6 - Rajiv Gandhi University of Health Sciences



]RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

Mr. SRI VIJAY.J

I YEAR M.SC NURSING MEDICAL SURGICAL NURSING YEAR 2011-2013

SRI VENKATESHWARA COLLEGE OF NURSING,

NO 98, MARUTHI INDUSTRIAL ESTATE,

PEENYA II STAGE,

BANGALORE-58

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION.

|1. |NAME OF THE CANDIDATE AND ADDRESS |SRIVIJAY.J |

| | |I YEAR M.SC NURSING |

| | |SRI VENKATESHWARA |

| | |COLLEGE OF NURSING, |

| | |NO98,MARUTHI INDUSTRIAL ESTATE, |

| | |PEENYA II STAGE, BANGALORE-58. |

|2. |NAME OF THE INSTITUTION |Sri Venkateshwara college of nursing, |

| | |No 98,Maruthi industrial estate, |

| | |Peenya II Stage,Bangalore -58. |

|3. |COURSE OF THE STUDY AND SUBJECT |I Year M.Sc.Nursing, |

| | |Medical Surgical Nursing. |

|4. |DATE OF ADMISSION OF THE COURSE |17-06-2011 |

|5. |TITLE OF THE STUDY |“A study to assess the effectiveness of structured teaching programme regarding |

| | |management of snakebite among rural people in selected area at bangalore.” |

6.BRIEF RESUME OF THE INTENDED WORK

|6.1 INTRODUCTION |

|Snake bites continue to be equally as mysterious as the snakes, since the dawn of human civilization in any part of world. Snakes produce a un imaginable |

|fear and anxiety. Snakebite being Myths in form of stories, folk tales, dramas, and film revolve around the dreaded snakes. Rivalry of snakes, mating of |

|snakes. Snakes are worshipped in India and auspicious day are marked in the name of snakes. |

|The outcome of snake bites depends on numerous factors, including the species of snake, the area of the body bitten, the amount of venom injected, and the |

|health conditions of the victim. Feelings of terror and panic are common after snakebite and can produce a characteristic set of symptoms mediated by the |

|autonomic nervous system, such as a racing heart and nausea. Bites from non-venomous snakes can also cause injury, often due to lacerations caused by the |

|snake's teeth, or from a resulting infection. A bite may also trigger an anaphylactic reaction, which is potentially fatal. First aid recommendations for |

|bites depend on the snakes inhabiting the region, as effective treatments for bites inflicted by some species can be ineffective for others. |

|The number of fatalities attributed to snake bites varies greatly by geographical area. Although deaths are relatively rare in Australia, Europe and North |

|America, the morbidity and mortality associated with snake bites is a serious public health problem in many regions of the world, particularly in rural |

|areas lacking medical facilities. Further, while South Asia, Southeast Asia, and sub-Saharan Africa report the highest number of bites, there is also a |

|high incidence in the Neotropics and other equatorial and subtropical regions. Each year tens of thousands of people die from snake bites, yet the risk of |

|being bitten can be lowered with preventive measures, such as wearing protective footwear and avoiding areas known to be inhabited by dangerous snakes. |

|The most common symptoms of all snakebites are overwhelming fear, panic, and emotional instability, which may cause symptoms such as nausea and vomiting, |

|diarrhea, vertigo, fainting, tachycardia, and cold, clammy skin, Television, literature, and folklore are in part responsible for the hype surrounding |

|snakebites, and a victim may have unwarranted thoughts of imminent death. |

|Dry snakebites, and those inflicted by a non-venomous species, can still cause severe injury to the victim. There are several reasons for this: a snakebite|

|which is not treated properly may become infected (as is often reported by the victims of viper bites whose fangs are capable of inflicting deep puncture |

|wounds), the bite may cause anaphylaxis in certain people, and the snake's saliva and fangs may harbor many dangerous microbial contaminants, including |

|Clostridium tetani. If neglected, an infection may spread and potentially kill the victim. |

|Most snakebite, whether by a venomous snake or not, will have some type of local effect. There is minor pain and redness in over 90% of cases, although |

|this varies depending on the site. Bites by vipers and some cobras may be extremely painful, with the local tissue sometimes becoming tender and severely |

|swollen within 5 minutes. This area may also bleed and blister and can eventually lead to tissue necrosis. Other common initial symptoms of pit viper and |

