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300123117selvam PDF
300123117selvam PDF
Mr. M. SELVAM
Reg. No: 301513451
A Dissertation Submitted to
The Tamil Nadu Dr. M.G.R. Medical University,
Chennai - 32.
2017
A STUDY TO EVALUATE THE EFFECTIVENESS OF PRE-OPERATIVE
TEACHING ON POST-OPERATIVE EXERCISE TO PREVENT
COMPLICATIONS AMONG PATIENTS UNDERGOING ABDOMINAL
SURGERIES IN SELECTED HOSPITAL AT CHENNAI
Mr. M. SELVAM
Reg. No: 301513451
A Dissertation Submitted to
The Tamil Nadu Dr. M.G.R. Medical University,
Chennai - 32.
2017
A STUDY TO EVALUATE THE EFFECTIVENESS OF PRE-OPERATIVE
TEACHING ON POST-OPERATIVE EXERCISE TO PREVENT
COMPLICATIONS AMONG PATIENTS UNDERGOING ABDOMINAL
SURGERIES IN SELECTED HOSPITAL AT CHENNAI
By
Mr. M. SELVAM
Reg. No: 301513451
_____________________ _____________________
INTERNAL EXAMINER EXTERNAL EXAMINER
A STUDY TO EVALUATE THE EFFECTIVENESS OF PRE-OPERATIVE
TEACHING ON POST-OPERATIVE EXERCISE TO PREVENT
COMPLICATIONS AMONG PATIENTS UNDERGOING ABDOMINAL
SURGERIES IN SELECTED HOSPITAL AT CHENNAI
RESEARCH GUIDE:
Prof. Dr. D.CHARMINI JEBAPRIYA, M.Sc (N)., M.Phil, Ph.D.,
Principal,
Texcity College of Nursing,
Coimbatore - 23.
SUBJECT GUIDE :
Mrs. LITTRESHIA BALIN. J, M.Sc (N)
Assistant Professor
Texcity College of Nursing,
Coimbatore - 23.
MEDICAL GUIDE :
Certified that this is the bonafide work of Mr. M. SELVAM, Texcity College of
Nursing, Coimbatore, submitted as a partial fulfillment of requirement for the Degree
of Master of Science in Nursing to The Tamilnadu Dr.M.G.R. Medical University,
Chennai. Under the Registration No: 301513451
College Seal
Anita Kanmani
Jan Hazo
&
Genesis 1:26
Watering the plants helps in producing sweet fruits. I have immense pleasure
to convey my thanks to Mrs. LITTRESHIA BALIN,M.sc (N) (MSN), Asssociate
Professor, Texcity College of Nursing, Coimbatore, for all the support rendered to me
during the endeavor. Her hard work, effort, interest, sincerity, suggestion,
constructing comments, helped to mould this study in a successful way. Her
inspiration and encouragement laid strong foundation in this research.
It is very essential to mention that her wisdom and helping nature has made
my research a lively and everlasting one.
Finally I dedicated this study to my loveable parents and family members for
their blessing, joy, hope and their fruitful prayer, inspiration, support and
encouragement for the accomplishment of my dreams in our entire Endeavour.
ABSTRACT
INTRODUCTION
The main aim of the present study was to evaluate the effectiveness of pre-
operative teaching on post-operative exercise to prevent complications among patients
undergoing abdominal surgeries in Sai hospital at Chennai.
OBJECTIVES
METHODS
A quantitative approach was used in the present study. The research design adopted
in this study was non equivalent pre and post test design as a sub type quasi
experimental design.A non probability purposive sampling technique was adapted to
select samples.
As a intervention pre operative teaching was given to prevent the post operative
complications for the patients undergoing abdominal surgeries
RESULTS
The mean score of experimental group and control group was 24.5 and 23.5.
The obtained‘t’ value 1.367 was less than the table value 1.367 was less than the table
value (1.960). This finding reveals than there is homogeneity exists among
experimental and control group before providing pre operative teaching.
The post test Deep Vein Thrombosis risk score of experimental group was
11.5 and that of the control group was 13.2. The calculated ‘t’ value was 2.55 at 39
degrees of freedom and at 0.05% level of significance which is greater than table
value (1.960). It reveals that pre operative teaching on post operative exercises had a
significant effect in reducing the risk of developing DVT among the experimental
group.
The post test wound status score of experimental group was 60.55 and that of
control group score was 50.45. The calculated ‘t’ value was 4.112 at 39 degrees of
freedom and at 0.05% level of significance which is greater than table value (1.960).
