RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

|1 |NAME OF THE CANDIDATE AND ADDRESS |Mr.muhammad ali.e.t.p |

| | |1st year MSc Nursing |

| | |Rajiv Gandhi College of Nursing, IIT Campus, |

| | |opp. Meenakshi Temple, |

| | |Bannerghatta Road, |

| | |Bangalore – 76. |

|2 |Name of the Instituition |RAJIV GANDHI COLLEGE OF NURSING |

|3 |Course of study and subject |ist year Msc nursing |

| | |medical surgical nursing |

|4 |Date of Admission to course | o1/06/2011 |

| 5 |Title of the Topic |a study to ASSESS THE effectiveness of planned teaching |

| | |programme on incentive SPIROMETRY AND DEEP breathing |

| | |exercises on pulmonary function among copd patients admitted|

| | |in a selected hospitals at banglore. |

6. BRIEF RESUME OF INTENTED WORK:

INTRODUCTION:-

“IT WOULD SEEM ADEIMATUS THAT THE DIRECTION IN WHICH EDUCATION STARTS A MAN, WILL DETERMINE HIS FUTURE LIFE”.

Weis & Hetchman

Health is given its due importance in Alma ata declaration (1978) from this emerged the symbolic goal of WHO-health is for all by the year 2000 AD. “Prevention is better than cure” is a well known concept in the present world; believe that health is more than a non-disease state. Hence preventive and promotives aspects of health are given more important than creative aspect. Health promotion has defined by the WHO as the process of enabling people to increase control over their own health.1

Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease, chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs, causing shortness of breath. In clinical practice, chronic obstructive pulmonary disease is defined by its characteristically low airflow on lung function test.2

The pulmonary function in respiratory health status can be assessed by performing the pulmonary function tests. The parameter used in various studies includes vital capacity fixed expiratory volume. Maximal voluntary ventilation, total lung capacity, Tidal Volume and other measures line chest expansion, stain climbing time, peek expiratory flow rate.

When we talk about exercise, we nearly always refer to physical exercise. Exercise is the physical exertion of the body - making the body do a physical activity which results in a healthy or healthier level of physical fitness and both physical and mental health. In other words, exercise aims to maintain or enhance our physical fitness and general health.

Spirometry is the most common of the pulmonary function tests, measuring lung function, specifically the measurement of the amount and/or speed of air that can be inhaled and exhaled. Spirometry is an important tool used for generating pneumotachographs which are helpful in assessing conditions such as asthma, pulmonary fibrosis, cystic fibrosis and chronic obstructive pulmonary diseases.

An incentive spirometer is a medical device used to help patients improve the functioning of their lungs. It is provided to patients who have had any surgery that might jeopardize respiratory function, particularly surgery to the lungs themselves, but also commonly to patients recovering from cardiac or other surgery involving extended time under anaesthesia and prolonged in-bed recovery. The incentive spirometer is also issued to patients recovering from rib damage to help minimize the chance of fluid build-up in the lungs. It can be used as well by wind instrument players, who want to improve their air flow.

There are several methods investigated standardized and prescribed for the respiratory exercises. Deep breathing exercise considered as one such method. Deep breathing exercises have been shown to prevent respiratory infection in patient with surgeries of the chest and abdomens. 3

Chronic obstructive pulmonary disease is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with chronic obstructive pulmonary diseases trouble breathing in and out. This is referred to as airflow obstruction. Breathing difficulties are caused by long-term damage to the lungs, usually because of smoking.

If simple activities of daily living, such as eating or grooming, have you "huffing' and a puffin'," then learning how to get the most out of every breath you take by practicing breathing exercises, should be an essential part of you chronic obstructive pulmonary diseases. Dyspnea, or shortness of breath, is a result of air hunger that causes you to feel like you can't catch your breath. It is primarily due to a lack of oxygen in the bloodstream and is directly related to disturbances in your lungs caused by chronic obstructive pulmonary diseases, as well as a variety of other causes.