|viper bites include lethargy, bleeding, weakness, nausea, and vomiting. Symptoms may become more life-threatening over time, developing into hypotension, |

|tachypnea, severe tachycardia, severe internal bleeding, altered sensorium, kidney failure and respiratory failure. |

|Interestingly, bites caused by the Mojave rattlesnake, kraits, coral snake, and the speckled rattlesnake reportedly cause little or no pain despite being |

|serious injuries. Victims may also describe a "rubbery," "minty," or "metallic" taste if bitten by certain species of rattlesnake. Spitting cobras and |

|rinkhalses can spit venom in their victims' eyes. This results in immediate pain, ophthalmoparesis, and sometimes blindness. |

|Some Australian elapids and most viper envenomations will cause coagulopathy, sometimes so severe that a person may bleed spontaneously from the mouth, |

|nose, and even old, seemingly-healed wounds. Internal organs may bleed, including the brain and intestines and will cause ecchymosis (bruising) of the |

|victim's skin. |

|Venom emitted from elapids, including sea snakes, kraits, cobras, king cobra, mambas, and many Australian species, contain toxins which attack the nervous |

|system, causing neurotoxicity. The victim may present with strange disturbances to their vision, including blurriness. Paresthesia throughout the body, as |

|well as difficulty speaking and breathing, may be reported. Nervous system problems will cause a huge array of symptoms, and those provided here are not |

|exhaustive. If the victim is not treated immediately they may die from respiratory failure. |

| |

|Since envenomation is completely voluntary, all venomous snakes are capable of biting without injecting venom into their victim. Snakes may deliver such a |

|"dry bite" rather than waste their venom on a creature too large for them to eat. However, the percentage of dry bites varies between species: 50% of bites|

|from the normally timid coral snake do not result in envenomation, whereas only 25% of pitviper bites are dry. Furthermore, some snake genera, such as |

|rattlesnakes, significantly increase the amount of venom injected in defensive bites compared to predatory strikes. |

|Some dry bites may also be the result of imprecise timing on the snake's part, as venom may be prematurely released before the fangs have penetrated the |

|victim's flesh. Even without venom, some snakes, particularly large constrictors such as those belonging to the Boidae and Pythonidae families, can deliver|

|damaging bites; large specimens often cause severe lacerations as the victim or the snake itself pull away, causing the flesh to be torn by the |

|needle-sharp recurved teeth embedded in the victim. While not as life-threatening as a bite from a venomous species, the bite can be at least temporarily |

|debilitating and could lead to dangerous infections if improperly dealt with. |

|6.2 NEED FOR THE STUDY: |

|Snake bite is a major Public health problems throughout the world especially in aims and objectives tropical and subtropical countries. |

|Snakes are legless reptiles, of the 2500:3000 species of snakes, about 500 belong to four families of venomous snakes and only about 200 species have |

|caused death or permanent disability by biting humans.approximatly about 3 lakhs as people are bitten by snakes every year and about 15,000 peoples in |

|India. About 500 peoples are bitten by poisonous snakes in Karnataka. While most snakes must open their mouths before biting, African and Middle Eastern |

|snakes belonging to the family Atractaspididae are able to fold their fangs to the side of their head without opening their mouth and jab at victims. |

|Venom emitted from some types of cobras, almost all vipers, some Australian elapids and some sea snakes causes necrosis of muscle tissue. Muscle tissue |

|will begin to die throughout the body, a condition known as rhabdomyolysis. Rhabdomyolysis can result in damage to the kidneys as a result of myoglobin |

|accumulation in the renal tubules. This, coupled with hypotension, can lead to acute renal failure, and, if left untreated, eventually death. |

|Snake bite is a major problem in Sri Lanka where recent decades of |

|warfare and economic sanctions have complicated its management. A retrospective review of snake bites in north-east Sri Lanka was undertaken in 2005 to |

|review management. Of 303 victims, 145 revealed a local response, 134 a prolonged clotting time, 46 ptosis and five respiratory failure. |

|One died. Of 97 snakes identified: 42 were saw-scaled vipers, 14 Russell's |

|vipers, 6 cobras and 6 kraits. Most bites occurred at the harvest and the median |

|age of victims was 32 years. There was no difference in morbidity or mortality at |

|any age. In total, 262 snake bite cases were treated within 3 hours of the bite, |