It reveals that pre operative teaching on post operative exercises played a significant
role in improving the wound status in experimental group.
I INTRODUCTION
1.1 Need for the study 2
1.2 Statement of the problem 3
1.3 Objectives 3
1.4 Hypotheses 3
1.5 Operational definition 4
1.6 Assumptions 4
1.7 Delimitations of the study 5
1.8 Projected outcome 5
1.9 Conceptual framework 6
II REVIEW OF LITERATURE
VI SUMMARY, CONCLUSION. 54
6.1 Summary
6.2 Conclusion 54
6.3 Implication 56
6.4 Limitation 56
6.5 Recommendation 58
58
REFEREENCES 59
APPENDICES
LIST OF TABLE
TABLE TITLE PAGE NO
NO
35
4.2 Distribution of value of Respiration Mean, Median &Standard
deviation and “t” value of respiratory Status of subjects between the
experimental group before Surgery.
4.3 Mean Standard Deviation &‘t’ Value of Respiratory Status of 37
Subjects between the Experimental and Control Group after Surgery
INTRODUCTION
Cross land, et.al., (2008) stated that respiratory complications were the most
lethal responsible for 5% to 35% of post-operative death. It can be reduced by proper
treatment along with pre t-operative teaching during hospitalization.
1.3 Objectives
1.4 Hypothesis
H1 -There will be a significant difference between pre test and post test of
respiratory status among the patients undergoing abdominal surgery in experimental
and control group.
Effectiveness
Pre-operative Teaching
Post-operative Exercises
It refers to the specific exercise’s done after 16-24 hours of the surgery such as
deep breathing, coughing, early ambulation, turning exercises and leg exercises,
which improve ventilation, circulation, and enhance wound healing and prevent
complications.
Post-operative Complications
1.6 Assumptions
Early ambulation improves blood flow to the extremities thus reduces the muscle
weakness and prevent respiratory complications, complications of wound healing and
Deep Vein Thrombosis.
The study was delimited to the patients admitted for the abdominal
surgery in Sai Hospital.
Data collection was delimited to 4 weeks
Conceptual Framework for this was derived from Rosenstock’s, Backer and
Mimans Health Belief Model (1974). It provides a way of understanding and
predicting how the client will behave in relation to their health and how they comply
with health care therapies. Use of the model is based on a person’s perception of the
susceptibility to an illness, the seriousness of the illness, the seriousness of the illness,
and the benefits of taking action to prevent the illness.
The health belief model helps to understand the factors influencing client
perception, beliefs and behaviors to plan care that will most effectively assist client in
maintaining or restoring health and preventing illness.
The first component in the model involves the persons perceptions regarding
seriousness of abdominal surgery and susceptibility to various pre operative
complications.
This cue to action is the pre operative teaching on post operative exercise
(deep breathing, coughing, leg exercise, turning and early ambulation) given by the
researcher.
The researcher assessed the pre operative respiratory status for the subjects of
both experimental and control group and provided pre operative teaching regarding
post operative exercise to the experimental group day before surgery.
The third component, the likelihood of actions, that a person will take actions
results from person perception of the benefits of and barriers to take action.
Preventive action may include life style changes increased adherence to medical
therapies or a search for medical advice or treatment. In this study likelihood of
action, the subjects of experimental group perceived the benefits of post operative
exercises such as earlier recovery, lung expansion, perceived of respiratory
complications, prevention of Deep Vein Thrombosis and improved wound healing
more than the perceived barriers such as pain, drowsiness, because of anesthesia,
sedative effect, unwillingness, lack of knowledge, and fear of breakdown of sutures.
.
Figure.1.1 Conceptual Frame Work for the Study, Rosenstock' Health Belief Model (1974) (Modified)
CHAPTER – II
REVIEW OF LITERATURE
A literature review helps to lay the foundations for a study and can also
inspires new research ideas.
Exercises have many well documented benefits for weight control and
prevention of diseases. Likewise post-operative exercise’s helps to reduce the
circulatory and respiratory complications among the patients undergoing abdominal
surgeries.
Aroma (2006) reported that the clients after abdominal surgeries had post
operative complications like atelectasis 39%, pneumoia was the frequent event over
25% followed by broncho constriction 18%, acute respiratory failure 15%, bronchial
constriction 3% and also stated that complications were mostly seen above 60 Years.
