INCENTIVE SPIROMETRY & PEAK EXPIRATORY FLOW RATE

MODULE DESCRIPTION

This module summarizes what and when an Incentive Spirometer and Peak Flow Rate
are used for and its benefits. It also discusses the proper use of the devices.

COURSE LEARNING OUTCOMES

At the end of the lesson, you should be able to:

1. Break down what an incentive spirometer and peak flow meter is and its parts,
2. Identify patients who needs the devices,
3. Enumerate the benefits of using an incentive spirometer and peak expiratory
flow rate,
4. Apprehend on how to properly use the devices.

PRETEST

A link will be sent by the instructor.

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WHAT IS AN INCENTIVE SPIROMETER?

An incentive spirometer is a handheld device that will expand your lungs by helping you
to breathe more deeply and fully. They are also referred to as sustained maximal inspiration devices
(SMIs).

Figure 1. Parts of Incentive Spirometer

Types:
1. Flow oriented Incentive spirometry
consists of a mouthpiece and corrugated tubing connected to a manifold
composed of three flow tubes containing light weight plastic balls. The
patient inhales through the mouth piece thereby creating a negative
pressure within the tubes. This causes them to rise. The number of balls
and the level to which they rise depends on the magnitude of the flow
achieved. At lower flows, the first ball rises to a level that depends on the
magnitude of flow. As the inspiratory flow increases, the second ball
rises, followed by the third ball.
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2. Volume Oriented Incentive Spirometry
enables the patient to inhale air through a mouthpiece and corrugated
tubing which is attached to a plastic bellows. The volume of air displaced
is indicated on a scale located on the device enclosure. After the patient
has achieved the maximum volume, the individual is instructed to hold
this volume constant for 3 to 5 seconds.

You need an Incentive Spirometer if you have:

✓ After surgery
✓ Pneumonia
✓ Chronic Obstructive Pulmonary Disease
✓ Cystic Fibrosis
✓ Other conditions (sickle cell anemia, asthma, or atelectasis)

How Incentive Spirometer measurement works

The main column of your incentive spirometer has a grid with numbers. These numbers are
usually expressed in millimeters and measure the total volume of your breath.

The piston in the main chamber of the spirometer rises upward along the grid as you breathe.
The deeper your breath, the higher the piston rises. Next to the main chamber is an indicator that your
doctor can set as a target.

There’s a smaller chamber on your spirometer that measures the speed of your breath. This
chamber contains a ball or piston that bobs up and down as the speed of your breath changes.

The ball will go to the top of the chamber if you’re breathing in too quickly and will go to the
bottom if you’re breathing too slowly.

Benefits of Incentive Spirometer

✓ Improve pulmonary ventilation

✓ Counteract the effects of anesthesia or hypoventilation
✓ Loosen respiratory secretions
✓ Facililtate respiratory gaseous exchange
✓ Expand collapsed alveoli
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Using an Incentive Spirometer

1. Sit upright in a chair or in bed. Hold the incentive spirometer at eye level.
o If you had surgery on your chest or abdomen (belly), hug or hold a pillow to help splint or
brace your incision (surgical cut) while you’re using the incentive spirometer. This will
help decrease pain at your incision.
2. Put the mouthpiece in your mouth and close your lips tightly around it. Slowly breathe out
(exhale) completely.
3. Breathe in (inhale) slowly through your mouth as deeply as you can. As you take the breath, you
will see the piston rise inside the large column. While the piston rises, the indicator on the right
should move upwards. It should stay in between the 2 arrows (see Figure 1).
4. Try to get the piston as high as you can, while keeping the indicator between the arrows.
o If the indicator doesn’t stay between the arrows, you’re breathing either too fast or too
slow.
5. When you get it as high as you can, hold your breath for 10 seconds, or as long as possible. While
you’re holding your breath, the piston will slowly fall to the base of the spirometer.
6. Once the piston reaches the bottom of the spirometer, breathe out slowly through your mouth.
Rest for a few seconds.
7. Repeat 10 times. Try to get the piston to the same level with each breath.
8. After each set of 10 breaths, try to cough, holding a pillow over your incision, as needed. Coughing
will help loosen or clear any mucus in your lungs.
9. Put the marker at the level the piston reached on your incentive spirometer. This will be your goal
next time.

Repeat these steps every hour that you’re awake.

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PEAK EXPIRATORY FLOW RATE

RATE
Peak expiratory flow rate (PEFR) or simply Peak Flow Rate is the maximum flow rate
generated during a forceful exhalation, starting from full lung inflation. PEFR primarily reflects large airway
flow and depends on the voluntary effort and muscular strength of the patient.

