Pt goals question

incentive spirometry encourages deep breathing by providing visual feedback while also measuring respiratory flow and volume. it increases lung volume, increases alveolar inflation and actually hyperinflates the alveoli preventing their collapse (thus preventing atelectasis and pneumonia), and promotes venous return. is is of most use for a patient on bed rest who is not able to breathe normally, can cooperate in using the device and can deep breathe effectively.

a goal is the expected result of a nursing intervention that has been ordered and performed by a nurse. for a goal of using the incentive spirometer for a patient who was admitted with pulmonary edema i would have anticipated that independent nursing interventions would have included encouraging this patient to be doing some deep breathing and coughing. pulmonary edema is fluid that has accumulated in the extravascular spaces of the lung and although it is often a complication of heart disorders it can be a chronic condition. these patients often have a persistent cough that may or may not be productive and are dyspneic, often with exertion. because their lungs are so gunked up with secretions they need to get those lungs expanded and those secretions moved up and out. an incentive spirometer would be employed to assist in that if the patient meets the criteria for it (able to breathe normally, can cooperate in using the device and can deep breathe effectively). so, the goal is quite appropriate.

i personally think that my first goal would be to reduce the pulmonary edema via collaborative care and then work on lung reexpansion since activity tolerance could possibly be increased. so my interventions after lung fields were cleared would be oob for meals to enhance lung expansion along with incentive spirometry use.

deep breathing and coughing comes under ineffective airway clearance and it can be a teaching intervention:

• deep breathing
  
  • lie supine with legs slightly bed at the knees; can also be done sitting and standing
    
  • take as deep breath as possible through the nose and allow the abdomen (not the chest) to rise
    
  • hold the breath for a count of five
    
  • exhale completely through pursed lips as if whistling allowing the ribs to sink downward and inward
    
  • rest several seconds and repeat 5 to 10 times every hour
    

  [*]coughing

  • take a slow deep through the nose and expand the chest fully
    
  • breathe out through the mouth feeling the chest sink down and in
    
  • take a second slow breath through the nose expanding the chest fully and breathing out
    
  • take a third breath in the same way but hold it
    
  • the patient should now cough two or three times (once is usually not enough) and concentrate on using the diaphragm to force the air out
    
  • follow with several normal breaths exhaling slowly
    
  • do this every 2 hours
    

priority of care. . .maslow (http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs). . .oxygenation comes first. you can't get any o2 into the airways until they are cleared of their gunk and the alveoli are opened.