The Agency for Health Care Research and Quality (2009) estimated that 4
patients of every 1,000 who undergo surgery will experience postoperative respiratory
failure, and eight of every 1,000 will experience a pulmonary embolus.
Mehta (2009) described that more than 1, 90,400 peoples in a year were
suffering from pulmonary complications like pneumonia, atelectasis, ARDS,
bronchitis after abdominal surgeries.
Mathew (2006) stated that post operative pains after abdominal surgery are a
significant source of infection, complications and prolonged length of stay in hospital.
Patient related to risk factors are poor general health, unsterile methods, laboratory
parameters and dependent functional status.
Ronald (2006) conducted prevalence survey of nosocomial infection. They
included all hospitalized patients (116) concept those who stayed less than 40 hours.
The result showed that 64.4% patients had nosocomial infections. The infection rate
increases with abdominal surgeries, debilitated post operative physical status, and
intensive care. The average increase in duration of hospital stay for infected patient
has ten days. This data confirm the importance of prevention of nosocomial infection
and emphasize the need of surveillance which control infections.
Bake (2008) suggested for the patients after abdominal surgeries, active
moments like dorsiflexion, plantar flexion, and subtalar inversion promotes the
highest blood supply to the extremities than passive movements.
Bardin and Simal (2008) observed the relationship between the movements
of foot and ankle with venous blood flow from lower limbs by using 20 post operative
patients. The active exercises produced higher peak (58%) and mean velocities of
blood flow (38%). The passive exercises produced 25% of peak and 13% of mean
velocities of blood flow.
Swapna (2010) conducted a study to assess the effectiveness of foot and hand
massage to relieve the post operative pain among the patients with abdominal
surgeries. Two group pre test and post test experimental group design was used
among 40 samples. The calculated ‘t’ value was 17.8 for the experimental group
regarding pain. The results showed that food and hand massage ad a significant effect
on post operative pain among the patients with abdominal surgery in experimental
group.
Vincent, et. all., (2006) conducted a study to assess the effectiveness of early
ambulation in patients after abdominal surgery. He advised ambulation of post
operative patients with in 24-48 hours after surger. The results showed that early
ambulation helps in preventing complications resulting from prolonged bed rest,
venous thrombosis, embolism, and showed a marked reduction in pulmonary
complications.
Johnson and Kean (2007) found that one of the most important responsibility
of the nurse in pre operative preparation of patient for surgery was per-operative
education. Pre-operative teaching helps to relieve emotional stress and prevention of
complications. By providing pre-operative teaching about post-operative exercises,
the nurse can inform, support and collaborate the planned care among the adult
surgical patients.
Thompson, et. al., (2005) said that all patients, regardless of age, are at risk
for post operative complications include post operative fever, atelectasis, wound
infection, embolism, and Deep Vein Thrombosis.
The Agency for Healthcare Research and Quality (2009) estimates that
four patients of every 1,000 will experience a pulmonary embolus. Respiratory
complications are the second most common reason for unexpected death or transfer to
an intensive care unit and often are preventable
Cooke and Nally (2007) investigated the effects of active movements of one
foot on venous blood flow, five days after surgery, movement of foot for one minute
and the result confirmed the beneficial hemodynamic effects of active movement of
the foot in the post operative period and decreasing risk of venous thrombosis.
Mollan, et. al., (2007) investigated the effect of active movement of one food
to enhance the venous blood flow for four days after total hip replacement. The actual
venous outflow at rest was measured with the use of venous occlusion stronin gauge
plethysmography. Results confirm the foot post operatively as a part of prophylactic
regimen directed by decreasing the risk of venous thrombosis.
Economo (2008) said that the ideal timing of pre operative teaching is not on
the day of surgery, but during the pre admission visit when diagnostic tests are
performed. At this time the nurse or resource persoructions provide written
instructions about many types of answers questions and provide an important patient
teaching. Most instructions provide written instructions about many types of surgery.
Singhal (2009) suggested that the post operative wound infection account for
14% to 16% of the 2 million nosocomial infections in the US, and 77% of deaths of
surgical patients can be traced back to surgical wound infection. The incidence of
wound sepsis is higher in patients who are malnourished immune suppressed of older
or who have had a prolonged hospital stay or a lengthy surgical procedure (Galbrith,
2007).
Owings (2007) said that with doctors performing over 45 million surgeries
each year in the US, even small improvements will produce significant results. By
implementing corrective changes to reduce the occurrence of postoperative wound
infection by even one-quarter of 1%, hospitals could prevent over 1,00,000 infections
each year.