|and 183 were given antivenom. Seventy victims reacted adversely, of whom 61 |

|received hydrocortisone, chlorpheniramine and subcutaneous adrenaline. No |

|significant side effects were noted. North-east Sri Lanka has endured two decades of civil |

|disruption but public knowledge and an established protocol for management, including |

|adrenaline, has compensated for shortages in medical staff and infrastructure. |

|The resumption of economic sanctions in 2007 is likely to counter that success. |

| |

| |

|6.3 STATEMENT OF THE PROBLEM: |

|A study to assess the effectiveness of structured teaching programme regarding management of snakebite among rural people in selected area at bangalore. |

| |

|OBJECTIVES OF THE STUDY: |

|1. To assess the pre test level of knowledge regarding management of snakebite among rural people. |

|2. To assess effectiveness of structured teaching programme regarding knowledge on management of snakebite among rural people. |

|. |

|3. To find out the association between the post test level of knowledge regarding management of snakebite among rural with their selected demographic |

|variables. |

| |

|OPERATIONAL DEFINITION: |

|1.ASSESS: |

|In this study assess refers to analyzing the difference in knowledge level regarding structured teaching programme of snake bite. |

|2. Effectiveness: |

|It refers to extend to which structured teaching program has achieve desired, and affects on the knowledge of the rural people. |

|3. Snakebite:You +1'd this publicly. Undo |

|Snakebite is an injury caused by a bite from a snake, which is may accidental or intentional. |

|4.Management: |

|It refers to prevention and emergency care of snake bite. |

|. |

6.6 ASSUMPTION

1. Rural people have knowledge regarding management of snakebite.

2. Structured teaching programs will enhance the knowledge regarding the management of snake bites.

6.7 HYPOTHESIS:

a) There is a significant association between the pre test and post test level of knowledge regarding management of snakebite among rural people.

b) There is a significant association between the post level of knowledge regarding snake bite and its management in selected demographical variables.

6.8 REVIEW OF LITERATURE:

A study was conducted on Current management of copperhead snakebite. Their aim is to assess the management for snake bite.It was conducted by longitudinal method by total of 142 Snakebites persons were taken.in that Ninety-four were of the Agkistrodon species-contortrix or piscivorus leukostoma (water moccasin). Three were rattlesnakes, and 3 were from the Texas coral snake (Micrurus fulvius tener). Forty-two were unidentified pit vipers. The result shows that the most common presenting symptoms were pain and swelling and in that Eighty-five percent were of grade 1 envenomations. Ten patients had laboratory abnormalities secondary to the snakebite. Forty-four were admitted for observation.No patients received antivenom, and no patients required surgical intervention. There were no deaths. One patienthad edema and ecchymosis that persisted for more than 1 month. The study concluded that the Accurate identification of the pit viper species involved in snakebites is essential.

A study was conducted on Rattlesnake bites in pregnant women. Their aim is to determine the number of rattlesnake bites in pregnant women. The study was conducted by a database all the age group of reproductive-age women. the Association of Poison Control Centers (AAPCC). Exposures coded as rattlesnake bites between 2001. 8,413 rattlesnake bites, with 767 (9.1%) involving reproductive-age women the result shows that a total of 8,430 rattele snake bite with 767(9.1%) involving reproductive age women. Of this,11(1.4%)were pregnant.the result shows that there is no significant diffirences between pregnant and non pregnant victims with regard to rates of hospital admission,anti venom admistration,or over all out come codes. The study concluded that this rare condition is associated with favorable short-term pregnancy outcomes.

A study was conducted on Venomous snake bites in Japan. The aim of the study was assess the incidence of snake bite in the nation.the method was hospital- bace database undertaken 1,670 in patient in a selected hospital from 404 hospitals during July 1-December 31 in 2007.the result shows that more than 60% were males, the average age was 60.1 years, and the in-hospital mortality rate was 0.2%. The incidence of mamushi bite, distributed between latitudes 30°N and 46°N, was estimated to be 1.67 bites/100,000/6 months. It is important to continue collecting all available data to monitor the trends of this life-threatening disease. The conclusion shows that the incidence of snake bite was increased.

