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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

PROFORMA SYNOPSIS REGISTRATION OF SUBJECT FOR DISSERTATION TITLE

TOPIC

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING PULMONARY REHABILITATION AMONG MALE PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) IN SELECTED HOSPITALS, BANGALORE.

SUBMITTED BY:

PRAVEEN.M

FIRST YEAR MSc NURSING

BRITE COLLEGE OF NURSING

BANGALORE.

|1. |NAME OF THE CANDIDATE AND ADDRESS |PRAVEEN. M |

| | |NO: 69, CHIKKAGOLLARAHATTI, MAGADI MAIN ROAD, BANGALORE-91. |

|2. |NAME OF THE INSTITUTION |BRITE COLLEGE OF NURSING |

|3. |COURSE OF STUDY AND SUBJECT |MASTERS OF SCIENCE IN NURSING |

| | |MEDICAL SURGICAL NURSING SPECIALITY |

|4. |DATE OF ADMISSION TO COURSE | O1/09/2010 |

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

| | |TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING PULMONARY |

| | |REHABILITATION AMONG MALE PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY |

| | |DISEASE (COPD) IN SELECTED HOSPITALS,BANGALORE. |

6.0 BRIEF RESUME OF INDENTED WORK:

INTRODUCTION

“When you can’t breathe, nothing else matters”

-American Lung Association.1

Pulmonary rehabilitation is an integral part of the clinical management and health maintenance of those patients with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.2

Pulmonary rehabilitation is a rehabilitation treatment structured for ill patients with chronic respiratory problems whose pulmonary function has decreased, even after other medical treatment. It is also for patients who remain symptomatic, even if their pulmonary function has not decreased after other medical treatment. An example of somebody who could qualify for pulmonary rehab might have COPD. Pulmonary rehabilitation is a program of exercise, disease management and counselling coordinated to benefit the individual.3 Pulmonary rehabilitation has been shown to improve shortness of breath and exercise capacity. It has also been shown to improve the sense of control a patient has over their disease as well as their emotions.4

Joyce M. Black view as chronic obstructive Pulmonary disease refers to several disorders that affect the movement of air in and out of the Lungs although, the most important of these obstructive, bronchitis, emphysema, and asthma-may occur in pure form, they most commonly coexist, with overlapping clinical manifestations. The term COPD is commonly used, but some pulmonologist think it is not completely accurate and the term chronic air flow limitations may be used in its place.5 Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD although some people smoke for years and never get COPD.6

6.1 NEED FOR THE STUDY

Although COPD affects people of all ages and over all, the incidence of COPD in women than in men and higher industrialized sectors and nations. From 1980 to 2000, the death rate from COPD for women rose from 20.1 deaths per 100,000 women to 56.7 deaths per 100,000 women; while for men, the rate grew from 73.0 deaths per 100,000 men to 82.6 deaths per 100,000 men.7

In 2010, almost 24 million adults over the age of 40 in India had COPD. Data monitor expects this number to increase 34% to approximately 32 million by 2020. COPD is predominately a disease of men and only 40% of cases in India occur in women. Over the forecast period, the growth in the number of total prevalent cases of COPD will be primarily driven by demographic changes.8

The World Health Organization (WHO) estimates that COPD as a single cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebrovascular disease and acute respiratory infection). The WHO estimates that in 2000, 2.74 million people died of COPD worldwide. According to the WHO, passive smoking carries serious risks, especially for children and those chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percent increase in risk of COPD in adults.

COPD is the fourth leading cause of death in the U.S. and is projected to be the third leading cause of death for both males and females by the year 2020. It is estimated that there may be currently be 16 million people in the United States currently diagnosed with COPD.

Men are 7 times more likely to be diagnosed with emphysema then women, though the prevalence in women is on a steady increase and this number is lowering with each year.9

More than 13 million Indians are victims of Chronic Obstructive Pulmonary Disease (COPD), where the patients’ airways are blocked.10 The prevalence rate of COPD in Indian males is 5% and in women is 2.7%, male to female ratio being 1.6:1.11

By all these information mentioned above are pointing towards the need for the research study on pulmonary rehabilitation among male chronic obstructive pulmonary disease patients. So researcher has taken this topic.

6.2 REVIEW OF LITERATURE

The review of literature is classified under the following headings:

1. Reviews related to pulmonary rehabilitation with COPD

2. General reviews related to COPD

3. Reviews related to exercise, diet, inhaler therapy, medications and home care

Management.

SECTION-I: REVIEWS RELATED TO PULMONARY REHABILITATION

WITH COPD:

Evans RA (2009), Dept of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester, United Kingdom. Status that it is not clear whether the benefits of pulmonary rehabilitation (PR) apply equally to patients with Chronic Obstructive Pulmonary Disease (COPD) with different levels of starting disability. We have therefore investigated the effect of pulmonary rehabilitation stratified by the MRC dyspnoea scale in patients with COPD. This is a retrospective, observational study of data collected from 450 consecutive patients with COPD attending outpatient PR: 247 male, mean (SD) age 69.5 (8.9) yrs and FEV(1) 44.6(19.7)% predicted. Patients with COPD, of all MRC dyspnoea grades, benefit comparably from pulmonary rehabilitation achieving both statistically and clinically meaningful improvements in exercise performance. MRC grade should therefore not be used to exclude patients from pulmonary rehabilitation.12

Troosters T et al., (2009), Epidemiology, Johns Hopkins School of Public Health, USA. Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. In unstable COPD patients who have suffered from an exacerbation recently, however, the effects of pulmonary rehabilitation are less established.13

Martino F (2009), Cardio-Thoracic and Vascular Department, University of Pisa, Italy. After PRP there was a significant improvement in exercise tolerance and quality of life, which correlated with baseline FEV (1)/VC, PaO (2), SpO (2), 6MWT and SGRQ. SGRQ significantly decreased and 6MWT significantly increased after PRP in all subgroups, except for patients with CV co morbidities. Both univariate and multivariate logistic regression analyses showed that BMI>25 and resting PaO (2)25 or with PaO(2) ................
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