Grief, et. al., (2006) suggested that in post operative patients, surgical site
infection is the most common nosocomial infection, with 67% of these infections
occurring within the incision and 33% occurring in an organ or space around the
surgical site. The morbidity rate associated with abdominal wound evisceration is
high; the mortality rate ranges between 10% and 40%, and can be as high as 44% for
adults. It can be prevented by careful attention to surgical techniques and proper
education (Centers for Disease Control and Prevention, 2008).
Lewis (2009) suggested that wound infection may result from contamination
of the wound from three major sources: exogenous flora present in the environment
and on the skin, oral flora and intestinal flora. An incision disrupts the protective skin
barrier. Therefore, wound healing is one of the major concerns during the post
operative period.
Foster (2007) conducted a study on 300 clients in Ohio State USA stated that
wound management for individual patients must be derived using best evidence and
taking into account. The study concluded that general factors such as safety, comfort,
pain management and convenience must be born in mind when deciding which
dressing is the best of individual patients.
CHAPTER –III
METHODOLOGY
This chapter includes research approach, research design, setting of the study,
population, sample size and sampling technique, criteria for the selection of the
sample, description of the tool, testing of the tool, pilot study, data collection
procedure and plan for data analysis.
Research design is the plan and strategy of investigation for answering the
research question. It is an overall blueprint, with the researcher selected to carry out
this study.
E O1 X O2 O3 O4 O5 O6
C O1 O2 O3 O4 O5 O6
E= Experimental Group
C=Control Group
Pre test and post test was done to assess the respiratory status. Post test was
done to assess risk of developing Deep Vein Thrombosis and Wound Status.
Independent Variables:
Dependent Variables
The study was conducted at Sai Hospital, Chennai. It is a 100 bedded multi-
specialty Hospital. The total number of beds in surgical unit is 25. On an average 30-
50 patients attend the outpatient department daily.
3.5 Population
The population is the total number of people, who meet the criteria that the
researcher has established for the study from which subjects will be selected and with
whom findings will be generalized. (Polit, 2004)
The population of the study constitutes all the patients who were undergone
abdominal surgery in Sai Hospital during the data collection period.
Inclusion Criteria
Exclusion Criteria
Present - 1
Absent - 0
The possible maximum score was 14 and the minimum score was 0. High
score indicates good respiratory status. Low score indicates poor respiratory status.
Present - 0
Absent - 1
The possible maximum score was 20 and the minimum score was 0. High
score indicates good respiratory status. Low score indicates poor respiratory status.
Present - 1
Absent - 0
Present - 1
Absent - 0
The possible maximum score 16 indicates, the high risk of developing Deep
Vein Thrombosis. Low score 0 indicates low risk of developing Deep Vein
Thrombosis.
Section V: Assessment of Wound Status
a - 5
b - 4
c - 3
d - 2
e - 1
Content Validity
The tool was given to five experts in the field of nursing medicine for
content validity. Necessary modifications were made as per expert’s opinion. The
modifications were incorporated in the preparation of final tool.
Reliability
Inter rater reliability was used to establish the reliability of respiratory status
tool Part A was 0.89. Part B was 0.87. The reliability of risk of developing Deep
Vein Thrombosis was 0.86. The reliability of wound status assessment was 0.89.
The pilot study was conducted to make sure that the tool was capable of
eliciting response from the respondents. It was conducted among 10 patients for a
period of one week, five patients for each control group and experimental group. The
pilot study revealed that the tool was reliable to conduct study.
The patients who were selected for control group were assessed pre-
operatively for respiratory status, and post-operatively for respiratory status, risk of
developing deep Vein Thrombosis and wound status for five consecutive days starting
from the first post-operative day.
The patients who were selected for experimental group were assessed pre-
operatively for respiratory status, gave the pre-operative teaching on post-operative
teaching on post-operative exercise. It was a teaching where the subject watches it for
about 20 minutes. Subjects were encouraged every second hourly to do the exercises.
The researcher then assessed for respiratory status, risk of developing Deep Vein
Thrombosis and wound status for the five consecutive days from the first post-
operative day.
