RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1 |NAME OF THE CANDIDATES AND ADDRES |Mr. TAMBE SHRIKANT SHIVAJI, |

| | |1ST YEAR M.Sc. NURSING. |

| | |SNEHA COLLEGE OF NURSING |

| | |BANGALORE. |

|2 | NAME OF THE INSTITUTION |SNEHA COLLEGE OF NURSING BANGALORE. |

|3 |COURSE OF STUDY & SUBJECT |1ST YEAR M.Sc. NURSING. |

| | |MEDICAL-SURGICAL NURSING. |

|4 |DATE OF ADMISSION |1-07-2011 |

|5 |TITLE OF THE TOPIC |“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING |

| | |PROGRAMME ON THE CARE OF PATIENTS WITH PACEMAKER AMONG THE STAFF |

| | |NURSES WORKING IN CRITICAL CARE UNIT (CCU) IN SELECTED HOSPITALS AT|

| | |BANGALORE”. |

|6 |BRIEF RESUME OF INTENDED WORK | |

| |6.1 NEED FOR THE STUDY |ENCLOSED |

| |6.2 REVIEW OF LITERATURE |ENCLOSED |

| |6.3 OBJECTIVE OF THE STUDY |ENCLOSED |

| |6.4 HYPOTHESIS |ENCLOSED |

|7 |MATERIAL AND METHODS |STAFF NURSES WORKING IN SELECTED HOSPITAL BANGALORE |

| |7.1 SOURSE OF DATA |SOCIODEMOGRAPHIC DATA SHEET, SELF ADMINISTERED QUESTIONNAIRE |

| | | |

| |7.2 METHOD OF DATA COLLECTION |YES |

| | | |

| | | |

| |7.3 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION | |

6. Brief Resume of the Intended Work

Introduction:

“While there are many diseases, there is, in a sense, only one health”

The heart is endowed with a specialized system for generating rhythmic electrical impulses and for conducting these impulses rapidly throughout the heart to cause contraction of the heart muscle. When this system functions normally, the atria contract about one-sixth of a second ahead of the ventricles. This orderly electrical activity must precede contraction to provide adequate cardiac output for perfusion of all body organs and tissues. The electrical impulse that signals your heart to contract begins in the senatorial node (also called the sinus node or SA node). This is your heart's natural pacemaker. The signal leaves the SA node and travels through the two upper chambers (atria).Then the signal passes through another node (the AV node). Finally, it passes through the lower chambers (ventricles).Different nerve messages signal your heart to beat slower or faster.1

The rhythmical and conduction systems of the heart are susceptible to damage by heart disease, especially by ischemia of the heart tissues resulting from decreased coronary artery blood flow. The consequence is often abnormal sequence of contraction through the heart chambers. The abnormal rhythms called dysrhythmias or arrhythmias can severely decrease the hearts ability to pump effectively, even to the extent of causing death.2

Dysrhythmias are disorder of the heart rhythm. Dysrhythmias are common in people with cardiac disorders but are also occur in people with normal hearts. Dysrhythmias are often detected because of associated manifestations of dizziness, palpitation and syncope. Abnormalities in conduction are dangerous because of reduced cardiac output, which can lead to impaired cerebral perfusion. The most common complication of dysrhythmia is sudden death.3

In 2008 dysrhythmias caused or contributed to 479,000 of more than 2,400,000 deaths in United States. Dysrhythmias are historically linked to human awareness of the strength and rhythm of the palpable pulse.4

When an arrhythmia is serious, you may need urgent treatment to restore a normal rhythm. This may include Electrical "shock" therapy (defibrillation or cardio version), Implanting a temporary pacemaker to interrupt the arrhythmia, Medications given through a vein (intravenous). Pacemakers provide an artificial SA node or purkinjie system. A pacemaker is indicated if the conduction system fails to transmit impulses from the sinus node to the ventricles, to generate an impulse spontaneously, or to maintain primary control of the pacing function of the heart. The condition may necessitate a pacemaker Ablation, Acute myocardial infarction, Autonomic nervous system failure, Cardiac surgery, Electrolyte imbalance, myocardial ischemia and Drug toxicity (antidysrhythmics).5

The population for pacemaker implant is not limited by age, sex, or race. Over 100,000 pacemakers are implanted per year in the United States. The occurrence is more frequent in the elderly with over 85% of implants received by those over age 65. A history of myocardial infarction (heart attack), congenital defect, or cardiac transplant also increases the likelihood of pacemaker implant.6

Pacemakers can be permanent or temporary. Temporary pacing can be used in emergent or elective situation that require limited, short-time pacing(less than 1 week). Permanent pacing is indicated for chronic or recurrent dysrhythmias that are severe, unresponsive to antidysrhythmic medication and caused by AV block or SA node malfunction.7

6.1 Need for the study

Cases of cardiovascular disease may increase from 2.9 crore in 2000 to as many as 6.4 crore in 2015. Deaths from CVD will also more than double. Prevalence rate of rural population remains lower than urban population; they will continue to increase, reaching around 13.5%of the rural population in the age group of 60-69 years by 2015.8

India, a country with more than one billion people, will likely account for 60 per cent of heart disease patients worldwide, by 2010.A study among Asian Indian men showed that half of all heart attacks in this population occur under the age of 50 years and 25 percent under the age of 40, according to the Indian organization. 9

Data on pacemaker implantation were obtained from the Medical Device Implant Supplement to the 2007 National Health Interview Survey, a nationally representative, According to national health population-based survey of 47,485 households (122,310 persons). The survey yielded an estimate of 456,482 no institutionalized adults with pacemakers (prevalence, 2.6 per 1,000). Prevalence rose significantly with age, from 0.4 per 1,000 among persons ages 18-64 to 26 per 1,000 among those ages 75 or older. Age-adjusted prevalence in males was 1.5 times that in females, and in whites 1.6 times that in nonwhites, although these differences were of borderline statistical significance. 10

A study of 52 patients with pacemaker lead–related endocarditis, hospital mortality was 7.6% and overall mortality was 26.9% after a mean follow-up of 20 months. Many operators routinely prescribe an antibiotic prophylaxis at the time of implantation to prevent such complications, although there is no present evidence that this strategy is beneficial. 11

A study was conducted on wound management and restrictive arm movement following cardiac device implantation. Recent guidelines on wound management published by The National Institute for Health and Clinical Excellence in the UK recommend covering the wound postoperatively for 48 h with a low-adherent transparent dressing and letting patients shower thereafter. Since specific guidelines for cardiac device patients are lacking, we suggest that further research address whether or not the NICE guidelines can be extrapolated to this area. Studies showed that early mobilisation and allowing a full range of arm movements following device implantation is safe. Further research must validate this findings.12

A study was conducted on Preoperative assessment of patient with implanted cardiac pacemakers and defibrillators There are more than 400,000 patients with pacemakers or implantable cardioverter defibrillators in Japan, and more patients undergoing surgery will have an implanted cardiac device. In these patients, preoperative evaluation of the indication for the implant, such as arrhythmias and ischemic heart disease, should be performed based on guideline. It is also important to determine whether a patient is pacemaker dependent, the type of device, and the programmed settings. In addition, many potential adverse interactions between electrical/magnetic activity and cardiac device function that may occur during the operative period should be assessed before surgery.13

A study was conducted on Change in quality of life in patients with permanent cardiac pacemakers the 42 subjects had moderate QOL (62.4 +/- 15.9 on a scale of 97) before pacemaker implantation and the QOL improved significantly after pacemaker implantation(p ................
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