COLLEGE OF NURSING

INCENTIVE SPIROMETRY

Instruction: Check on the column of your choice as to what level is the performance of the student in the following procedures. Be
guided with the scoring indicated as follows:
Level of performance -
4 Very satisfactory (Performed all the procedures correctly)
3 Satisfactory (Needs minimal assistance in performing the procedure)
2 Good (Needs more practice in performing the procedure)
1 Fair (inappropriate in the performance of the procedure)

STEPS PROCEDURE 4 3 2 1
1 Wash hands
2 Explain the procedure to the client
3 Assemble equipment needed at bedside
Attach sterile flow tube and mouthpiece to the device. Set flow rate or volume as determined by
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Physician or Respiratory Therapist.
5 Assess client’s condition.
6 Position on sitting or semi fowler’s position.
7 Auscultate client’s lungs.
8 Instruct client to insert the mouthpiece and close his lips tightly.
9 Instruct client to exhale normally, then inhale as slowly and deeply as possible.
Ask him to retain the entire volume of air he inhaled for 3 seconds or, if using a device with a
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light indicator, wait for the light to turn off then note the tidal volume.
11 Tell client to remove the mouthpiece and exhale normally.
Allow client to relax and take several normal breaths before attempting another cycle with the
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spirometer.
13 Repeat this sequence 5-10 times during every waking hour.
14 Encourage him to cough out after each effort. Observe expectorated secretions.
15 Auscultate lungs and compare findings with the first auscultation.
Instruct him to remove the mouthpiece, wash in warm water, and wipe it dry, store mouthpiece in
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a container, and label it properly.
After completing the exercise, compute the volume by multiplying the setting by the duration the
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client kept the ball suspended.
18 When using a volume incentive spirometer, take the volume reading directly from the spirometer.

Total Score :

Remarks:

Name and Signature of Student Name and Signature of RD Instructor

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UC-VPAA-CON-FORM-118_RLE Page 1 of 1
October 2015 Rev.00