Incentive spirometer

From Wikipedia, the free encyclopedia

An incentive spirometer - the inhalation nozzle is towards the camera, the curved plastic on the left is a handle, the plunger
is in the middle (along with an adjustable mark to indicate a goal) and on the right side is an indicator showing whether the
patient is inhaling too rapidly

An incentive spirometer is a medical device used to help patients improve the functioning of
their lungs. It is provided to patients who have had any surgery that might jeopardize respiratory
function, particularly surgery to the lungs themselves,[1] but also commonly to patients recovering
from cardiac or other surgery involving extended time under anesthesia and prolonged in-bed
recovery. The incentive spirometer is also issued to patients recovering from rib damage to help
minimize the chance of fluid build-up in the lungs. It can be used as well by wind instrument players,
who want to improve their air flow.
The patient breathes in from the device as slowly and as deeply as possible, then holds his/her
breath for 26 seconds. This provides back pressure which pops open alveoli. It is the same
maneuver as in yawning. An indicator provides a gauge of how well the patient's lung or lungs are
functioning, by indicating sustained inhalation vacuum. The patient is generally asked to do many
repetitions a day while measuring his or her progress by way of the gauge.

See also[edit]

Spirometer, a device for measuring lung capacity.

Spirometer
From Wikipedia, the free encyclopedia

A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A
spirometer measures ventilation, the movement of air into and out of the lungs. The spirogram will
identify two different types of abnormal ventilation patterns, obstructive and restrictive. There are
various types of spirometers which use a number of different methods for measurement (pressure
transducers, ultrasonic, water gauge).

PNF OF RESPIRATION
Posted on June 28, 2012

PNF OF RESPIRATION

Definition:
It is the term used to describe externally applied proprioceptive and tactile stimulus that
produces reflex respiratory movt. Responses and that appears to alter rate and depth of
breathing

INDICATION:

1-For a unconscious patients-As it is not possible to place them in optimum position for
postural drainage.

-Inadequate ventilation due to shallower monotonus resp. is a major factor in development

of atelectasis
-Inadequate ventilations- retension of secretion
Deranged mech. ventilation or resp. function is another complication of lack of muscle tone
and instability of chest wall.
-Stiff chest as a result of lack of costal muscle.

2-As a relaxation procedure to conscious patient like CVA and GBS.

Application of PNF result:

1-Visible deeper inspiration

2-larger expansion of ribs
3-Increased epigastric excursion
4-Change in R.R.
5-Involuntary coughing
6-Changes in breath sounds
7-Return of mech.chest wall stability
8-Less necesscity for suctioning
9-More normal resp.pattern
10-Increase in level of consciousness

11-Retension of new pattern by sucessive repetition.

Responses most pronounced in deeply unconscious.

Techniques:
1-Perioral pressure
2-Intercostal stretch
3-Vertebral pressure
4-Co contraction of abdomen
5-Anterior stretch basal lift
6-Sustained manual pressure

Perioral pressure:
Procedure-Stimulation is provided by applying firm pressure to patients upper lip
-Pressure is maintained for the length of time that the therapist wishes the pt.to breath in
activated pattern.
PRECAUTIONS-Keep the side of finger on lip to prevent occlusion of nasal passage and use of
surgical gloves

Observation:

The response to this stimulus is a brief period of apnea followed by increased

epigastric excursions (approx-5 sec)

As the stimulus is maintained the epigastric excursion may increase so that movt is
transmitted to upper chest and the pt. appears to be in deep breathing.

R.R. may become slower.

When this is applied to unconscious patient-if the mouth is open it will close, swallowing

noted and sucking movt. are evident even in the presence of oral airways

Movt in chewing ,sucking ,swallowing have been reported in stroking the lips in
comatose pt. due to infantile rooting reflexes.

Studies reveal that perioral pressure to reduce spastic m/s tone .it said that perioral
pressure would inhibit hypertonus and that if the pt.mouth was open the pressure will
close it.

Some uses the stimulus as a method of relaxation.

Intercostal stretch:

Mech-Reflexive activation of diaphragm by intercostal afferents and its margins.

Procedure:This is provided by applying pressure to upper border of a rib in order to

stretch the intercostal m/s in a downward direction(not inward)

Application of stretch should be timed with exhalation

Maintain till pt. achives normal breathing pattern

Can be performed unilaterally or bilaterally on any rib with exception of floating ribs or
fractured

Observation-The response to this stimulus is a gradual increased in resp. movt. In the

area under and around the stretch.

PRECAUTION-Care must be exercised around the female mammary tissues.

-when performed over area of instability as in the presence of paradoxical movt. in upper rib
cage over areas of decrease mobility this is an effective procedure
Vertebral pressure:

Pressure is applied to uppermost thoracic vertebrae results in increase epigastric

excursion in the presence of a relaxed abdominal wall.

Pressure over lower thoracic vertebrae results in inspiratory movt. of apical thorax

Mech-Firm pressure is applied directly over the vertebrae of the upper and lower
thoracic cage activities the dorsal intercostal muscles

-Pressure should be applied with an upper hand for comfort and must be firm enough to
provideintrafusal stretch.
-so patient shoud be in supine position to eliminate stabilization of patient and to observe
patients relaxation.
In every intercostal space the dorsal part of external (insp) & dorsal part of inter (exp)
intercostal m/s are antagonistic during quiet breathing.

Co contraction of abdomen:

Observation-Increase epigastric movts.

-increase tone in abdominal m/s activation of diaphragm

-decrease girth in obese
-depression of umblicus

Pressure is directed across the abdomen produces intrafusal stretch ,thus activating
the m/s spindle side contralateral to pressure reached first.AS

As those m/s stretched and shortened they stretch the intrafusal fibre of opposive
m/s and vice versa and cycle goes on..

This should be done bilatrally with pressure applied alternately and maintained for some
seconds on either side
Anterior stretch basal lift:

Procedure-Placing the hands under the ribs of the supine patients and lifting gently
upwards.

Done uni or bilaterly

Observation-As the lift is sustained stretch is maintained and increasing movt. Of the
ribs in a lateral and post direction can be seen and felt.

Increased epigastric movt. Also often becomes obvious

The lift to back places stretch to the spaces between some of the mid thoracic ribs.

The epigastric movt.suggest that the diaphragm is being activated by intercostals.

Dr.vikas dwivedi