RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON PREVENTION OF STROKE

IN YOUNG AMONG PATIENTS ATTENDING

THE OPD OF SNR HOSPITAL,

AT KOLAR DISTRICT,

KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

MRS. GARA. SARA GRACE

A.E & C.S. PAVAN COLLEGE OF NURSING

KOLAR, KARNATAKA


RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MRS. GARA SARA GRACE
A.E. & C.S. PAVAN COLLEGE OF NURSING
KOLAR – 563101, KARNATAKA
2 / NAME OF THE INSTITUTION / A.E. & C.S. PAVAN COLLEGE OF NURSING
3 / COURSE OF STUDY AND SUBJECT / M.SC. (NURSING)
MEDICAL AND SURGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 01.06.2010
5 / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION OF STROKE IN YOUNG AMONG PATIENTS ATTENDING THE OPD OF SNR HOSPITAL, AT KOLAR DISTRICT, KARNATAKA.


6. BRIEF RESUME OF THE INTENDED WORK :

INTRODUCTION :

Recover faster after a stroke. Time lost is brain lost. Start Today. 38

- Michael Morgan

Health and illness are dynamic patterns that changes with time and social circumstances, they are mutually exclusive.

The brain accounts for approximately 2% of the total body weight , in an average young adult, the brain weights approximately 1200gms.2

Stroke is the Primary Cerebro Vascular disorder. In the United States, it is the third leading cause of death after heart disease and Cancer. Approximately 7,80,000 people experience a stroke each year in the United States. Approximately 600000 of these are new strokes, and 180000 are recurrent strokes. Stroke is a leading cause of serious long – term disability.

A stroke, Cerebro Vascular accident (CVA) or “Brain attack” is a sudden loss of function resulting from disruption of the blood supply to a part of the brain. 3

Stroke is a leading cause of morbidity and mortality in industrialized countries. When it occurs in young persons, they may have a longer period of time to live with their disability and this may contribute to a lifetime of medical complications. The lost productivity of a young working person may account for cause associated with stroke exceeding the cost of stroke in an older person. Analysis of community surveys from different regions of India, a crude stroke prevalence rate about 203 per 100,000 population above 20 years of age amounting to a total of about 1 million cases. In Kolkata stroke prevalence rate is 545 per 100,000 population. 35

Many studies have shown an increased prevalence of stroke in the young (those less than 40 years) in India ranging from 18.8 to 32.0% stroke cases with a male female ratio of 1.1 : 1 corresponding figures in the US (Persons less than 30 years) and Japan are 2.8% and 7.6% respectively. 36

Recent community surveys for stroke in India identified 320 cases in 145, 456 person, indicating a crude prevalence rate of 220/10,000 population predominantly young population of India dilutes overall stroke prevalence. 39

THERE ARE TWO MAJOR TYPES OF STROKE :

1)  Ischemic stroke

2)  Haemorrhagic Stroke

ISCHEMIC STROKE :

When a blood vessel that supplies blood to the brain is blocked by a blood clot, this is called an ischemic stroke. A blocked artery may happen in two ways :

Ø  A clot may form in an artery that is already very narrow. This is called a thrombus. If it completely blocks the artery it is called a Thrombolytic stroke.

Ø  A clot may break off from somewhere in your body and travel up to the brain to block a small artery. This is called an embolism. It causes an embolic stroke.

HAEMORRHAGIC STROKE :

A second major cause of stroke is bleeding in the brain. This is called hemorrhagic stroke. It can occur when small blood vessels become weak and burst. Some people have defects in the blood vessels of the brain that is more likely. The flow of blood that occurs after the blood vessel ruptures damages brain cells. 4

Although few people are aware of this, the fact is that young people often experience stroke. The common causes of stroke in young people are the same as those of older people, high blood pressure diabetes and heart diseases are the most frequent causes of stroke for every one.5

According to WHO (2007) causes of ischemic stroke in young adults (15 – 45 years) are diverse, but undetermined etiology is common in a majority of studies. A study conducted on young adults admitted to a medical centre over a period of 27 years among 272 young patients.

The etiological diagnoses were undetermined in 36% of pts, large artery athero sclerosis in 21%, Cardio embolism in 17%, non – atherosclerotic vasculopathy in 17% and other specific etiologies in 9% while the first study period (1974 – 1988) 45% upto were diagnosed with uncertain etiology.In the last period (1989 – 2002) only 26% were diagnosed with cryptogenic stroke. They concluded today specific causes i.e. non– athero sclerotic vasculopathy, large artery atherosclerosis, cardio embolism and haemotological disorders are identified in the majority of patients. 6

Preeclampsia effects 3% - 8% of pregnancies in United States. Pre eclamsia is known to an important risk factor for pregnancy associated stroke.7

A population based case – control study of risk factors for ischemic stroke in women ages 15 – 44 years from (1992 – 1996; 2001 – 2003) examined the independent association between a history of pre eclampsia and the likelihood of ischemic stroke. After multivariable adjustment for age, race, education and the number of pregnancies , women with a history of preeclampsia were 60% more likely to have a non – pregnancy related ischemic stroke than those without a history of Preeclampsia. 8

The following life styles changes may help prevent a stroke. They are to avoid fatty foods, follow a healthy low fat diet, to avoid alcoholic drinks, to exercise regularly for 30 minutes a day if the person is not overweight, 60-90 minutes a day if the person is overweight, to quit smoking, and also every one should keep their blood pressure below 140/90mm of Hg. All should follow Doctor’s treatment recommendations if the person have high blood pressure, diabetes, high cholesterol and heart diseases.

