2
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Mr.Bala prathap king
M.Sc(N) Ist year
Medical Surgical Nursing
Year 2008-2010
Cauvery College of nursing
Mysore-15
ANNEXURE-1
Rajiv Gandhi University of Health Sciences Karnataka,
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 / Name of the candidate and address(in block letters) / K.G.BALAPRATHAP KING
CAUVERY COLLEGE OF NURSING ,
242, 3rd FLOOR BIBI AESHA MILLI HOSPITAL BANNIMANTAP,
SUBHASH NAGAR,
MYSORE- 570015.
2 / Name of the institution / CAUVERY COLLEGE OF NURSING
3 / Course of study and subject / MASTER IN NURSING
MEDICAL SURGICAL NURSING
4 / Date and admission to course / 30-06-2008
5 / Title and topic / A STUDY TO DETERMINE THE EFFCTIVENESS OF PRE-OPERATIVE TEACHING ABOUT EXERCISES IN PREVENTION OF POST-OPERATIVE COMPLICATION AMONG PATIENTS SUBJECTED TO ABDOMINAL SURGERIES.
INTRODUCTION
“LIFE IS NOT JUST LIVING, IT’S LIVING IN HEALTH”
Health is a state of complete physical, mental and social well being and not merely the absence of any disease or infirmity (WHO 1948). Health of the each individual is maintained by diet, exercise and day to day activities. The goal of the entire medical fraternity is maintaining sound health and attainment of health for all by year 2015 A.D.
Diseases can be cured by either medical interventions or surgical interventions. Surgery may be elective in which it is carefully planned and anticipated. The need for surgery may sometimes arise with sudden and unanticipated urgency and is called emergency surgery.
Blachwell says that significant pulmonary complications have been estimated to occur in 20% to 70% of patients following abdominal surgery. Atelectasis is the most frequent pulmonary complications during first 48 hrs after surgery.
Lounius (1999) found that DVT and its complications including pulmonary embolism are major health problem resulting in more than 2, 60,000 hospital administration and 1, 00,000 death in each year. To minimize the patient morbidity and mortality early diagnosis, treatment is essential.
Gallicher (2004) suggested that the nurse plays a significant role in preparing the patients for surgery, maintaining surveillance of the patient during surgery, prevention of complication and facilitating recovery.
Keeran and Richard (2005) in a meta analysis of research on pre – operative education said that providing people with education before surgery has a beneficial one. The effective pre – operative teaching has been associated with reduced anxiety level. Earlier ambulation leg exercises, breathing exercises will reduce post operative complications and increased involvement in post discharge self care activities (Kimata 2001).
Johnson, Rodraging and Meckar (1992), one of the most important responsibility of nurse in pre – operative preparation of the patients for surgery is pre – operative education. Pre – operative teaching helps to relieve emotional stress and prevention of complications. So nursing interventions should be directed to prevent complications and the client can return to the highest level of possible functioning. Pre – operative information helps to lessen anxiety, reduce the amount of anaesthesia needed, decreases post surgical pain for the rapid wound healing.
Pre – operative teaching on post – operative exercises is shown to have the highest level of functioning possible among the abdominal surgery patients. Therefore, the nursing practice is patient centred rather than task centred. Patient’s education is the best way to prevent post – operative complications and the nurses are having more responsibility to provide patients education.
NEED FOR STUDY
Surgical procedure can disrupts the patient’s personal, professional, economic life and the physical body. For surgery when a client is under general anaesthesia, the lungs do not ventilate fully. The discomfort of anabdominal or thoracic incision inhibits inspiration. The abdominal pain induces voluntary and reflex muscle spasm affecting primarily the abdominalmuscles and the diaphragm. This leads to more rapid but shallow respirations, poorly expanding the lower lobes of the lungs (Bonica 1999).
In 21stcentury, advances in anaesthesia, surgical environment and technology have allowed more predictable and safer outcomes for patients. Along with medical field, nursing profession has also made vast studies. In spite of those advances post – operative complications are quite common. Nursing profession has moved from the “cure” model to “care” model. The prevention and health promotion is recognized as an important function of the nurse contemporary. Patient’s education regarding post – operative exercise is the best way to prevent post – operative complication and to enhance the good health status of the abdominal surgery.
