Review of literature



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE : Ms. PAVITHRA.C.

CANDIDATE AND I YEAR M.Sc. NURSING,

ADDRESS KEMPEGOWDA COLLEGE OF

NURSING,

K.R. ROAD, V.V. PURAM,

BANGALORE-560004.

2. NAME OF THE : KEMPEGOWDA COLLEGE OF

INSTITUTION NURSING, BANGALORE-560004.

3. COURSE OF STUDY & : I YEAR M.Sc. NURSING,

SUBJECT MEDICAL SURGICAL NURSING.

4. DATE OF ADMISSION : 13/04/2010

5. TITLE OF THE TOPIC : “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING IMPORTANCE OF DIETARY MODIFICATION AMONG PATIENTS WITH RENAL CALCULI IN A SELECTED HOSPITAL, BANGALORE.”

6. BRIEF RESUME OF THE INTENTED WORK

6.1 Need for the study

"A GOOD DIET AND EXCERCISE KEEPS THE DISEASE AWAY.”

Kidneys are the pair of excretory organs situated on the posterior abdominal wall, one each side of the vertebral column behind the peritoneum.(1) The functions of kidney is

regulation of blood volume, blood pressure and blood glucose level, maintenance of

blood PH, production of hormones, excretion of metabolic wastes products, excess salts

and water.(2) The major disorders or disease of kidneys are renal calculi, renal artery

stenosis, renal vein thrombosis, polycystic kidney disease, renal failure and nephrotic

syndrome.(3)Renal stone or calculus is one of the most common disease of the urinary tract. It occurs more frequently in men than in women, more in age group of 30- 45years .In worldwide the prevalence rate is 2-20% and in India it is4-20 %( nearly 1/1000 people).(4)

Renal calculus is stone like body composed of urinary salts bound together by a colloid matrix of organic materials .It consist of a nucleus around with concentric layers of urinary salts are deposited .The cause of renal stone are hyper excretion of relatively insoluble urinary constituents, physiological changes in urine PH, environmental and dietary factors. Depending on causes they are classified as calcium phosphate, calcium oxlate, uric acid, cystine and struvite.(5)

A special renal diet can help to control the built of waste product and fluid in the blood and decreases stone formation in kidney. Dietary regulation alone can work as an effective treatment to eliminate or as precautionary mechanism to prevent renal calculi. The key focus of the diet is maintaining the acid -alkaline balance and intake of 3 liters of water per day may reduces the risk of stone formation.Certain foods that should be avoided in general are alcoholic beverages and condiments, vegetables such as radishes, tomatoes, spinach, beans, onion, carrots, pea etc. animal protein like milk, curd, cheese.(6)

A study was conducted on” Intake of vitamine B6 and vitamineC and the risk of kidney stones in women” in Brigham women’s hospital of America. A sample of 85,557 women with no history of renal calculi was selected in cohort. A semi quantitative food frequency questionnaires were used to assess vitamine consumption. A total 1078 incident cases of renal calculi was documented during 14-15 years follow up period. The study concluded that a high intake of vitamine B6 was inversely associated with risk of stone formation.(7)

A study was conducted on “dietary factors and medullary sponge kidneys as causes of the so-called idiopathic renal leak of calcium” in Switzerland. A sample of 89 cases was selected and a careful retrospective analysis was done using intravenous pyelogram, and found that increase sodium and protein intake result in crystallization of salt. Hence it concluded that dietary factors play key role in idiopathic hypercalcuria .(8)

A study was conducted on “Effect of dietary excess in animal protein and sodium on the composition and crystallization kinetics of calcium oxalate monohydrate in urines of healthy men” in Netherlands. A sample of 80 healthy men was taken for one week and they were given high animal protein and sodium , there was increased excretion rates in calcium, uric acid etc in urine .The study result revealed that high animal protein and sodium intake are in risk of formation of calcium oxalate crystal.(9)

A study conducted in universitary institute of health sciences research of Spain has discussed the importance of “renal lithiasis and nutrition.” Renal lithiasis is multifactorial with number of etiological factors that can be adequately modified through diet, since urine composition is directly related to diet. It concluded that appropriate habitual diet will be a measure to prevent formation of kidney stones.(10)

During my clinical experience the investigator myself had provided care to renal calculi patients and observed that majority of patients were inadequate with knowledge regarding importance of dietary modification. Hence the investigator feels that there is a need for giving structured teaching programme on importance dietary modification among renal calculi patients.