The sedentary lifestyle and demanding work culture, today, more and more youngsters in their 20’s are being diagnosed as high BP patients. Thus, a daily exercise regime and healthy lifestyle is highly recommended.49

People with diabetes tend to develop heart disease or have strokes at an earlier age than other people. The prevention and reduction of metabolic syndrome is essential to reduce cardiovascular and cerebro vascular diseases and to save lives pointing to the regular check – ups and such as diet and exercise with modest weight loss and moderate physical activity. Young people with pre – diabetes can delay or prevent type 2 diabetes and lower their risk of heart disease and stroke. 28

National survey of stroke reports that the case – fatality rate for young patients aged 15 – 45 years with stroke was 20.4%. Young adults with stroke deserve an extensive but tailored evaluation, which should include angiography and echocardiolgraphy.29

Drug abuse is becoming increasing importance as the risk of stroke in young is severe. Isolated angiitis of the central nervous system, heritable disorders of connective tissue and genetically determined disorders like, mitochondrial cytopathies account for a small proportion of ischemic strokes in the young due to drug abuse. Educational programmes regarding the use of drugs and the adverse effect of drug dependency will be helpful in preventing stroke among young people. 12

Since, stroke can happen to any one we should all be aware of these symptoms and know how to recognize if some one around as has this problem. A stroke can happen with no obvious cause, to people of any age. The factors known to increase the likelihood of stroke cannot be changed but some other risks may be reduced by lifestyle changes or medication . 9

6.1 NEED FOR THE STUDY.

People believe that only the elderly can get strokes. However, 20 – 30% of all strokes in India occurs under 45 years of age. More than 200 people die of stroke every day in our country. Compared to heart attacks the awareness about brain stroke is very limited. Over 250 persons in a

population of 100000 are struck by brain attack and about 20% of heart patients are susceptible to it.50

According to statistics by the World Stroke Organization (WSO) one in every six individual has a stroke at least once in their life time. In India the situation is equally grave with around two lakh people getting an attack every year. Around 20% of the stroke victims in India are less than 40 years of age and stroke has now been declared as the third most common cause of disability in the country after heart attack and head injury. Of late, there has been an increase in the number of youth victims of stroke between the age of 10 and 40 years49.

Stroke in young is the most common cause of disability and dependence. More than 70% of stroke survivors remains vocationally impaired and more than 30% require assistance for their activities.

Cerebro vascular diseases play an important world wide role in the morbidity and mortality of young adults posing serious medical, Socio – Economic and rehabilitation problems. The earliest report on prevalence of stroke in young in India was from Vellore, which estimated 0.56 per 1000 population. A study in Karnataka estimated 1.18/1000 and 0.98/1000 prevalence in Urban and Rural areas respectively. The prevalence rose to 1.514 per thousand in Karnataka in recent studies. Studies in India suggest that the prevalence of stroke in young in Indian population to be two per one 1000 Individuals36.

The stroke association UK states that every year, over 130000 people have a stroke. One person in every five minutes is experiencing stroke. Any one can have stroke, including, young people, children, and even babies. A Stroke is the third most common cause of death in the U.K. and it is the single most common cause of severe disability. Stroke is an emergency, stroke is the third biggest killer disease, the situation is similar through at the world. Almost one in 4 men and on one in 5 women aged 15-45 can expect to have a stroke.5

Contrary to a common view, Ischemic stroke under the age of 45 is not rare. In the Lausanne stroke Registry, more than 10% of the patients were with in this age limit. Overall, the causes of stroke in the young adult do not really differ from those in the older individuals.22

Women have a one in five chances of having a stroke during their life time. Younger women have unique risks during their child bearing years because of pregnancy, pre eclampsia and the use of contraceptives. In addition, menopause represents a risk because of the potential for increasing blood pressure , low density lipo protein cholesterol, abdominal obesity, insulin resistance, and decreasing high density lipo protein cholesterol. 51

One study found that medical costs in the year following a young stroke is approximately $43,000. Young stroke survivors often experience decades of weekly therapy sessions, seizure and spasticity medications, orthotics , behavioural interventions etc.

Although cerebral infarction is predominantly a disease of the senescence, its occurrence in younger age group is not rare. Stroke in the young is particularly tragic because of the potential to create a long term burden for the victims, their families and the community. The causes of Ischemic stroke in young adults are many and diverse. Such patients usually require more extensive investigations in order to find an underlying cause than more elderly patients.12

One study found that during 7 years (1960 – 67) , 69 patients younger than 45 years were admitted after an acute first stroke to 3 hospitals in Jerusalem. The annual incidence per 100000 was estimated to be 2.5 for those younger than 34 years and 22.2 for the age 35 to 44 years and was higher in females. In 600000 Jewish residents in North Israel during 1 year , 15 strokes in patients younger than 45 years were identified prospectively. During 15 years (1974 to 1988) 171 female ages 17 to 45 years were referred to rehabilitation institution after a first stroke18.

Stroke in young is a neglected epidemic in India. India’s population is one billion plus, taking prevalence rate of 900 per 100000 in to account, stroke is then indeed occurring in epidemic proportions in India. Our knowledge about epidemiology of stroke in India is so poor.19

Unaware of the problems people develop lifestyle habits like smoking , high calorie and high cholesterol diet intake, heavy alcohol use, cocaine abuse at which directly or indirectly contribute to stroke in the young age which in turns leads severe disability and long term dependency.

ICMR (Indian council of medical research) indicate that in 2004 there were 930,985 cases of stroke in India with 639,455 deaths and 6.4 million disability adjusted life years lost (DALY) 45.

In India the incidence of stroke is likely to rise in coming years due to

increase in population, increase in life expectancy, rapid urbanization from migration of villagers to the cities, changing life styles involving sedentary habits, smoking, excess alcohol usage and rising stress level in life.44