Callaghan (2002)stated that pre – operative teaching combined with post – operative exercise helps the patient to wear of physiological effects of anaesthesia, stimulates peristalsis movements and reduces the post – operative complications like pneumonia, circulatory problems. It increase the ventilation and reduces stasis of bronchial secretions in the lungs, reduces the possibility of post – operative abdominal distension, prevents stasis of blood, increase the rate of healing in abdominal wound.
Domina and Keran (1998) say that pre – operative teaching of respiration exercise reduces the post – operative pulmonary complications and hospital stay. Patients with thick, copious secretions may benefit from post – operative breathing and coughing exercises.
The National Health Care Quality Report, 4 in every 10 Indians suffer from post – operative complication after abdominal surgery. Hence, health experts are givingimportance to exercise like early ambulation, breathing exercise, coughing exercise, leg exercise and turning exercise to treat it rather medicine alone. The incidence of post – operative complication is 26.78% in among men, while the incidence rate is 27.65% among women.
(Greta 2000).
In clinical experience in surgical wards, found that pre – operative teaching regarding post – operative exercise was not given more importance in nursing care, many patients developed post – operative complications which motivated the researchers to do a study on The effectiveness of pre – operative teaching on post – teaching exercise in preventing selected post – operative complication of patients subjected to abdominal surgeries.
OPERATIONAL DEFINITIONS
Effectiveness: it refers the desired change can be bought about by teaching programme, in the respiratory status, blood flow and wound healing process as a result of post – operative exercise.
Pre – operative teaching: it refers to video assisted teaching about post – operative exercise which includes breathing, coughing exercise, early ambulation, turning and leg exercises given one day before surgery.
Post – operative exercise: it refers to specific exercise after 16 – 24 hrs of the surgery such as deep breathing, coughing exercise, early ambulation, turning and leg exercise which is to be followed to improve ventilation, circulation and enhance wound healing and prevent complication.
Post – operative complication: it refers to specific problem such as respiratory complications, DVT, wound infection and delayed wound healing occur in the post – operative period due to lack of post – operative exercise
ASSUMPTIONS
· Those who are undergoing surgery prone to multiple physiological complication.
· Early ambulation includes deep breathing, coughing exercise, leg exercise predictably reducing the chance
respiratory complications, deep vein thrombosis and escalate wound healing process.
REVIEW OF LITERATURE
The need for healthy body and mind to lead a happy life has been felt by people for centuries. People have more health conscious in their day to day life styles. Exercises have many well documented benefits for weight control and prevention of disease.
The post – operative exercises help to reduce the circulatory and respiratory complications among the patients who are undergoing abdominal surgery.Review of literature is discussed under the following headings:
1. Comprehensive review of prevalence of post – operative complication
2. Post – operative exercises in preventing the post – operative
complication
1. Comprehensive view of prevalence of pre – operative complication:
Simon (2004) reported that over 2, 60,000 hospital admissions are undergoing surgery. In Meta analysis of epidemiological studies of India. It was reported that about 35% to 39% of patients were affected by complication after abdominal surgery. It was concluded that Atelectasis, pneumonia, pleural effusion, respiratory infection.
Filardo and Faresin (2002) reported that pneumonia was the frequent event 34% followed bronchi constriction 17%, acute respiratory failure 13%, and bronchial constriction 2% and also stated that these complication seen between ages above 56 years old.
Sharma (2000) stated that 70% clients destroyed pulmonary complication after surgery reported that post – operative complication contributes the overall peri – operative morbidity and mortality.
Chandra and Robinson (2003) stated that the post – operative pulmonary complications in the abdominal surgeries are at significant source of morbidity, mortality and prolonged length of stay in hospital. Patient related risk factors are COPD, recent cigarette use, poor general health and laboratory parameters.
Crossland (1999) stated that respiratory complications are the most lethal responsible for 5% to 35% of post – operative death. It reveals because of decreased vital capacity and functional capacity after abdominal surgery.
Kilpadi Dorna and Mathew (1999) conducted a prospective study on respiratory complications over a six month period with a total sample of 584 executive patients who underwent elective or emergency surgery and found that 81 of them (13.9%) has respiratory complications. Pneumonia was the most common complication (68%).
Handoanda, Travere and Savoce (2001) reviewed the survey of nosochomial infection. They included all hospitalized patients (116) covered those who stayed less than 40 hours. The result showed that 19 patients have nosochomial infections.
