PROBLEM STATEMENT:



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

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MS.JAYASHRI.J.JAVALI

FIRST YEAR M.Sc NURSING

OBSTETRICS AND GYNECOLOGICAL NURSING

2011-2013

V.S.S COLLEGE OF NURSING No78, NAGADEVANAHALLI,

MYSORE RING ROAD,

BANGALORE

RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES

KARNATAKA, BENGALURU

PROFORMA FOR REGISTRATION OF SUBJECT FOR SYNOPSIS

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|1.Name of the Candidate |Ms. Jayashri.J.Javali |

|And Address |1st Year M.Sc Nursing |

| |V.S.S College of Nursing, |

| |Nagadevanahalli, Kengeri |

| |Bengaluru-560056 |

| |Karnataka. |

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|2.Name of the Institution |V.S.S College of Nursing, |

| |Nagadevanahalli, Kengeri |

| |Bengaluru -560056 |

| |Karnataka. |

| | |

| |First Year M.Sc Nursing |

| |Obstetrics And Gynecological Nursing. |

|3.Course of Study and Subject | |

| | |

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| |26/05/2011 |

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|4. Date of Admission | |

|Of the course | |

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| |“A study to assess the effectiveness of early ambulation and |

|5. Topic of the Study |post operative recovery among the women has undergone abdominal|

| |hysterectomy in selected hospital in Bangalore.” |

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6. BACKGROUND OF THE STUDY

6.1 INTRODUCTION:

Early ambulation is procedure characterized by a shorter period of hospitalization or recumbency or by more rapid of mobilization than the normal practice in the presence of guider or nursing staff or physiotherapist.1

After any surgical interruption or loss of independent mobility can have a wide ranging effect on all aspects of person’s life. As nurse, researcher or as therapist a knowledge of methods ,helps available to maintain and/or increase a persons level of mobility is essential part of being able to help restore him to high as functional level as is practicable .2

One of the major purposes of the early ambulation process is to help patients to achieve as high a level of functional independence as possible within the limit of their particular impairments. Human ambulation or gait is one of the basic components of independent functional, commonaly affected by either disease process, injury or by surgery. The desired outcome of most physical therapy interventions is to either restore or to improve a patient’s ambulatory status.3

The 1st or 2nd days of minimal movements and gentle turning .Patients will advised to under go slow mobilization within there limit and depending on the surgical interventions as well as patient state. Early ambulation arise from the fact that ,tissue recovery as well as returning of normal day to day functions would depend on the movements that takes place at the phase of post operative recovery .Thus knowing what benefits will bring would be useful in being motivated to do so even with significant of discomfort of this time.4

• Early movements prevent deep vein thrombosis.

• The mobilization will helps the bowels to move and the gasses to expelled, thus eliminating the discomfort of abdominal distention, constipation as well as it improves appetite.

• Early ambulation prevents joint stiffness and contractures.

• Mobilizations paramount important that surgical patients build up their mental state in order to tackle the slow recovery and gaining functional normalcy. Thus early ambulation should support a mental stability and early surgical recovery.4

6.2 THE NEED FOR THE STUDY:

Early ambulation of the patients as soon as possible after surgery is thought to reduce many complications. The physiotherapy can be categorized as an important mechanical method. The other mechanical method of prophylaxes act on the same principle as early mobilization in that they stimulate calf muscles and put pressure on calf and leg veins, thus discouraging stasis and pooling of blood in the lower extremities .This intermittent pneumatic leg compression enhances blood flow in deep veins of extrimites. This method is virtually free of side effects.5

Early ambulation after abdominal hysterectomy or any other abdominal surgery has been encourage to prevent complications such as Pneumonia, pulmonary embolism,atelectasis, deep vein thrombosis ,bladder dysfunctions and other morbidity related complications ,along with nosocomial infections. Early ambulation increases ventilation and reduces bronchial secretions in the lungs.6

One of the researcher ‘BUSCJH.E.FISHER AIII’suggested that unless there were specific contraindications such as shock, extremity disability ,severe generalized peitonites,heavey bleeding or aninseure wound,ostioporosis and psychosis cases were mobilized on the 1st post operative day. The procedure was generally linked and accepted by all classes of patient’s functional general point of view .It was obvious that the moral of these patients was excellent and effect of this on the pre operative cases was to patients become pretty well able to look after themselves.7

FACT SHEET – HYSTERECTOMY IN US (2000-04)