The patient breathes in from the device as slowly and as deeply as possible. An indicator provides a gauge of how well the patient's lung or lungs are functioning, by indicating sustained inhalation vacuum. The patient is generally asked to do many repetitions a day while measuring his or her progress by way of the gauge.

Health promotion is integral part of nursing care. There are several way, by which individual can promote their health. Exercise is one of the major elements in health promotion activities. It strengthens the circulatory, respiratory, musculoskeletal system. Respiratory exercise is given more important because, it promotes high level wellness. Respiratory exercises have psychological affect on individual’s health.

A pilot study conducted in six healthy adolescents showed an improvement in the respiratory muscles strength and endurance after fixed in incremental muscle loading exercise.4

COPD is the 6th commonest cause of death globally. In Karnataka, males had a higher prevalence of COPD 11.1 percentage compared to females 4.5 percentage. Statistics shows that chronic obstructive pulmonary disease is a leading cause of death and disability in the United States. Data from a national health survey suggests that at least 24 million Americans were affected by the disease in 2000.

To evaluate the importance of periodic deep breathing. It was found that person who had normal alveolar ventilation and V1 when they were prohibited from spontaneous deep breaths had reduced functional residual capacity and rate volume.5

They are studied the effect of incentive spirometry in 10 patients with normal pulmonary function and after the CABG operation. The result indicated that ventilation was responsible for alveolar long collapse and incentive spirometry helped to return pulmonary to normal.6

6.1 NEED FOR THE STUDY:-

WHO in 2000 estimates that prevalence of 2.7 million died of chronic obstructive pulmonary disease. About 1.5 million emergency department visits by adult 25 age and older made for chronic obstructive pulmonary disease in 2000. More emergency visits chronic obstructive pulmonary disease made by adult female than adult male.7

India facing various environment problems.70 percentage of respiratory suspended particular matter is high in Indian environment. The sources of respiratory suspended particular matter are diesel vehicle, power plant, cook stoves and industrial process emissions. Mostly, individual particles cannot be seen with the naked eye, but collectively they appear as what is called “black spot”, dust clouds, or grey hazes. Particular matter less than 2.5 micro meters in diameter is known as ‘fine’ particles. Fine particles result from fuel combustion, residential fire places and wood stone. These all suspected to be respiratory toxicant individual with pre- existing lung diseases can develop adverse health effect by routing finer particles. It reduce long function and increases long disease. Solution to be above mentioned health problem can be drawn by giving priority to preventives and promotive measures, several studies suggested the possibility that the respiratory function in normal individual also can be improved by introduction of respiratory muscles exercises. An average adult human being breaths 22,000 cu.cm of air and along with it 1600 million dust particles daily.8

In Karnataka prevalence of chronic obstructive pulmonary disease is 64.3 percentage affected chronic obstructive pulmonary disease. Prevalence of chronic cough is an important indicator of respiratory morbidity in the community.

It is known fact that our environment is the source of most disease. Communicable and non-communicable respiratory infection are one of the most common disease, it can spread from one person to another Patients admitted in the hospital are may have low immunity therefore they are exposed to a number of respiratory infections which can impair their pulmonary function.

The present study is planned with chronic obstructive pulmonary disease patients admitted in the hospital as the population may have less respiratory muscles strength. They may have Hospital acquired infection. There will be close contact in between the patients. Therefore the patients with low the level with poor exercise habits require to strengthen their respiratory capacity for maintaining physical health like any other type of muscles, the respiratory muscles also can be strengthened through regular exercise can be performed with or without the use of mechanical devices.

Deep breathing exercise selected in this study for improving the pulmonary function of the patients are simple, can be performed without any expenses or complex devices and doesn’t require a particular area in a hospital for the practices.

