Funda - Oxygenation - Situation 1 Incentive spirometers or...

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Situation 1: Incentive spirometers, or sustained maximal inspiration devices (SMIs) are used primarily to improve pulmonary ventilation and re-expand collapsed alveoli. This is commonly used in patients postoperatively and patients with respiratory diseases. They can also be used to measure the amount of air inhaled through the mouthpiece. Mr. Tinker, a patient who is diagnosed of COPD (chronic bronchitis), was admitted to the medicine ward. Baseline data include the following: Oxygen saturation: 88%, PaO2: 70 mmHg and PaCO2: 52 mmHg. The doctor orders incentive spirometry 5 times daily to improve pulmonary function. 1. Nurse Ilidan is performing client education regarding the correct use of an incentive spirometer to Mr. Tinker. Which of the following should he include in his health teaching? a. “You should exhale as fast and hard as possible to elevate the balls or cylinder properly.” b. “You should exhale slowly and steadily to make the device work.” c. “Inhaling slowly and steadily while using the device is the correct way to make the device work.” d. “The entire device should be cleaned using soapy water once a week.” Rationale: A and B: Exhaling is done only after holding the breath. C: Inhaling slowly and steadily while the mouth is sealed onto the mouthpiece will elevate the balls or cylinders of the incentive spirometer. D: Only the mouthpiece is washable and the entire device should never be submerged in water. Source: Fundamental of Nursing by Kozier et. al., 8 th edition, 2008 2. Which of the following should Nurse Ilidan exclude in his health teachings? a. “Seal your mouth tightly around the mouthpiece.” b. “Hold your breath for about 6 seconds initially, decreasing to 2 seconds (optimal), after deep inhalation.” c. “Greater lung expansion is achieved with a very slow inspiration.” d. “Perform coughing after every incentive effort.” Rationale: A: Ensures good airflow to the device. B: After deep inhalation, the patient holds his breath for 2 seconds initially, and then exhales normally. This is gradually increased to 6 seconds (optimal). C: A very slow inspiration ensures greater lung expansion than with a brisk, shallow inspiration. D: Deep inhalation may loosen secretions, and coughing can facilitate removing them. Source: Fundamental of Nursing by Kozier et. al., 8 th edition, 2008 3. Mr. Tinker has been using an SMI for about 2 day. Which of the following objective data would best indicate that adequate ventilation of the alveoli is achieved? a. a sustained elevation of the balls or cylinders b. the balls or cylinders snap to the top of the chamber c. the balls or cylinder rises and falls very quickly d. the balls or cylinder rises quickly and falls slowly
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Rationale: A: This means that the patient is able to hold breath. This ensures that the alveoli are adequately inflated ventilated. (Odd answer wins) B, C and D: If the ball or cylinder rises quickly or snaps to the top, then this means that the patient is inhaling too rapidly. These are all incorrect practices. Instruct the patient to
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Funda - Oxygenation - Situation 1 Incentive spirometers or...

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