Research Design
Non equivalent control group pre test post test design,quasi experimental
Population
All patients who were undergone abdominal surgery in Sai Hospital,
Tambaram, Chennai
Sampling Technique
Non probability purposive sampling technique
Sample Size
Experimental group =20 Control group=20
Post test
Assessment of respiratory status, risk of developing Deep Vein
Thrombosis and wound status for the five consecutive days from
the first post-operative day
Data Analysis
Descriptive and Inferential Statistics
This chapter deals with analysis and interpretation of the data collected from
patients undergoing abdominal surgeries, to assess the effectiveness of pre operative
teaching on post operative exercises. The findings based on the descriptive and
inferential statistical analysis were presented under the following headings:
Table: 4.1 Frequency & percentage and Distribution of pre test level of knowledge
score among sample with their Selected Demographic Variable
(n = 40)
1. Age
a. 21-30 years 6 30 7 35
b. 31-40 years 5 25 4 20
c. 41-50 years 4 20 3 15
d. 51-60 years 5 25 6 30
2. Sex
a. Male 6 30 5 25
b. Female 14 70 15 75
3. Education
a. Primary 9 45 7 35
b. Secondary 7 35 8 40
c. Higher 1 5 5 25
Secondary
d. Graduate 3 15 0 0
e. Post graduate 0 0 0 0
4. Occupation
a. Student 1 5 0 0
b. Unemployed 7 35 10 50
c. Self employed 1 5 0 0
d. Labour 8 40 8 40
e. Office worker 3 15 2 10
Cont...
S. Demographic Experimental Group Control Group (n=20)
(n=20)
No. Variables
Frequency Percentage Frequency Percentage
(f) (%) (f) (%)
5. Family income per
month
a. Rs. 2001-5000 2 10 1 5
75 18 90
b. Rs. 5001-10,000 15
15 1 5
c. Rs. >-10,000 3
6. Personal Habits
a. Smoking 2 10 2 10
b. Tobacco and 5 25 6 30
betel chewing
c. Alcohol 4 20 1 5
d. Nil 9 45 11 55
7. Weight of patient
a. 35-45kg 1 5 2 10
b. 46-55kg 6 30 7 35
c. 56-70kg 13 65 9 45
d. >70kg 0 0 2 10
8. Height of patient
a. 145-150cm 2 10 2 10
b. 151-155cm 5 25 12 60
c. 156-160cm 13 65 5 25
d. >160cm 0 0 1 5
9. Duration of
hospitalization
a. 7 days 18 90 19 95
b. >7 days 2 10 1 5
On considering the sex 6(30%) were males and 14(70%) were females in
experimental group, 5(25%) were males and 15(75%) were females in control group.
With regard to the occupation, 1(5%) was student, 7(35%) were unemployed,
1(5%) was self employed, 8(40%) were labours and 3(15%) were office workers in
experimental group, 10(50%) were unemployed, 8(40%) were labours and 2(10%)
were office workers in control group.
Regarding the monthly family income, 2(10%) had an income between Rs.
2001-5000, 15(75%) had an income between Rs.5001-10,000 and 3(15%) had income
above Rs. 10,000 in experimental group, 1(5%) had an income between Rs. 5001-
10,000 and 1(5%) had income above Rs.10,000 in control group.
On considering the personal habits 2(10%) were smokers, 5(25%) were having
the habit of tobacco and betel chewing, 4(20%) were alcoholics and rest 9(45%)
belongs to nil category in experimental group, 2(10%) were smokers, 6(30%) were
having the habit of tobacco and betel chewing, 1(5%) was alcoholic and rest 11(55%)
belongs to nil category in control group.
With regard to the weight 1(5%) weighed in the range of 35-45kg, 6(30%) in
the range of 46-55kg and 13(65%) in the range of 155-160cm in experimental group,
2(10%) were in the range of 145-150cm, 12(60%) in the range of 151-155cm, 5(25%)
in the range of 156-160cm and 1(5%) was above 160cm in control group.
On considering the duration of hospitalization, majority of patients 18(90%)
stayed in the hospital for 7days and rest 2(10%) stayed for more than 7days in
experimental group, 19(95%) stayed in the hospital for 7days and 1(5%) stayed for
more than 7days in control group.
With regard to the type of family 13(65%) belongs to nuclear family and
7(35%) belongs to joint family in experimental group, 15(75%) belongs to nuclear
family and 5 (25%) belong to joint family in control group.