The second exercise included is the incentive spirometry. Incentive spirometry is a simple device. The cost of which ranges from Rs 300 – 600. The use of this spirometry requires simple instructions and individual can handle it easily. Both the exercises are found to be practical. Hence the investigator had selected these exercises as intervention straggles for improving the pulmonary function of the patients and their effect a patient’s well being through health promotion.

A review of available literature indicated that studies on the effect of the respiratory exercise on respiratory muscles strength to the individuals admitted in the hospitals are very few. The investigator was interested to apply these two methods and compare their efficacy in patients. This particular query was generated from the investigators interest in preventive health care. There is literature related to both deep breathing and incentive spirometry separately as already mentioned. But so far the investigator had not cross any published study or articles in comparing the efficacy of these two exercises. It is hoped that this study will open up a new horizon to the preventive and promotive care in relation to respiratory health.

Pulmonary disease is more prevalence in the modern day due to various types of pollutants in the environment and climate change due to this makes person handicapped. Deep breathing exercises helps to increase lung capacity. By doing this study it helps to the clients with respiratory problem to promote their respiratory system. Hence research felt a need to conduct the study to find the effectiveness of incentive spirometry and deep breathing exercises on C0PD patients.

6.2 REVIEW OF LITERATURE:-

Review of literature is organized under following categories: 1) Description about incentive spirometer and deep breathing exercise

2) Related studies on incentive spirometer and deep breathing exercises on pulmonary function. 3) Studies related to effect of incentive spirometer and deep breathing exercise on pulmonary function.

1) Description about incentive spirometer and deep breathing exercises. Incentive spirometry is designed to mimic natural sighing or yawning by encouraging the patients to take long, slow, deep breath. This is accomplished by using a device that provides patients with visual or other positive feedback when they inhale at a predetermined flow rate or volume and sustain the inflation for a minimum of 3 seconds. Incentive spirometry is also referred to as sustained maximal inspiration, is a component of bronchial hygiene therapy.9

The objectives of the incentive spirometry are to increase transpulmonary pressure and inspiratory volumes, improve inspiratory muscles performance and reestablish or stimulate the normal pattern of pulmonary hyperinflation. When this procedure is repeated on a regular basis, airway patency may be maintained and lung atelectasis prevented and reversed.10

Deep breathing exercise increases metabolism is by increasing the oxygen to the cells. Breathing deeply is a simple effective addition to a healthy lifestyle. Bringing conscious attention to our breath, lengthening and deepening the drawing in of oxygen, nourishes every cell of our body and promotes health11

A study conducted to the use of incentive spirometry following CABG surgery. It was observed that 95% of the hospitals were carrying out the incentive spirometry following cardio thorax and abdominal surgery. They also suggested that it can be used as a means of encouraging deep breathing in patients following surgery. It was an effective programme. Since it improved patient performance.12

Health promotion is a basic concept for nursing practice. Since the era of Florence nightingale health promotion has continued to be major focus for nursing as was reflected in the American nurses’ association social policy. Deep breathing exercise plays major role in health promotion of patients. Improvements in pulmonary function help in health promotion

2) Related studies on incentive spirometer and deep breathing exercises on pulmonary function

A study was conduct to determine if the addition of deep breathing techniques to standardized physiotherapist directed program of early mobilization improved clinical outcomes in potential undergoing open abdominal therapy. Fifty six patients undergoing open abdominal surgery at high risk of developing post operative pulmonary complication were randomized before operation to an early mobilization plus deep breathing and coughing group, mobility duration, frequency and intensity of breathing intervention were qualified for the groups. It was concluded that the addition of deep breathing and laughing exercises to a physiotherapist directed program of early mobilization does not significantly reduce the incidence of clinically significant post operative pulmonary complication on high risk open abdominal surgery subjects.13

A study conducted in different categories of chronic obstructive pulmonary disease in railway workers on Eastern India to evaluate the pulmonary function showed the pulmonary function test values were significantly deteriorated in all categories of chronic obstructive pulmonary disease patients as compared to normal non- smokers, significant deterioration was observed emphysematous patients when compared to other categories and chronic obstructive pulmonary disease patients.14

