Marzan, Darren

N360 Ottoson
11/8/15
Week 4 Reflective Journal
Week 4: Evidence Based Practice
Select one nursing intervention you implemented for your patient today and explain the scientific
rationale for its use. Use electronic resources to select an original research article supporting its
use. Please provide at least a 10 sentence synopsis of the article and provide appropriate
reference.
A nursing intervention that I implemented for my patient was the teaching and
reinforcement of coughing, deep breathing and use of incentive spirometry. My patient was day
four post-op of an ORIF of the right acetabulum with a history of being a pack a day smoker. He
was at bedrest for most of the day and was able to ambulate with the forward wheel walker in his
room, with the nasal cannula supplementing 1-2 LPM of O2 to keep his O2 saturation above
92%. Because he had limited mobility, he was at risk for pulmonary complications. I reinforced
coughing and deep breathing for my patient to keep his airways clear as well as using the
incentive spirometry to increase the volume of air to his lungs.
According to an article written by Davis (2012), pulmonary complications can have
serious consequences including prolonged hospital stay, higher healthcare costs and negative
health outcomes. These risks and complications can be reduced by the use of therapeutic
maneuvers that increase lung volume. Incentive spirometry is the main prophylactic breathing
therapy used to reduce risk of pulmonary complications. The article explores the implications of
incentive spirometry and its applications to nursing practice. Pulmonary complications can arise
due to limited mobility, effects of anesthesia, restricted breathing, history of smoking, obesity,
among other factors. This compromises inspiration and atelectasis (collapsing of aveoli) may
occur furthering pulmonary dysfunction and reduced tidal volume. Breathing exercises and
incentive spirometry are the most beneficial to prevent respiratory complications. The steps for

IS use are easy to follow and the nurse must observe proper usage. The patient should be
positioned upright to promote optimal lung expansion, they should exhale and then close their
lips around the mouthpiece. The patient should inhale slowly until unable to do any more then
hold breathe for 2-3 seconds and exhale slowly. The process should be repeated 10 times hourly.
I regularly reminded him of this treatment and he was able to perform it properly within
my supervision as well as with the primary nurse. Through the usage of the IS and CDB, my
patient has improved their lung capacity. He went from a level of 2000 on the first day of my
care with him to 2500 on the second day. He was also able to be weaned off from the oxygen
mask to the nasal cannula. Presently he is now at 1LPM of O2 on the nasal cannula with an
oxygen saturation above 94%.

References
Davis, S. (2012). Incentive spirometry after abdominal surgery. Nursing Times. Retrieved from
http://www.nursingtimes.net/Journals/2012/07/05/l/l/s/PrRev-spirom- 120626.pdf