40
35%
35
30% 30%
30
25% 25%
25
PERCENTAGE
20% 20%
20 GROUP I EXPREMENTAL
15% GROUP II CONTROL
15
10
0
21-30 YEARS 31-40 YEARS 41-50 YEARS 51-60 YEARS
80% 75%
70%
70%
60%
PERCENTAGE
50%
20%
10%
0%
Male Female
60
50%
50
40%40%
PERCENTAGE
40 35%
30
80 75%
70
PERCENTAGE
60
50 GROUP I EXPREMENTAL
40 GROUP II CONTROL
30
20 15%
10%
10 5% 5% 2.8%
0
2001-5000 5001-10,000 10,000
60 55%
50 45%
PERCENTAGE
40
30%
30 25%
GROUP I EXPREMENTAL
20%
20 GROUP II CONTROL
10% 10%
10 5%
0
SMOKING TOBACCO AND ALCOHOL NIL
BETAL CHEWING
60
50
45%
40
PERCENTAGE
35%
30% GROUP I EXPREMENTAL
30 GROUP II CONTROL
20
10% 10%
10
5%
0%
0
35-45% 46-55% 56-70% > 70%
70 65%
60%
60
50
PERCENTAGE
40
GROUP I EXPREMENTAL
30 GROUP II CONTROL
25% 25%
20
10% 10%
10 5%
0%
0
145-150CM 151-155CM 156-160CM >160CM
60
50 GROUP I EXPREMENTAL
40 GROUP II CONTROL
30
20
10%
10 5%
0
7 DAYS > 7 DAYS
80 75%
70 65%
60
PERCENTAGE
50
40 group I expremental
35%
group ii control
30 25%
20
10
0
Neulear Joint
Table 4.2 Data on value of Respiration Mean, Median &Standard deviation and
“t” value of respiratory Status of subjects between the experimental group
before Surgery.
(n = 40)
S. No Group Mean Mean SD ‘t’ value
difference
1. Experimental 24.5 2.8
2. Control 23.5 1 1.5 1.367*
Table 4.2 shows that the mean score of experimental group and control group
was 24.5 and 23.5. The obtained‘t’ value 1.367 was less than the table value 1.367
was less than the table value (1.960). This finding reveals than there is homogeneity
exists among experimental and control group before providing pre operative teaching.
24.6 24.5
24.4
24.2
24
23.8 Experimental
Control
23.6 23.5
23.4
23.2
23
Experimental Control
Table 4.3 shows that the mean score of respiratory status after the abdominal
surgery of experiment group was 30.6 and that of control group was 24.35. The
calculated “t” value 10.85 is greater than table value (1.960). It shows that pre-
operative teaching was found to be effective in improving the post-operative
respiratory status of experimental group. .
35
Experimental
30 Control
25
20
15
10
0
Experimental contol
(n = 40)
2. Control 13 1.94
*Significance at 0.05 level
Table 4.4 shows that the post test score of respiratory complication after
abdominal surgery in experimental group was 11.3 and that of control group was 13.
The calculated ‘t’ value was 2.54 was significant at 39 degrees of freedom and at 0.05
level of significant which is greater than table value (1.960). It shows that pre
operative teaching was effective in preventing post operative respiratory
complications.
13.5
13
13
12.5
12
Experimental
11.5 11.3 Control
11
10.5
10
Experimental Control
Table 4.5 Comparison of Post Test Score of Risk of Deep Vein Thrombosis
Between Experimental and Control Group
Table 4.5 shows that the post test Deep Vein Thrombosis risk score of
experimental group was 11.5 and that of the control group was 13.2. The calculated
‘t’ value was 2.55 at 39 degrees of freedom and at 0.05% level of significance which
is greater than table value (1.960). It reveals that pre operative teaching on post
operative exercises had a significant effect in reducing the risk of developing DVT
among the experimental group.
13.5
13.2
13
12.5
12 Experimental
Control
11.5
11.5
11
10.5
Experimental Control
Table 4.6 Mean Standard deviation, Mean Difference and ‘t’ Value and
Comparison of Post Test Score of Wound Status Between Experimental and
Control Group
(n = 40)
Table 4.6 shows that the post test wound status score of experimental group
was 60.55 and that of control group score was 50.45. The calculated‘t’ value was
4.112 at 39 degrees of freedom and at 0.05% level of significance which is greater
than table value (1.960). It reveals that pre operative teaching on post operative
exercises played a significant role in improving the wound status in experimental
group.
70
60
50
40
Experimental
30 Control
20
10
0
Experimental Control
d. 51-60 years 3 2
2. Sex
a. Male 3 3 0.074
8 6 df=1
b. Female
3. Education
a. Primary 6 3
b. Secondary 3 4 3.159
c. Higher Secondary 0 1 df=4
d. Graduate 2 1
e. Post graduate 0 0
4. Occupation
0 1
a. Student
5 2 3.43
b. Unemployed 0 1 df=4
c. Self employed 4 4
2 1
d. Labor
e. Office worker
Cont...