A survey to assess the effect of air pollution episodes on pulmonary functions and respiratory symptoms. It was found that there was decline in the pulmonary function during on air pollution episodes in the primary school children. The response persisted for 2 weeks. After 2 year again a decline in the pulmonary function was observed associated with an air pollution episode, lung functions levels were even lower after 2 weeks of the episode.15

Assessed the risk of cardio pulmonary symptoms on mortality in non smokers who were passively exposed to environment smoke. The result indicated that there was a significant reduction in the passive smokers than the control. There was positive correlation between the high exposure and increased incidence and symptoms and depth.16

3) Studies related to effect of incentive spirometer and deep breathing exercise on pulmonary function.

The study to find the effect of breathing exercises and ambulation on the pattern of ventilation in post-operative patients, during the deep breathing exercises patients had a large significant increase in tidal volume, while respiratory rate decreased non significantly. Ambulation caused small and non-significant increases in both tidal volume and respiratory rate. He concluded that if one of the aims of ambulation is to increase tidal volume. Patients might need to be encouraged to augment their tidal volume17

A study to find the effect of programmed lung exercise on the symptoms of patients with bronchial asthma attending asthma clinics. The pulmonary function was tested before giving the exercise. Then the exercise was given for 15 days and on the 15th day the pulmonary function was again tested, the patient were ached to do self assessment of the symptoms on the fourth, eighth, Twelfth and fifteenth day the result of the study showed a high significance which clearly indicated improvement and importance of lung exercise in the care of patients with asthma.18

A study among the asthma patients to find the effectiveness of diaphragmatic or abdominal breathing. There were 4 groups. One group with conventional medical treatment, second with diaphragmatic or with physiotherapy. But no breathing exercise. The result of the study indicated that there was an improvement in the condition. All the therapies showed greater improvement than medical therapy.19

A study to evaluate the effect of incentive spirometry to chest physiotherapy to prevent pro-operative pulmonary complications after thoracic surgery for lung and esophageal resections 67 patients undergoing effective thoracic surgery for lung and esophageal resections were selected physiotherapy breathing exercises laughing and coughing plus incentive spirometer was compared with Pulmonary Test alone, it was concluded that pulmonary complications after ling and esophagus surgery were relatively low. The addition of Incentive Spirometer to Pulmonary Test did not further reduce pulmonary complications or hospital stay. Although we cannot rule out beneficial effects in a subgroup of high risk patients, routine use of Incentive Spirometer after thoracic surgery seems to be ineffective.20

A survey to assess the effect of an occupational exposure to dust on respiratory health. Spirometry was used to measure the pulmonary function. The parameters selected were FVC and FEV1. The study showed reduction in pulmonary function. Parameters selected in those who had used a portable Spirometer to determine the effect of addition of incentive spirometry to post-operative pulmonary physiotherapy in reducing the pulmonary complication in patient after CABG, the result indicated no added benefit than physiotherapy alone.21

6.3. STATEMENT OF THE PROBLEM:-

A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME OF INCENTIVE SPIROMETRY AND DEEP BREATHING EXERCISES ON PULMONARY FUNCTION AMONG CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS IN SELECTED HOSPITAL AT BANGLORE.

6.4. OBJECTIVES OF THE STUDY:-

➢ To assess the knowledge of COPD patient regarding deep breathing exercises and incentive spirometer before and after planned teaching programme.

➢ To assess the effectiveness of planned teaching programme on deep breathing exercises and incentive spirometer among COPD patients.

➢ To associate pre-test knowledge of COPD patients with their demographic variables.

➢ To associate post-test knowledge of COPD patients with their demographic variables.

5. OPERATIONAL DEFINITION:

• ASSESS:-To find out the knowledge of incentive spirometer and deep breathing exercises on chronic obstructive pulmonary disease by providing skill and demonstration.