6.2 Review of literature:

A study conducted on “Effects of a low salt diet on idiopathic hypercalciuria in calcium –oxalate stone formers” in Italy. A sample 210 patients was selected and divided them into 2 groups, one group (102) with control diet and another group (108) with low sodium diet, on follow up visit urine samples was collected and analyzed for excretion of calcium and oxalate salts .The result value was compared with both group, the urinary calcium and oxalate salts was normal in 61.9% of the patients on low salt diet and 34% of the patients with control diet. The study concludes that a low – salt diet can reduce calcium excretion in hypercalciuria stone formers.(11)

A research was conducted on “Association of body mass index and urine PH in patients with urolithiasis”in Taiwan. A sample of 342 patients with urolithiasis was selected and the mean urine PH is analyzed, in obese groups urine PH was 6.25, 6.14 and 6.00 respectively and urine PH is inversely related to BMI . The result reveals that obese patients have a risk of renal calculi.(12)

A study conducted on “Dash –style diet associates with reduced risk for kidney stones”in Brigham women’s hospital of United states. A sample 5645 cases were selected over of 50 years follow up and they constructed a dash score based eight food components and data was analyzed with various food components. The conclusion states that consumption of dash –style diet is associated with a marked decrease in kidney stone risk.(13)

A study was conducted on “Quantification of the stone clinic effect in patients with nephrolithiasis” in United States .A 25 samples(11female and 14 male) with recurrent nephrolithiasis were prospectively followed for one year with 3 month interval for medical evaluation, patients were is advised to increases the fluid intake and restrict intake of salt and protein. Twenty four hour two urine sample were collected and measured for excretion of urinary salts by using Tiselius index, metabolic and radiological activity. The study concluded that stone clinic significantly decreased urinary super saturation for calcium oxalate and formation of new kidney stones in 80% f patients during first year of follow up.(14)

A study conducted on “The effect of different diets on urine composition and the risk of calcium oxalate crystallization” in Europe .A ten healthy male volunteers was selected and they were given four different diet for a specific period like self-selected diet (14 days), western diet (5days) normal mixed diet (5 days) and ovo-lacto-vegetarian diet(5 days), the risk of calcium oxalate crystallation was calculated by relative super saturation from urine composition. Calcium oxalate crystallation was highest during self-selected diet and western diet and significant decrease during normal mixed diet, there was no significant change in ovo-lacto-vegetarian diet. The study concluded that change in usual dietary habits for a normal mixed diet significantly reduces the risk of calcium oxalate crystallization.(15)

A prospective cohort study conducted in United States on “Beverage use and risk for kidney stone in women” for 8 years follow up .A sample of 81093 women with no history of renal stones were selected and assessed for beverage use and diet intake by self administered food frequency questionnaire. A719 cases of kidney stones were documented and found that it was highest quintile in women with specific beverages compared to women in lowest quintile. It concluded that an increases in total fluid intake can reduce risk for kidney stones .(16 )

A study was conducted on “Dietary and behavioral risk factors for urolithiasis: potential implication for prevention” in America. A 392 sample were selected and data were collected through telephone interviews, the findings suggested appropriate behavioral intervention reduces the morbidity associated with urolithiasis.(17)

A study was conducted on” Diet soda and kidney function “ in United states . An 11 year study conducted on group of 3000 women samples, it outlined the effects of artificial sweeteners on the human body. The result indicated that those who drank two or more artificially sweetened beverages a day doubled their risk factors of more –rapid-than-normal kidney function.(18)

6.3 Statement of the problem

“Effectiveness of structured teaching programme on knowledge regarding importance of dietary modification among patients with renal calculi in a selected hospital, Bangalore.”

