when an adequate seal is made around the mouthpiece, thus preventing leakage of exhaled air.

9 While ensuring that the child maintains the seal around the mouthpiece, direct the child to inhale slowly and deeply through the mouthpiece (without using his or her nose) and raise the ball (flow oriented) or the piston/plate (volume oriented) in the chamber to the set target.

During inhalation, the child’s goal should be to keep the ball or indicator in the optimal region on the device or to move the ball or indicator to its highest level (depending on the device used at your institution). Inhaling through the nose or mouth and nose diminishes the child’s ability to move the indicator to the highest level (Figure 49-1).

10 Instruct the child to hold his or her breath for 3 to 5 seconds, remove the mouthpiece, and then exhale normally in a slow and even fashion.

Holding the breath ensures optimum lung expansion by allowing the alveoli to re-expand. Normal slow exhaling prevents collapse of the alveoli.

11 Note the highest level the volume indicator reaches. Mark this on the device. Volume on IS should increase with practice as the child reaches maximum lung capacity.

Figure 49-1 The child is instructed to place his or her mouth over the mouthpiece of the device so there is a good seal over the mouthpiece.

Marking the baseline assists the child as he or she seeks improvement during future attempts.

12 Direct the child to take two to four normal breaths and then repeat the process five to ten times per session, at a minimum, every one to two hours while awake. If appropriate, encourage the child to perform the procedure independently, with new and increasing volumes established each day. Have tissue available and encourage child to cough as needed.

When the procedure is repeated on a regular basis, airway patency is maintained, and lung atelectasis can be prevented or reversed. Procedure facilitates expectoration of secretions.

13 Monitor the child for any untoward effects, such as dizziness, hyperventilation, or shortness of breath.

Hyperventilation, exacerbation of bronchospasm, and extreme fatigue may occur. If such symptoms occur, stop the procedure and notify the child’s healthcare prescriber.

14 When the session is complete, return the child to a comfortable position, and return the bed to its lowest position. Assess child’s safety and raise side rails, if appropriate.

Ensures child’s comfort and safety.

15a Remove the mouthpiece from the spirometer and disinfect following manufacturers’ instructions.

Removes sputum from device and reduces transmission of microorganisms during future use.

15b Reattach the mouthpiece and store the unit at the child’s bedside within easy reach of the child.

Allows child easy access to the spirometer.

15c All IS equipment should be disposed of in an appropriate trash receptacle when the equipment is no longer needed in the child’s treatment plan.

Standard precautions.