In US approximately 600000 hysterectomies are performed each year procedure is the second most frequently performed major surgical procedure among reproductive aged women from 2000-2004 on estimated 3.1 million US. The hysterectomy rate decreased slightly from 5.4/1000 in 2000 to 5.1/1000 in 2004 .The rate of hysterectomy differed from age .Overall rates were highest among women aged 42-44years and lowest among women aged 50-54years.It is decreased slightly over the period from 8.9/1000in 2000 and 6.9/1000 in 2004.It differed by geographic region. The overall rates during study period was highest from women living in south (6.3/1000) and the lowest for those in North (4.3/1000).During 2000-2004 the three conditions often associated with hysterectomy were uterine leimyoma (Fibroid uterus), Endometriosis and Uterine prolepses.8

COMMUNITY BASED SURVEY:

Women’s organization that operated on community based survey. The women’s of rural 9.8% of rural women and 5.3% of urban had under gone hysterectomy compared to rural and urban respectely.Aproximately 1/3rd of all hysterectomy were in women younger than 35years of age.

In India study on hysterectomy till the last decade have focused per yearly on clinical out comes with limited analysis of precedence of hysterectomies and its public health implications, 6-9 in 2008.Study in Haryan is one of the wealthier study Singh and Aurora to found that 70 women’s in rural sample of 1000 women had undergone hysterectomy, primarily for heavy menstrual bleeding. Proximately half (46%) of women underwent hysterectomy reported some of later complications such as excessive bleeding, fever and pain.9

Recent research in Andhra Pradesh suggests must higher rate of hysterectomy than in Haryana and in relatively in younger women.2010 study in rural population found that 45% of 3452 women are reproductive age surveyed had already undergone the previously at a median age of 24 years because of acute pelvic inflammatory diseases, uterine prolapse,UTI and Uterine bleeding.9

6.3 REVIEW OF LITERATURE:

Literature review is standard requisition of scientific research. Reading and writing the pertinent information of the attempt in research topic. It also support and explained the resin for the propose topic of research and Avoids unnecessary duplication explore the feasibility and illuminate the way of New researcher.

The reviews of literatures are organized as follows.

1. Studies related to early ambulation of postoperative abdominal surgeries.

2. The studies related to postoperative abdominal hysterectomy.

1. THE REVIEWS RELATED TO EARLY AMBULATION AFTER POST OPERATIVEABDOMINAL SURGERY:

1. DR.MOHANRAJU et.al (2003)

A descriptive study done in GGSM(Gopal gouda santhavary memorial)Hospital Mysore to assess satisfaction regarding post operative nursing care among patients undergone abdominal surgeries. The size is 80 patients, convenient sample technique. The tool used was structural interview questionnaires schedule comprised of two sections, part 1 consists of background factors 2,interview schedule on patients level satisfaction .The max.score was 84 and the minor score was 0.The reliability was valued by 5 experts. The was tested using Karl Person’s method and correlation ,coefficient was r=0.56.The collected openian were analyzed by using descriptive and inferential statistics.Frequence and distribution was assess the level of satisfaction regarding nursing care Chi square test was used to satisfaction and background factors . The study concluded that satisfaction regarding aspects of post operative nursing care and early ambulation among patients undergone abdominal surgeries were satisfied on physiological care.10

2. ROCHEL (2001)

A descriptive study was conducted in Holy Cross Hospital, Kerala. The sample was 30 viewed through purposive sampling technique. The tool was structured interview was made half an hour before the surgery and observation schedule 6 hrs after surgery. The reliability co-efficient was found to be 0.82. the statistical analysis included both descriptive and inferential statistics. Frequency and percentage distribution to assess pre operative, post operative Nursing care. Chi square used find out the association between level of care and demographic variables Carl Pearson correlation co-efficient used to find out the relationship between pre operative care, and post operative complications. The study concluded and suggested that the nursing care provided to abdominal surgery patients is adequate in area like need for safety has to be improved. Explanation to fly members also has to be improved.11

3. E.WILLIAMSON ETC (2003)

A descriptive study was conducted in H.Leemuffitt cancer centre. This study has been conducted to determine risk of developing a pulmonary embolism in patients having major abdominal surgery subgroups pre and post operative cancer and benign subgroups. The method of sample collected was randomized technique. The total samples of 1374 patients in that 4.4% were diagnosed with pulmonary embolism. The difference between those with and without cancer patients was determined. The significant P value is P=0.0006. Finally this study concluded by determining the rate of post operative pulmonary embolism patients with cancer who have undergone abdominal surgeries to be 4.4%. This rate persisted despite vigorous use of SCD’s early ambulation in patients.12

4. GURU NANAK, NIRMAL KAUR (2007)

A Quasi experimental study conducted in Guru Nank medical and education trust, (Punjab-India). The sample was 30 convenient sampling technique 15 each experimental and control respectively. The result findings were non-significant differences of post test performances score between two groups. P value is P ................
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