RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |JAMUNA LAXMI MAHARJAN |

| | |I YEAR M.Sc. NURSING STUDENT |

| | |Smt. NAGARATHNAMMA COLLEGE OF NURSING, |

| | |ACHARYA DR.SARVEPALLI RADHAKRISHNAN ROAD,BANGALORE – 90 |

|2. |NAME OF THE INSTITUTION |SMT. NAGARATHNAMMA COLLEGE OF NURSING, |

| | |ACHARYA DR.SARVEPALLI RADHAKRISHNAN ROAD,BANGALORE – 90 |

|3. |COURSE OF STUDY AND SUBJECT |I YEAR M.Sc. NURSING |

| | |MEDICAL-SURGICAL NURSING |

|4. |DATE OF ADMISSION TO COURSE |15.06.2012. |

|5. |TITLE OF THE TOPIC |EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME(STP) ON KNOWLEDGE AND PRACTICE |

| | |REGARDING ‘ARTERIAL BLOOD GAS (ABG) ANALYSIS,’ AMONG UNDERGRADUATE NURSING |

| | |STUDENTS,IN A SELECTED EDUCATIONAL INSTITUTE, BANGALORE. |

| | | |

|6. |BRIEF RESUME OF THE INTENDED WORK: |

| |INTRODUCTION: |

| |‘If you give a man a fish he will have a single meal; |

| |If you teach him how to fish he will eat all his life.” |

| |Kaun Tzer |

| |Arterial blood gas (ABG) analysis provide valuable information about a patient’s status ,the underlying cause of the imbalance, |

| |the body’s ability to regulate pH, & the patient’s overall oxygen status.1 |

| |Blood gas analysis is a basic and useful laboratory test for the critical care of patients. Arterial blood gas analysis is an |

| |essential investigation for assessing clinical oxygenation and acid-base status in critically ill patients, providing information|

| |about ventilation, oxygenation, and acid-base status, the three closely & interrelated physiological parameters that maintain pH |

| |homeostasis.5 Non-invasive methods, such as pulse oximetry, transcutaneous monitoring of oxygen and carbon dioxide, and end tidal|

| |carbon dioxide have been proven to be useful, but they do not give information about pH, PO 2 , BE and bicarbonate.6 |

| |Arterial blood gas analysis is used to measure the pH and the partial pressures of oxygen and carbon dioxide in arterial blood. |

| |Disorders of acid–base balance can lead to severe complications in many disease states, and occasionally the abnormality may be |

| |so severe as to become a life-threatening risk factor. The process of analysis and monitoring of arterial blood gas (ABG) is an |

| |essential part of diagnosing and managing the oxygenation status and acid–base balance of the high-risk patients, as well as in |

| |the care of critically ill patients in the Intensive Care Unit. 4 |

| | |

| |Arterial blood gas (ABG) sampling represents the gold standard method for acquiring patients′ acid-base status. The most common |

| |complications associated with arterial puncture are pain, arterial injury, aneurysm formation, hemorrhage, and thrombosis with |

| |distal ischemia. The risks increase with repeated arterial punctures, especially with insertion of a catheter when performed by |

| |inexperienced individuals. Additionally, this procedure carries a small but appreciable risk of needle stick injury to health |

| |care workers, with the consequent risk of transmission of blood borne viruses such as hepatitis C and human immunodeficiency |

| |virus (HIV).6 |

| |Interpretation of arterial blood gases (ABGs) is an essential assessment skill for the PACU nurse. ABG analysis can be fun and |

| |exciting, as well as an important tool for patient care. Acid-base imbalances are associated with various clinical conditions. |

| |Using ABGs as an assessment tool, the PACU nurse can determine the patient's acid-base status and initiate prompt, appropriate |

| |nursing intervention and medical consultation.8 |

| |Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care|

| |personnel. ABG interpretation is especially important in critically ill patients.3 |

|6.1 |NEED FOR THE STUDY |

| |Nurses are integral part to health care delivery and it is important that they have a clear understanding of the nature of the |

| |procedures that they would have to perform for the patients. The under-graduate students are the future nurses, responsible for |

| |providing the nursing service, so it is necessary to have the knowledge of ABG assessment & analysis. Adequate knowledge on the |

| |arterial blood gas (ABG) analysis & it’s interpretation in a crucial situation is important to handle any critical situation to |

| |save the life. |

| | |

| |Arterial blood gas (ABG) analysis is an essential part of diagnosing and managing a patient's oxygenation status and acid-base |

| |balance. Disorders of acid-base balance can create complications in many disease states, and occasionally the abnormality may be |

| |so severe so as to become a life-threatening risk factor.4 |

| |More than 5 million patients are admitted annually to ICUs in the United States with respiratory insufficiency/failure, |

| |postoperative management, ischemic heart disorder, sepsis, and heart failure. Treatment of many serious conditions has become |

| |more frequent, including gastrointestinal hemorrhage, hemodynamic abnormalities, multiple organ system failure, respiratory |

| |insufficiency or failure, sepsis, and shock. Also evident is the dramatic rise in patients 85 years and older, from 4.1% in 1991 |

| |to 6.9% in 2004. Between 2000 and 2020, the population younger than 65 years is expected to grow by about 10%, while the number |

| |of individuals 65 years and older is projected to rise by approximately 50%. Frequently, patients in the ICU require ventilatory |

| |or cardiovascular support, invasive monitoring, and intensive observation by nursing and physician staff members. The leading |

| |causes of death in the ICU are multi-organ failure, cardiovascular failure, and sepsis. Multi-organ failure has a mortality rate |

| |of 11% to 18%. Sepsis, the second leading cause of death in non-coronary ICUs, carries a mortality rate of 25% to 30%.26 |

| | |

| |In the 55th annual report (2010-2011) of all India Institute of Medical Science ,New Delhi mentioned along with many other |

| |investigations arterial blood gas analysis test done is 36000.Special investigations in ICU monitored 24 hours.27 |

| | |

| |Neonatal & Pediatric literature found concerning correlation of paired capillary & arterial measurements of pH& PCo2 done by |

| |different investigation on different year found are 116 samples from PICU, patients(including 8 neonates ) with |

| |varying,pathologies,28% of patients ventilated,33 premature infants admitted to NICU,birth weight range 635-2500g;75 samples from|

| |PICU patients from0.6-134months(including 8 neonates) with various pathologies.30 |

| | |

| |A study conducted on the nursing personnel working in the critical care units shows that the nurses take an active part in |

| |collecting ABG samples, their knowledge in interpreting ABG reports is inadequate and in all the learning need areas, the |

| |expressed learning need as “Necessary” and “Desirable” were 100%. The study shows that the teaching protocol was found to be |

| |effective in promoting the knowledge level of nursing personnel on “nurses’ responsibility in ABG analysis (t29=6.529, P ................
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