Case studies in Unit 3.2 Incentive Spirometry

Name:Date: 2007

  1. Your patient is a 45 year-old WF who is s/p [status post-- or ‘after’] 1 day, cerebral surgery secondary to brain cancer. She is 5 feet 6 inches tall. While she is sleepy, she does arouse easily and can sit up on the side of the bed without help. Her breath sounds are clear and present in the basal areas.
  2. How do you want to monitor her?

Check her VS, Sp02 and her x-ray report.

Check her chart for indications or hazards for any respiratory care you might want to suggest.

  1. What therapy might you select for her?

She has no s/s of increased respiratory distress- so no supplementary 02 is needed.

Currently, she has no problem with retained secretions or bronchospasm so SVN and IS are not indicated.

  1. If you do pick IS as a reasonable therapy for her, what minimal goal and what maximal goal should we pick?

If she was a good candidate for IS—which she is not-- I would want to start her off on an initial Inspiratory Capacity of

66 inches = 100 pounds + (6x5) = 130 pounds/2.2 =59kg

At 12 ml/Kg IBW her initial setting needs to be at least 700 ml.

Her maximal goal would be about 3 x the minimum or 2100 ml.

  1. If you decided not to pick IS, why not?

Based on s/s, she doesn’t need help with secretions

Her surgery doesn’t interfere with her ability to take a deep breath.

Directed coughing is contraindicated in the face of increased intracranial pressures—we can assume this is possible with her.

  1. Your patient is a 55 year-old BM who is s/p [status post-- or after] 1 day, open heart surgery. He is 5 feet 8 inches tall. He is on a PCA and is sleepy but he is easily aroused, His respiratory rate is a bit fast at 28 and he is breathing shallowly. His breath sounds show rhonchi in the upper lobes and crackles in the bases.
  2. How do you want to monitor him?

Check his HR, Sp02 and x-ray report.

Check his chart for indications or hazards for any respiratory care you might want to suggest

  1. What therapy might you select for him?

Because of his heart problems and his s/s of respiratory distress seen with increased RR, I would put him on 1-2 lpm nasal cannula; I would reassess his VS for improvement.

Because he is post-op thoracic surgery patient within the first 3 days, I would recommend Incentive Spirometer Q1-2 hours x 3 days& I would assess the VS, BBS and the sputum for effective IS treatment

  1. If you do pick IS as a reasonable therapy for him, what minimal goal and what maximal goal should we pick?

I would want to start him off on an initial Inspiratory Capacity of:

68 inches = 105 pounds + (6x8) = 153 pounds/2.2 =70kg

At 12 ml/Kg IBW his initial setting needs to be at least 850 ml.[round up 840]

His maximal goal would be about 3 x the minimum or 2550 ml.

  1. If you decided not to pick IS, why not?

n/a

  1. Your patient is a 35 year-old LAF who is s/p [status post-- or after] 1 day, total hysterectomy [lower abdomen]. She is 5 feet1 inches tall. While she is sleepy, she does arouse easily. Her respiratory rate is a bit fast at 26 and she is breathing shallowly. Her breath sounds show rhonchi in the upper lobes and crackles in the bases. She has some wheezing in the right lung.
  2. How do you want to monitor her?

Check her Sp02 and her x-ray report.

Check her chart for indications or hazards for any respiratory care you might want to suggest.

  1. What therapy might you select for her?

If her Sp02 is lower than 90-92%, I would start her on 1-2 lpm nasal cannula and reassess her VS and her Sp02.

I would suggest we give her 2.5 mg of Albuterol or .63 mg levalbuterol PRN for wheezing before we give IS. Reassess her VS and BBS after the treatment

I would suggest we give her IS q 1-2 hours x 3 days. Assess the VS, BBS and the sputum for effective IS treatment

  1. If you do pick IS as a reasonable therapy for her, what minimal goal and what maximal goal should we pick?

I would want to start her off on an initial Inspiratory Capacity of:

61 inches = 100 pounds + (1x5) = 105 pounds/2.2 =48kg

At 12 ml/Kg IBW her initial setting needs to be at least 575 ml.

Her maximal goal would be about 3 x the minimum or 1720 ml.

  1. If you decided not to pick IS, why not?

n/a she is a good candidate for IS as long as we control her wheezing.

  1. Your patient is a 25 year-old LAM who is s/p [status post-- or after] 1 day, fracture of the hip he got in a construction accident. He is in traction. He is 5 feet4 inches tall. He is on a PCA and is sleepy but he is easily aroused, His respiratory rate is a bit fast at 28 and he is breathing shallowly. His breath sounds show rhonchi in the upper lobes and crackles in the bases.
  2. How do you want to monitor him?

Check his Sp02 and x-ray report.

Check his chart for indications or hazards for any respiratory care you might want to suggest.

  1. What therapy might you select for him?

If his Sp02 is less than 90-92%, start him on 1-2 lpm nasal cannula and reassess VS and Sp02 for improvement. Watch him closely for sudden increase in SOB and increased hypoxemia because he is at risk for a pulmonary embolism.

While strictly speaking, he is not a thoracic or upper abdominal surgery patient, he is in traction so he is immobilized; he has s/s of retained secretions and is sedated so I would suggest a IS Q 1-2 hours as long as he is in traction. As soon as he is up and out of bed DC this.

  1. If you do pick IS as a reasonable therapy for him, what minimal goal and what maximal goal should we pick?

I would want to start him off on an initial Inspiratory Capacity of:

64 inches = 105 pounds + (6x4) = 129 pounds/2.2 =59kg

At 12 ml/Kg IBW his initial setting needs to be at least 700 ml

His maximal goal would be about 3 x the minimum or 2100 ml.

  1. If you decided not to pick IS, why not?

Based on his s/s he needs IS, but if his rapid breathing persisted in the face of improving BBS, consider a pulmonary embolism.

  1. Your patient is an 85 year-old WF who is s/p [status post-- or after] 1 day, reduction of a hip fracture she got falling off her porch. She is in traction. She is 5 feet 8 inches tall. She is on a PCA and is very confused. Her respiratory rate is a bit fast at 31 and she is breathing shallowly. Her breath sounds show rhonchi in the upper lobes and diminished breath sounds in the lower lobes.
  2. How do you want to monitor her?

Check her Sp02 and x-ray report.

Check her chart for indications or hazards for any respiratory care you might want to suggest.

  1. What therapy might you select for her?

If her Sp02 is less than 90-92%, start her on 1-2 lpm nasal cannula and reassess VS and Sp02 for improvement. Watch her closely for sudden increase in SOB and increased hypoxemia because she is at risk for a pulmonary embolism.

While strictly speaking,she is not a thoracic or upper abdominal surgery patient, she is in traction so she is immobilized; she has s/s of retained secretions and is sedated so I would suggest a IS Q 1-2 hours as long as she is in traction. As soon as she is up and out of bed DC this.

  1. If you do pick IS as a reasonable therapy for her, what minimal goal and what maximal goal should we pick?

I would want to start her off on an initial Inspiratory Capacity of:

68 inches = 100 pounds + (8x5) = 140 pounds/2.2 =64kg

At 12 ml/Kg IBW her initial setting needs to be at least 760 ml.

Her maximal goal would be about 3 x the minimum or 2300 ml.

  1. If you decided not to pick IS, why not?

Based on her s/s she needs IS, but if her rapid breathing persisted in the face of improving BBS, consider a pulmonary embolism.