A study was conducted on severe snakebites in northern KwaZulu-Natal: treatment modalities and outcomes. The aim is to study the outcomes of severe snakebites in patients admitted to Ngwelezana Hospital, the seasonal variations, and the effectiveness and complications of antivenom. .the method was hospital- bace database. The study was conducted over one year (1 June 2007 to 31 May 2008). the result shows that the total of 243 snakebite patients were recorded. The highest incidence was in the summer months; 46 (18.93%) patients experienced one or more severe complications; 29 (11.93%) patients received some form of definitive managementin hospital; and 22 (9.05%) of the latter patients received antivenom. Antivenom was administered to more children than adults. Adverse reactions to antivenom The conclusion shows that Snakebites are common in the summer months in north eastern Children are particularly vulnerable to snakebites.

.

A study was conducted on a survey of snakebite management knowledge amongst select physicians in a hospital and the implications for snakebite training.The aim is to assess the level of knowledge regarding snakebite management in doctors likely to treat such bites.the study was conducted by a questionnaire method and consisting of 29 multiple-choice questionsat snakebite victims. The result shows that only 29% of responding doctors were confident about treating snakebites the study concluded that there is clear room for improvement in the knowledge base and confidence level of physicians treating snakebites.

A study was conducted on Presentation and complications of snakebite in a tertiary care hospital. Their aim is to determine frequency of various modes of presentation, complications and management of snakebite. the study was conducted by descriptive method by patients over 12 years of age and presenting to emergency department with history of snakebite and features of envenomation. the result shows that the total of 65 patients were enrolled in the study with 40 males (61.5%) and 25 (38.5%) females. Maximum cases 15 (23%) were seen in the month of August. Age group, that was maximally affected, was between 26-30 years (12 cases or18.5%). Only 2 patients had neurotoxic snakebite, whereas rest of the cases were vasculo toxic in nature. The conclusion shows that the snakebite is a major public health problem.

A study was conducted on a locally developed snakebite management. The aim of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom used in treating snakebites in a developing country and its effect on mortality.There experimental method of sample was undertaken. The result show that after training, data were collected. The concluded that 839 snakebite victims over a 12-month period and included epidemiological data, and mortality

A study was conducted on snakebite envenoming .the aim of the study is the clinical characteristics, factors involved in complications and the outcomes in relation to timing of polyvalent snake antivenom (SAV) administration in patients with snakebite . the method of study is hospital base data base was undertaken.. Patients were recruited from cases of snakebites admitted in hospitals.The result shows that 200 (34%) of 586 cases with snakebites had envenoming; 58% were men, 52% were aged 31-50 years and 93% were outdoor bites. The species of snake wasidentified in 34.5% of the venomous bites. 93.5% had signs of local envenoming.

A study was conducted on Snakebite management, first few hours a guide for primary care physicians. The aim of the study is to improve the snake bite management.Total 176 samples collected in a simple randomized method The result was that the patients are referred to distant, better equipped hospitals and thus make journeys without the cover of snake venom antiserum. The study was concluded that guidance for the primary healthcare doctor in identification of medically significant snakes, treatment, referral criteria and equipment necessary to successfully manage snakebite in a primary care environment.

A study was conducted on premedication and early adverse reactions in the management of snake bites.their aim is to examine antivenom use, premedication, early adverse reactions and patient outcomes after snake bite.The Retrospective chart analysis of all admissions for snake bite with documented antivenom use. The result was antivenom use was documented in 136/1881 (7.2%) snake bite admissions and most (121/136: 88.9%) received a single vial. CSL Polyvalent antivenom was administered to 112/136 (82.4%). One hundred and eleven patients (81.6%) happened to have been given premedication with adrenaline and/or promethazine and/or hydrocortisone. The study concluded that polyvalent antivenom is the main treatment for envenomation in rural health centres, and early adverse reactions are common and adrenaline premedication appears to significantly reduce acute adverse reaction rates.

A study was conducted on first aid training on knowledge and skills. their aim is to To define the extent of Senior First Aid training in a sample of the community, and to evaluate the effect of previous training on first aid knowledge and skills.A telephone survey of a random sample and practical assessment of first aid skills in a subsample done. The study of result shows that the 30.4% of respondents had completed a Senior First Aid certificate. The study concluded that overall knowledge and performance of first aid skills by the community are poor, but are improved by first aid training courses.

7. MATERIALS AND METHOD:

7.1 SOURCES OF DATA:

All the people in the selected rural area.