Family income per month
5. a. Rs. 2001-5000 1 1 0.72
9 6
b. Rs. 5001-10,000 df=2
1 2
c. Rs. >-10,000
6. Personal Habits
a. Smoking 1 1
3 2
b. Tobacco and betel chewing 3.29
1 3
c. Alcohol 7 2 df=3
d. Nil
7. Weight of patient
a. 35-45kg 1 0 0.706
3 3
b. 46-55kg df=3
7 6
c. 56-70kg 0 0
d. >70kg
8. Height of patient
a. 145-150cm 2 0 20.323*
2 3
b. 151-155cm df=3
7 6
c. 156-160cm 0 0
d. >160cm
* Significant
Table 4.7 shows the association of demographic variable with post test scores
of respiratory status of the experimental group. The x2 value of height was 20.323 at
3 of degree of freedom and significant at 0.05 level. This shows that the height of
patient was associated with respiratory status of patients.
4. Occupation 13.62*
a. Student 1 0 df=4
b. Unemployed
6 1
c. Self employed
0 1
d. Labor
e. Office worker 0 8
1 2
b. Rs. 5001-10,000 6 9
c. Rs. >-10,000 2 1
a. Smoking 0 2 df=3
b. Tobacco and betel chewing 1 4
c. Alcohol 1 3
d. Nil 6 3
a. 35-45kg 1 0 df=3
b. 46-55kg 1 5
c. 56-70kg 6 7
d. >70kg 0 0
a. 145-150cm 1 1 df=3
b. 151-155cm 1 4
c. 156-160cm 6 7
d. >160cm 0 0
Table 4.8 shows the association of demographic variable with the risk of
developing Deep Vein Thrombosis of the experimental group. The x2 value oof
occupation was 13.62 at 4 degrees of freedom significant at o.05 level. This
shows that occupations of patients are associated with the risk of developing Deep
Vein Thrombosis. The other variables like age, sex, education, income, personal
habits and weight were not associated with the risk of developing Deep Vein
Thrombosis.
Table.9 Data on Association of Demographic Variables With Wound Status
Score of Patients
(n = 20)
Mean Mean
1. Age
21-30 years 6 0
51-60 years 2 3
2. Sex 0.71
Male 5 1 df=1
Female 9 5
3. Education
Primary
4 5
Secondary
6 1
5.29
Higher Secondary
1 0
Graduate df=4
3 0
Post graduate
0 0
4. Occupation
1 0
Student 4.276
1 2
Unemployed
df=4
3 2
Self employed
4 0
Labour
5 2
Office worker
5. Family income Per month
Cont...
Rs. 2001-5000 2 0 4.02
6. Personal Habits
Smoking
2 0
Tobacco and betel chewing
5 0
4.62
Alcohol
2 2
Nil df=3
5 4
7. Weight of Patient
35-45kg 0 1
46-55kg 0 6
7.49
56-70kg 8 5
df=3
>70kg 0 0
8. Height of patient
145-150cm 1 1
151-155cm 5 0 19.39*
156-160cm 8 5 df=3
>160cm 0 0
*Significant
Table 4.9 shows the association of demographic variable with the wound
status scores of the experimental group. The X2 value of height was 19.39 at 3
degrees of freedom significant at 0.05 level. This shows that the height of patients are
associated with the wound status.
CHAPTER-V
5.1 The First Objective of the Study was to assess the Respiratory Status of the
Patients Subjected to Abdominal Surgery in experimental and Control Group
pre operatively
5.2 The Second Objective of the Study was to Assess Respiratory Status, Risk of
Developing Deep Vein Thrombosis, Wound Status of Patients Undergoing
Abdominal Surgery Post operatively
To assess the respiratory status of subjects, observational checklist of 34
questions were used. The mean score of the experimental group was 30.6, and the
mean score of the control group was 24.35. It shows that pre operative teaching of
deep breathing exercise was significantly effective in improving the respiratory status
of the experimental group.
5.3 The Third Objective of the Study Was to Compare the Post operative
Respiratory Status Risk of Developing Deep Vein Thrombosis Wound Status
Between Control and Experimental Group.
The mean respiratory status score of experimental group 30.6 is higher than the
mean respiratory status score of the control group 24.35. The obtained ‘t’ value 10.85
at df (39) was significant at 0.05 level. It implies that the pre operative teaching on
deep breathing exercises were found to be effective in improving the post operative
respiratory status of the experimental group.
