Nursing care
Incentive Spirometry: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Incentive spirometry is a device-guided breathing exercise used to prevent atelectasis and pneumonia after surgery or with reduced mobility. The patient inhales slowly through the mouthpiece, holds the breath for three seconds, and repeats ten times every waking hour. Most patients instinctively exhale into the device instead, which defeats the purpose and needs correcting on the first attempt.
Indications and contraindications
Incentive spirometry is ordered after upper abdominal or thoracic surgery, after cardiac surgery, and for patients with restricted chest expansion from obesity, neuromuscular disease, or prolonged bed rest. The goal is sustained maximal inspiration, which reinflates collapsed alveoli and reduces the risk of postoperative atelectasis and pneumonia. It is a prevention tool, not a treatment for established respiratory failure.
It is unsuitable for a patient who cannot generate a voluntary deep breath or follow instructions, including those who are unconscious, heavily sedated, or confused. Active hemoptysis, an unstable chest wall, recent eye, thoracic, or abdominal surgery where the breath-hold and effort could raise intracranial, intraocular, or intra-abdominal pressure unacceptably, and an unrepaired pneumothorax all warrant a hold and a call to the provider before proceeding. A patient in acute bronchospasm should have that treated first.
Getting the patient ready
Sit the patient upright, in bed or in a chair, to allow full diaphragmatic excursion; a supine patient cannot achieve maximal inspiration. Assess baseline respiratory rate, effort, and oxygen saturation before the first attempt, and treat pain proactively — a patient guarding a fresh incision will not inhale deeply no matter how clear the instructions are. Splinting the incision with a pillow or folded blanket held against the chest or abdomen reduces the discomfort enough to get a genuine effort.
Explain the purpose in plain terms: this keeps the small air sacs in the lungs open and lowers the chance of a chest infection. Demonstrate the technique once before handing over the device, and set the indicator markers to a realistic starting goal based on the patient's baseline volume rather than an arbitrary target. A rushed handover with no demonstration is the most common reason patients use the device incorrectly for days before anyone notices.
Technique and safety checks
The patient seals the lips around the mouthpiece, exhales normally first, then inhales slowly and steadily to raise the piston or float, holds that breath for three seconds, and exhales normally away from the device. Ten repetitions an hour while awake is the standard target, spaced out rather than done in one burst, since a rapid run of ten breaths back to back risks hyperventilation and dizziness without giving the alveoli time to actually recruit.
Watch the coaching indicator, not just the volume marker — most units include a second gauge showing inspiratory flow rate, and a patient pulling too fast will hit volume without the sustained hold that makes the exercise effective. The single most common error is exhaling into the mouthpiece instead of inhaling; correct this the moment it happens, because a patient who has been blowing out for two days has been doing a breathing exercise with none of the intended benefit.
What can go wrong
Overuse in rapid succession causes hyperventilation, lightheadedness, and occasionally syncope from the drop in carbon dioxide; pace the ten hourly breaths rather than clustering them. Fatigue and poor pain control cause under-use, which is the more common failure and the one most likely to be missed on a busy shift — a device left untouched on the bedside table achieves nothing.
In a patient with a fresh sternotomy or laparotomy, forceful effort against poor pain control can also discourage the patient from repeating the exercise, so timing the attempt after analgesia has taken effect matters as much as the technique itself. Barotrauma is rare with correct technique but has been reported with excessive, forced effort in patients with bullous lung disease, which is one reason the device is used to guide a sustained effort rather than a maximal forced one.
Ongoing care
Reassess technique at each rounding pass in the first 24 to 48 hours rather than assuming a single teaching session was retained; fatigue, sedation, and pain shift throughout a shift and change what the patient can actually manage. Track the volume achieved against the patient's personal baseline and document trend, not just a single reading — a plateau or decline is a cue to reassess pain control, positioning, or coach again on technique.
Auscultate breath sounds before and periodically after use to note whether crackles or diminished sounds are improving, and correlate with oxygen saturation. Continue the exercise through the recovery period until the patient is ambulating regularly and lung expansion has normalised, not just until discharge teaching is checked off.
Common exam questions
NCLEX items on this skill usually test whether you know the correct breathing pattern: a slow, sustained inhale held for three seconds, not a rapid breath and not an exhale into the device. Expect a question describing a patient blowing into the mouthpiece and asking you to identify the error, or a stem asking for the correct frequency, which is ten times an hour while awake.
Other items test contraindications and positioning — recognising that a supine, sedated, or uncooperative patient is not a candidate, and that upright positioning is required for a valid effort. A question may also present a postoperative patient guarding their incision and ask for the priority intervention before spirometry, which is adequate pain management and incisional splinting.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
How many times a day should a patient use an incentive spirometer?
Ten breaths an hour while awake is the standard target, spaced out rather than done as one continuous set. For a patient awake roughly sixteen hours a day, that works out to around 160 breaths, though the exact frequency should follow the specific order.
Why does my patient keep getting a lower reading than yesterday?
A falling volume usually reflects poor pain control, fatigue, or reverting to incorrect technique rather than true deterioration, so reassess all three before escalating. If the drop is sudden and accompanied by new crackles, reduced saturation, or increased work of breathing, notify the provider.
Can incentive spirometry be used on a ventilated patient?
No. It requires a voluntary, coordinated inhalation through a handheld mouthpiece, which a ventilated or heavily sedated patient cannot perform. Lung expansion in that population is managed through ventilator settings and positioning instead.
What should the nurse do if the patient feels dizzy while using the device?
Stop the exercise, have the patient rest and breathe normally, and reassess before resuming with longer pauses between breaths. Dizziness during incentive spirometry is almost always hyperventilation from breaths taken too close together rather than a sign of deterioration.