7.2 METHOD OF DATA COLLECTION:

I) Research design: Research design adopted for this study is quasi-experimental one group pre-test and post- test design.

II) Research variables:

➢ Dependent variables: knowledge regarding snake bite and its management.

➢ Independent variables: structured teaching programme regarding management of snakebite

➢ Demographical variables: it contains baseline information of age, gender and educational status, occupational and knowledge about snake bite.

III) Research Setting:

The study will be conducted in selected rural area at Bangalore.

IV. Research method

The study will be done by using structured questionnaire method

V) Population: All people who are resides in selected area.

VI. Sample

All the people who fulfill the inclusion criteria are considered as sample and the sample size is 60.

VI) Criteria for sample selection:

Inclusion criteria:

The study includes

1. Both male female persons between the age group of 20 to 50 years.

2. Persons who can communicate in Kannada or English.

Exclusion criteria:

The study excludes the

1. Person who are not willing to participate in the program.

2. Who are not available at the time of data collection.

VII. Sampling technique

Convenient sampling technique is chosen for this study.

VIII) Tools for data collection:

It consist of following section

Section A: Selected demographic variables such as as age, gender, and educational status and occupational status and previous knowledge of snake bite .

Section B: Structured questionnaire to assess the level of knowledge regarding management of snakebite among rural people.

IX) Method of data collection:

After obtaining permission from the authorities, the investigator will obtain informed consent from the general public. The investigator individually assesses knowledge of people by using structured questionnaires and on the same day administers structured teaching program. The post test knowledge will be assessed after seven days by using the same structured questionnaire.

Duration of study : 4-6 Weeks

X. Plan for data analysis

The data collected will be analyzed by means descriptive statistics and inferential statistics.

Descriptive statistics frequency, percentage distribution of demographic variables and mean, standard deviation will be used for level of knowledge.

Inferential statistics chi-square test will be used to associate the level of knowledge and selected demographic variables.

XI) Project outcome:

The structured teaching programme will improve the knowledge regarding management of snakebite among rural people .

7.3 Does the study require any investigation or interview to be conducted on patient or human or animal?

Yes, structured teaching programme on knowledge regarding management of snake bite rural people

7.4 Has ethical clearance been obtained from institution?

Yes, the permission will obtained from the ethical committee of Sri Venkateshwara College of Nursing.

8.LIST OF REFERENCES

1. J Am Coll Surg. 2011 Apr;212(4):470-4; discussion 474-5.

2. BMC Emerg Med. 2011 Feb 3;11:2.

3. J Reprod Med. 2010 Nov-Dec;55(11-12):520-2.

4. J Trop Med Hyg. 2011 Jan;84(1):135-6.

5. S Afr Med J. 2009 Nov;99(11):814-8.

6. Wilderness Environ Med. 2009 Winter;20(4):364-70.

7. J Coll Physicians Surg Pak. 2009 May;19(5):304-7.

8. Wilderness Environ Med. 2008 Winter;19(4):267-74.

9. Emerg Med J. 2008 Apr;25(4):200-4.

10. J Indian Med Assoc. 2007 Jun;105(6):324, 326, 328 passim.

11. Rural Remote Health. 2007 Oct-Dec;7(4):751. Epub 2007 Dec 12.

12. Wilderness Environ Med. 2007 Spring;18(1):2-9.

13. Toxicon. 2007 May;49(6):780-92. Epub 2006 Dec 2.

14. Aust N Z J Public Health. 2006 Apr;30(2):147-50.

15. Bull Soc Pathol Exot. 2005 Nov;98(4):273-6.

16. Trans R Soc Trop Med Hyg. 2006 Jul;100(7):693-5. Epub 2005 Nov 14.

17. Natl Med J India. 2005 Mar-Apr;18(2):71-5.

18. Curr Opin Pediatr. 2005 Apr;17(2):234-8.

19. J R Army Med Corps. 2004 Jun;150(2):97-8.

20. Trans R Soc Trop Med Hyg. 2004 May;98(5):278-83.

21. Ned Tijdschr Geneeskd. 1998 Dec 19;142(51):2773-7.

9. SINGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNTION OF:

11.1Guide :

11.2 Signature :

11.3 Co-guide :

11.4 Signature :

11.5 Head of Department :

11.6 Signature :

12.1 Remarks of principal :

12.2 Signature :

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