6.4 Objectives of the study

1. To assess the pre-test knowledge on dietary modification among patients with renal calculi

2. To determine the effectiveness of structured teaching programme on knowledge regarding importance of dietary modification among patients with renal calculi

3. To find out the association of knowledge score with selected demographic variables.

6.5 Hypotheses

H1 There is a significant improvement in post –test knowledge score compared to the pre-test knowledge score of renal calculi patients.

H2 There is a significant association between pre-test knowledge score with selected demographic variables.

6.6 Operational Definition

• Effectiveness: Refers to gain in knowledge as determined by the significant difference between pre-test and post test knowledge scores.

• Structured teaching programme: Refers to a planned and organized teaching programme aimed at educating the participants or renal calculi patients regarding importance of dietary modification.

• Knowledge: Refers to information provided by the patients with renal calculi regarding importance of dietary modification.

• Importance: Refers to the condition in which having great effect on diet to prevent the reoccurrence and complication of renal calculi.

• Dietary modification: Refers to preferable alteration or change in the food items which are help full in preventing the reformation of calculi.

• Patients: Refers to people admitted with renal calculi problem at Kempegowda Institute of Medical Sciences, Hospital and Research Centre.

• Renal calculi: Refers to small chunks of crystallized material which become trapped in kidneys, bladder or urinary tract.

7. MATERIALS AND METHODS

7.1. SOURCE OF DATA : Data will be collected from selective patients in

Kempegowda Institute of Medical sciences,

Hospital and Research centre, Bangalore-04.

7.2. METHOD OF : Structured interview schedule

COLLECTION

OF DATA

7.2.1. STUDY SUBJECTS: Renal calculi patients at Kempegowda Institute of

Medical sciences, Hospital and Research centre,

Bangalore-04.

7.2.2. INCLUSION AND EXCLUSION CRITERIA:

(a) INCLUSION CRITERIA : 1.Renal calculi patients who are willing to participate in the study and

present at the time of data collection.

2.Patients who can understand kannada and English

(b) EXCLUSION CRITERIA : 1. Who has been exposed to

Educational programme on dietary

modification

7.2.3. RESEARCH DESIGN : One group pre-test and post-test design.

7.2.4. SETTING : Kempegowda Institute of Medical Sciences, Hospital and Research Centre, Bangalore.

7.2.5. SAMPLING TECHNIQUE : purposive sampling technique.

7.2.6. (A) SAMPLE SIZE : 40

(B) DURATION OF STUDY : 8 Weeks.

7.2.7. TOOL OF THE RESEARCH: Structured interview schedule will be constructed into two parts:

(a) Part A-Demographic data.

(b) Part B- Knowledge questionnaire

regarding importance of dietary

modification.

7.2.8 COLLECTION OF DATA : After obtaining informed written consent from the participants, the investigator will collect data by using structured interview schedule to assess the knowledge before and after giving Structured teaching programme.

7.2.9 METHOD OF DATA : 1. The investigator will use appropriate

ANALYSIS descriptive statistics like mean, median,

AND PRESENTATION standard deviation and inferential statistics namely paired t-test and Chi-square test to analyses the data.

: 2. The analyzed data will be presented in the form of tables and graphs where ever necessary.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.

Yes, the study will be conducted on renal calculi patients regarding importance of dietary modification using structured teaching programme.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

• Yes, ethical clearance has been obtained from the concerned authority of institution.

• Informed written consent will be obtained from the participants prior to the study.

• Privacy, confidentiality and anonymity will be guarded.

• Scientific objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES

1. B.D Chaurasia. Human Anatomy Regional and Applied Dissection and Clinical kidney and ureter. 4th ed 2nd vol. New Delhi. Satish kumar jain publications; 2004. p. 295.