Peak Flow Meter

A peak flow meter is a portable, inexpensive, hand-held device used to measure how air flows
from your lungs in one "fast blast." In other words, the meter measures your ability to push air out of
your lungs.

Standard-range
Peak flow meters come in two ranges:
a) Low-range
✓ A low-range peak flow meter is for small children
b) Standard-range
✓ a standard-range peak flow meter is for
older children, teenagers and adults

Who Benefits from Using a Peak Flow Meter? Low-range

✓ People with asthma, especially those with a new diagnosis or someone who takes a daily
controller medicine

Importance of Measuring Peak Flow Rate

✓ can help healthcare providers to make decisions about treatment and adjust medicines
✓ may show changes on asthma status before a patient can feel them
✓ readings can show when to start following the steps on asthma action plan
✓ can help determine the severity of asthma episode; decide when to use rescue medicine;
and decide when to seek emergency care.
✓ may help patient and healthcare provider identify causes of asthma at work, home or
play, and it can help parents determine what might be triggering their child's asthma
STEPS IN USING PEAK FLOW METER
1. Review medical record per patient’s baseline PEFR.
2. Assess previous PEFR readings and target set by patient’s health care provider.
3. Help patient to appropriate position (stand or sit up straight).
4. Assess patient’s baseline knowledge of when and how to use PEFR.
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5. Slid mouthpiece into base of numbered scale.

6. Instruct patient to take a deep breath.

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7. Have patient place meter mouthpiece in mouth and close lips firmly.
8. Have patient blow out hard and fast in one breath through mouth.
9. Monitor PEFR results, assess if patient is in expected range.
10. Inform patient of his or her acceptable range.
11. Ask patient to demonstrate recording PEFR using traffic light pattern if patient is to record at
home.
12. Ask patient to demonstrate how to use PEFR device.
13. Compare patient’s PEFR with personal best.
14. Record PEFR measurement before and after therapy and patient’s ability to perform PEFR.
15. Instruct patient to clean unit weekly (preferably before and after use) following manufacturer’s
instructions.

How to Chart Peak Flow Rates

Chart the HIGHEST of the three readings. This is called the "personal best." The chart could include the
date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0)
liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top.
You could leave room at the bottom of the page for notes to describe how you are feeling or to list any
other thoughts you may have.

NORMAL PEAK FLOW RATE

✓ A "normal" peak flow rate is based on a person's age, height, sex and race. A standardized
"normal" may be obtained from a chart comparing the person with asthma to a population
without breathing problems.

Three Zones of Measurement

(Traffic Light Colors)

1. Green Zone
➢ 80 to 100 percent of the usual or "normal" peak flow rate signals all clear. A reading in
this zone means that asthma is under reasonably good control. Continue prescribed
program of management.

2. Yellow Zone
➢ 50 to 80 percent of usual or "normal" peak flow rate signals caution. It is time for
decisions. Airways are narrowing and may require extra treatment. Symptoms can get
better or worse depending on what the patient do, or how and when he used his
prescribed medication. The patient and healthcare provider should have a plan for yellow
zone readings.

3. Red Zone
➢ Less than 50 percent of usual or "normal" peak flow rate signals a Medical Alert.
Immediate decisions and actions need to be taken. Severe airway narrowing may be
occurring. Take rescue medications right away. Contact healthcare provider immediately
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and follow the plan given for red zone readings.

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POST TEST

A link will be sent by the instructor.

REFERENCE

https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-
asthma/measuring-your-peak-flow-rate. (2020, May 27). Retrieved from American Lung
Association.
https://www.mskcc.org/cancer-care/patient-education/how-use-your-incentive-spirometer. (2019, June
27). Retrieved from Memorial Sloan Kettering Cancer Center.
Neuspiel, D. R. (2020). Peak Expiratory Flow Rate Measurement. Medscape,
https://emedicine.medscape.com/article/1413347-overview.
Yetman, D. (2020, March 27). https://www.healthline.com/health/incentive-spirometer. Retrieved from
healthline.

REFERENCES

Berman, A., Snyder, S., kozier, B., & Erb, G. (2007). Kozier & Erb's FUNDAMENTALS OF NURSING
Concepts, Process, and Practice 8th Edition. Pearson Education South Asia PTE. Ltd.

Kumar, A. S., Alaprthi, G. K., & et.al. (2016). Comparison of Flow and Volume Incentive Spirometry on
Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical
Trial. Journal of Clinical and Diagnostic Research.

Perry, A. G., Potter, P., & Ostendorf, W. (2018). Skills Performance Checklists for Clinical Nursing Skills &
Techniques 9th edition. Elsevier (Singapore) Pte. Ltd.

REFLECTION

➢ How can you as a nurse, encourage cooperation in using Incentive Spirometry for GERIATRIC
and PEDIATRIC patients.
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