• EFFECTIVENESS:- It is the significant gain in knowledge of COPD patients with regards to incentive spirometry and deep breathing exercises as evidenced by the difference in pre-test and post-test scores

• PLANNED TEACHING PROGRAMME:-It is a teaching programme

For COPD patients regarding incentive spirometry and deep breathing

exercises.

• INCENTIVE SPIROMETER:-It is a medical device used to help the patient to improve their pulmonary function which aids in the lung expansion or to breathe deeply.

• DEEP BREATHING EXERCISE:- It is a type of diaphragmatic breathing which helps in the expansion of lung tissue surface. There by increasing the area of respiratory exchange.

• PULMONARY FUNCTION:- It refers to the functioning of the respiratory system with normal inhalation and exhalation.

• COPD: - Chronic obstructive pulmonary disease. It is the disorder that persistently obstructs bronchial air flow, and causes difficulty in breathing to the patients.

6 ASSUMPTIONS:- - 1) Increase in pulmonary function helps in relieving breathing difficulties

2) Regular exercise of the respiratory muscles increase muscle tone and expandability.

3) Planned teaching programme of incentive spirometry and deep breathing

Exercises may improve the knowledge of COPD patients

6.7 HYPOTHESIS:-

H1- There will be a significant relationship between pre-test knowledge score among COPD patients with selected demographic variables.

H2- the mean post-test knowledge score of COPD patients will be significantly higher than the mean pre-test knowledge score.

6.8 DELIMITATION:-

The study is delimited to COPD patients admitted in the selected hospital at Bangalore. The data will be collected between 4-6 weeks

7 MATERIALS AND METHOD:-

7.1 SOURCE OF DATA:-

Data will be collected by administrating of knowledge questionnaire on COPD patients before and after planned teaching programme in the selected hospital at Bangalore.

7.1.1 RESEARCH DESIGN:-

Quasi experimental design, pre-test and post- test research design.

7.1.2 SETTINGS:-

The study will be conducted in the selected hospital at Bangalore.

7.2.3 POPULATION:-

The populations included in this study are all the available COPD patients admitted in hospital at Bangalore

7.2 METHOD OF DATA COLLECTION:-

7.2.1 SAMPLING PROCEDURE:-

Convenient sampling technique will be used to select the sample for the study.

7.2.2 SAMPLE SIZE:-

60 patients who are fulfilling inclusive criteria admitted in a selected hospital at Bangalore

7.2.3 INCLUSION CRITERIA:-

-Patients who are willing to participate in the study.

-Patients who are available during the period and data collection.

-Both male and female patients admitted in the hospitals

-Patient who can able to read and write Kannada

7.2.4 EXCLUSION CRITERIA:-

-Patients who are critical condition.

-Patients who are previously trained.

-Patients who are admitted for other problem.

7.2.5 INSTRUMENTS INTENDED TO BE USED:-

PART-1: demographic variables. PART-2: knowledge questionnaire

PART-3: Planned teaching programme on deep breathing exercises and incentive spirometry.

7.2.6 DATA COLLECTION METHOD:-

Data will be collected fromC0PD patients admitted in the hospital by administering the structured knowledge questionnaire

7.2.7 PLAN FOR DATA ANALYSIS:-

1. Differential: Mean, mode, median standard deviation, percentage will be calculated.

2. Inferential: chi square and T test will be done to evaluate the effectiveness of Planned Teaching Programme.

7.3 DOES THE STUDY REQUIRE INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL?

-Yes, the study will be conducted to assess the effectiveness of planned teaching programme of incentive spirometry and deep breathing exercises on pulmonary function among COPD patients.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION:-

1) Permission will be obtained from the research committee and Rajiv Gandhi College of nursing

2) Informed consent will be obtained from the director of selected hospital at Bangalore.

3) Informed consent will be obtained from the patients of selected hospital to participate in the study.