Locombe (1992) stated that lower respiratory tract symptoms are associated after abdominal operation. They found about 2.4% patients developed lower respiratory tract infection.
Hollis (2000) stated that 90% pulmonary emboli originate from the lower extremities. The risk of developing pulmonary complications is highest in patients undergoing cardiac, thoracic and upper abdominal surgery.
Hargghar (2001) found that biliary breakage, wound dehiscence of abdominal wall and hepatic failure and major post – operative complications. Ineffective wound healing may be because of wound infection, wound dehiscence,and evisceration.
Smentana (2003) identified that deep breathing exercises, incentive spirometry and epidural anaesthesia reduce the risk of post – operative complications in cardiac and abdominal surgical clients.
2. Post – operative exercise in preventing the post – operative complications
The peri-anesthesia nurse in instrumental in managing and preventing complications associated with abdominal surgery in order to prevent the morbidity and mortality. The nurse must be familiar with the treatment and complication related to surgical procedure. Although, complication occurs in patient’s due to poor nutrition, immobilization and impaired circulation (Anielsk , 2000).
Kathleen and Hall (2004) say that exercise and activity are basic human needs. They must be met in both health maintenance and rehabilitation. Movements and exercise for breathing, muscle joint, body systems are importance to health person in order to meet the daily activities.
Gan, et al. (2000) said that exercise training leads to numerous changes in muscle structure. There is an increase in number of mitochondria per muscle fibre in higher level of oxidative enzymes, a slower utilization of muscle glycogen and blood glucose a greater reliance of fatty acid oxidation.
Breathing exercise helps to use entire lung and keep chest muscles active. Lungs do not more oxygen with each breath and to breathe with less effort. Breathing exercise also can reduce symptoms caused by anxiety and stress. Anxiety and stress increase the heart and breathing rate and increase the body’s demand for oxygen. Learning to control breath rate is a big benefit. (University of Michingam Health Syste , 2005).
Jullia (2000) suggest that the common technique, to reduce the work of breathing and improving the efficiency of ventilation are positioning, breathing technique and mobilization. Mobilization is the key to optimize, not only the efficiency of ventilation but also cardiovascular and musculoskeletal training.
Johnston (1999) studied the effect of deep breathing and ambulation after surgery. Findings show that both exercise and ambulation significantly increase minute ventilation. During deep breathing exercise patients had large significant increase initial volume, while the respiratory rate decrease non – significantly by comparison ambulation cost small increase in tidal volume and respiratory rate.
Bake (1999) in a study on the effects of breathing exercise in connection with abdominal surgery is effective in preventing pulmonary complications especially in high risk patient such as obese person.
Clagett (2002) suggested that active movement like ankle dorsiflexion, plantar flexion and subtalar inversion promotes the highest blood supply to the extremities than passive movements.
Feig (2003) emphasized that low molecular heparin along with ankle, foot exercise, elastic compression helps to reduce the thromboses formation among the risk groups those who underwent hysterectomy and mastectomy.
Linda (1995) stated that compression stockings device usage in post operative patient was effectively reducing the occurrence of venous stasis.
Selvinjose (2002) did a study on effective of pre – operative teaching on post – operative exercise in abdominal surgery patients and it was found to be very effective in preventing the post – operative complications.
OBJECTIVES
1. Assess the respiratory parameters and risk of venous stasis of patients subjected to abdominal surgery in
experimental group and control group pre – operatively.
2. Assess respiratory status, risk of developing deep vein thrombosis and wound status of patients undergoing
abdominal surgery in post – operatively.
3. Compare the post – operative respiratory parameter and sign of deep vein thrombosis, wound status between
control group and experimental group.
4. To associate the respiratory parameter and sign of deep vein thrombosis, wound status of patients underwent
abdominal surgeries with demographic variables.
STATEMENT OF THE PROBLEM
A study to determine the effectiveness of pre-operative teaching about exercises in prevention of post-operative complication among patients subjected to abdominal surgeries at K.R.H. hospital, Mysore .
Material and methods
Method of collection of data
Research approach
The study will be conducted in two phases
Phase I
Survey approach will be used
Phase II
Pre experimental approach will be used in Phase II
Research design
Phase I
Descriptive survey desig will beused in phase I
Phase II
The one group pre test / post test design will be used in phase II