2. Gerard J, Derrickson B. Principles’ of anatomy and physiology 11th ed. United States: John Wiley and sons; 2009. p. 993

3. Lewis, Heitkemper, Dirksen. Medical surgical nursing, renal and urological problem 6thed. New York: Mosby publications;1996.p. 1185-6

4. Raja. History and milestones of the urinary calculus disease [online]. URL: http:// st-joes.

5. Renal calculi (kidney stones) concepts for Registered Nurse[online].2009[cited 2010 Dec 06] Available from: URL: renal-calculi.html.

6. Food for kidney stones[online] 2008 Jul 25[cited 2010 Nov 25]; Available from: URL: http:// diet.health kidney –stone-food.

7. Gary C etal. Intake of vitamin B6 and vitamin C and the risk of kidney stones in women. J Am Soc Nephrol 1999; 10: 840-45.

8. Jaeger P etal. Dietary factors and medullar sponge kidneys as causes of idiopathic renal leak of calcium. AM J Nephrol 1987; 7(4) : 257-63

9. Kok D etal. Effects of dietary excess in animal protein and sodium on the composition and crystallization kinetics of calcium oxalate monohydrate in urines of healthy men. J Clin endocrinol metab 1990 Oct;71(4) : 861-7

10. Grases F,Costa A, Prieto R. Renal lithiasis and nutrition.. Nutr J 2006 september; 6: 235-238.

11. Nouvenne A etl. Effects of a low salt diet on idiopathic hypercalciuria in calcium-oxalate stone formers. Amj Clin Nutr 2010 Mar; 9 (3):565-70

12. Li W, Chou YH etal. Association of body mass index and urine PH in patients with urolithiasis..Urol Res 2009 Aug; 37(4):193-6

13. Taylor E, Fung T, Curhan G. DASH –Style diet associates with reduced risk for kidney stones. J Am Soc Nephrol 2009 Oct; 20(10): 2

14. Carvalho M etl. Quantificaton of the stone clinic effect in patients with nephrolithiasis. Rev Assoc Med Bras 2004 March; 50(1):79-82

15. Stamper M. Research on diet soda and kidney function. J Am Soc Nephrol 1998 Sep ;28(4):25

16. Curhan G etal. Beverage use and risk of kidney stone in women. Ann Intern Med 1998 Apr; 128(7): 534-40

17. Valene C etal. Dietary and behavioral risk factors for urolithiasis potential implications for prevention.American journal of kidney diseases 1996 Aug; 28 (2):195- 201

18. Stener R, Hesse A.The effect of different diets on urine compostion and the risk of calcium oxalate crystallization in healthy subjects.Eur urol sep; 42 (3) : 289-96.

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|9 |SIGNATURE OF THE : | |

| |CANDIDATE | |

|10 |REMARKS OF THE GUIDE : |The research topic selected by the candidate is relevant as it is|

| | |emphasized on the knowledge regarding importance of dietary |

| | |modifications among patients with renal calculi. |

|11 |NAME AND DESIGNATION : |

|11.1 |GUIDE : |Mrs. UMA DEVI .A .K, M.Sc.(N) |

| | |Lecturer. |

| | |Department Medical Surgical Nursing, |

| | |Kempegowda College of Nursing, |

| | |K.R. Road, V.V Puram, |

| | |Bangalore-560004. |

|11.2 |SIGNATURE : | |

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|11.3 |CO-GUIDE : | |

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|11.4 |SIGNATURE : | |

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|11.5 |HEAD OF THE : |Mr. SHIVANANDA.M.S. PGDIRPM., M.Sc.(N) |

| |DEPARTMENT |Associate professor. |

| | |Head of the Department, |

| | |Department of Medical Surgical Nursing, |

| | |Kempegowda College of Nursing, |

| | |K.R. Road, V.V Puram, |

| | |Bangalore-560004. |

|11.6 |SIGNATURE : | |

|12 |REMARKS OF THE : |Topic selected for the study is relevant and forwarded for |

| |CHAIRMAN/PRINCIPAL |needful action. |

|12.1 |SIGNATURE : | |

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