8. LIST OF REFERENCES:-

1) http//en.wiki/adhd.

2)

3) Hall jc, tarala, tappier and hall j l, prevention of British medical journal 2001 UK London, 312(70):148-52

4) Catham K, Balduien J, Oliver W, Summer L and Friffiths H. Fix load incremental Respiratory muscle training: a pilot study and physiotherapy, 1996 New York USA; 82(7); 422-6

5) Prasanna kumari, the study to find out the effect of programmed breathing exercise. On pulmonary function in the and post-operative periods in patients undergoing mitral valvotomy, national medical journal8 (7)133-7

6) Stephen c. Changes in pulmonary function after naturally acquired respiratory infection in normal persons. American review of respiratory diseases USA newyork 1999; 20. 1057-93.

7) discussion/Adhd

8)

9) Craven JL, Evans GA, Davenport PJ, William RHP.The evaluation of incentive spirometry in the management of post-operative pulmonary complication.Br j surg 1974; 61:793-797

10) Petz TJ.Physiologic effect of IPPB, Blow bottles and incentive spirometry.Curo rev respir ther 1979; 110:567-583.

11) Pam grout “jump starts your metabolism: how to loose weight by changing the way you breathe. “Fireside 1998 30-34

12) Jerkins and Souter C, a survey into the use of incentives spirometry following CABG survey, physio theory pract 1990 London u.k; 6,117-126

13) Mackay MR. Ellis E, john stone c. Randomized clinical trial of physiotherapy after open abdominal surgery in the high risk patients. Aust J Physiother 2005 Sydney Australia; 51(3), 151-9

14) Chatterjee S, chattopaadhay BP and saha D, pulmonary function of different categories of chronic obstructive pulmonary disease in railway workers of eastern India, sangyo-ina-daigaku-zasshi 1995 17(3) 173-189

15) Hoek G, brukenreef B, hotschreuder p and lumens. Effects of air pollution episodes on pulmonary functions and respiratory symptoms, toxicology and India’s health, 1990, new Delhi India 6(5)189-97

16) Hoek G, brukenreef B, hotschreuder p and lumens. Effects of air pollution episodes on pulmonary functions and respiratory symptoms, toxicology and India’s health, 1990, new Delhi India 6(5)189-97

17) Orfanos p, Ellis e, Johnston c, effect of deep breathing exercise and ambulation on pattern in ventilation in post operative patient ,aust j physiotherapy 1999 Sydney Australia 45(3);172-182

18) jyothi T R a study to dig out the effect of programmed lung exercises on the symptom of patient with bronchial asthma attending asthma clinics, un published thesis, SNDT Women’s university Bombay 1990 India Bombay 3-11

19) Southan D J diaphragmatic or abdominal breathing in asthmatic and physiotherapy; its value in physiotherapy 1995 New York USA; 73(8) 427

20) Gosselink r, schrener k, cops, dely p froosters t, incentive spirometer does not enhance recovery after thoracic surgery. Crit care med 2000. USA 28(3) 679

21) Wild P, Refregier m, Aubrtin A, Carten B and mountinn JJ, survey of the respiratory health of workers of a factor. Occupational and environmental medicine 1997, France124-142

22) Black and Jacob medical surgical nursing (5thedition) WB sounder’s company Philadelphia

.

23) Levis, Collier and heithmper, medical surgical nursing: (4th edition) Missouri Mosby: 1996, 121-141

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|Signature of Candidate | |

| |This study can be helpful for the improvement of |

|Remarks of the Guide |pulmonary function and relieve breathing difficulty |

| |among COPD patients if they follow effectively. |

| | |

|Name and Designation of the Guide |MISS DHANALAXMI. |

| | |

|Signature | |

| | |

|Head of the department |MISS DHANALAXMI. |

| | |

|Signature | |

| | |

|Remarks of chairman and principal |The study is appropriate and can be proceeded. |

| | |

|Signature of Principal | |

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