A form of checklist which included 8 questions was used for assessing the risk
of developing Deep Vein Thrombosis. The mean score of the experimental group was
11.5 and the mean score of control group was 13.2. The obtained ‘t’ value 2.55 at df
(39) was significant at 0.05 level. It indicated that post operative leg and turning
exercises reduces the risk of developing Deep Vein Thrombosis among the subjects of
experimental group than the control group.
5.4 The Fourth Objective was to Associate Respiratory Status, the Risk of
Developing Deep Vein Thrombosis Score, Wound Status Scores of Patients after
Abdominal Surgeries with Selected Demographic Variables
The demographic habits, height and weight were associated with post test
score of respiratory status, risk of developing Deep Vein Thrombosis and wound
status.
There was significant association of height with post test score of respiratory
status, occupation with post test score of risk of development Deep Vein Thrombosis
and also height and weight with post test score of wound status. All other variables
showed no significant association with post test score of respiratory status, risk of
developing Deep Vein Thrombosis and wound status score.
CHAPTER VI
6.1 SUMMARY
The study was conducted to determine the effectiveness of pre operative teaching on
post operative exercises to prevent selected post operative complications of patients
subjected to abdominal surgeries at Sai Hospital, Chennai.
OBJECTIVES
HYPOTHESIS
H1 -There will be a significant difference between pre test and post test of
respiratory status among the patients undergoing abdominal surgery in experimental
and control group.
In this study, assessment was done with the help of structured questionnaire to
prevent the complication among patients undergoing abdominal surgeries. The
objective were analyzed by using inferential and descriptive statistics.
The mean “t” value for the respiratory status of both experimental and control
group after surgery 10.85 was higher than the status of both experimental and control
group before surgery.
There was association of height with respiratory and wound status, and
occupation with risk of developing Deep Vein Thrombosis.
The mean score of experimental group and control group was 24.5 and 23.5.
The obtained ‘t’ value 1.367 was less than the table value 1.367 was less than the
table value (1.960). This finding reveals than there is homogeneity exists among
experimental and control group before providing pre operative teaching.
The post test Deep Vein Thrombosis risk score of experimental group was
11.5 and that of the control group was 13.2. The calculated ‘t’ value was 2.55 at 39
degrees of freedom and at 0.05% level of significance which is greater than table
value (1.960). It reveals that pre operative teaching on post operative exercises had a
significant effect in reducing the risk of developing DVT among the experimental
group.
The post test wound status score of experimental group was 60.55 and that of
control group score was 50.45. The calculated ‘t’ value was 4.112 at 39 degrees of
freedom and at 0.05% level of significance which is greater than table value (1.960).
It reveals that pre operative teaching on post operative exercises played a significant
role in improving the wound status in experimental group.
6.2Conclusion
The respiratory status of the patients who received pre operative teaching on
post operative exercise was significantly higher than the patients who did not receive
pre operative teaching on post operative exercises.
The post operative complications of the patients who received pre operative
teaching on post operative exercise was significantly less than those who did not
received pre operative exercises was significantly higher than those patients who did
not received pre operatively. Hence alternative hypothesis is accepted.
The demographic variables such as age, sex, education, personal habits, family
income and weight shown no significant association, where as height showed a
significant association with respiratory and wound status, and occupation with risk of
developing Deep Vein Thrombosis among patients in experimental group.
Abdominal surgeries and the complications arising after the surgery due to the
anesthesia, prolonged bed rest, wound infections etc can be prevented in various
aspects. One method is keeping the client informed regarding the post operative
exercises, care, diet etc, In this context nurses have a major role to play in helping the
clients to prevent complications like atelectasis, pneumonia, Deep Vein Thrombosis
and wound infections. The findings of the study have implications on nursing
practices, nursing education, nursing administration and nursing research.
Nursing Practice
Nursing Administration
The health administrators should be able to motivate and initiate the health personnel
in organizing and participation in various educational programmes.
Nursing Research
6.4 Limitations
6.5 Recommendations
A similar study can be conducted for a large group as a long term basis.
A similar study can be conducted with randomization.
A similar study can be conducted to assess the effectiveness of early
ambulation and exercise in preventing Deep Vein Thrombosis can be done.
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Medical University. Chennai
APPENDIX-I
APPENDIX-II
APPENDIX-III
LIST OF EXPERTS
5. Mr.Praveen Msc(N),
Medical surgical department,
Varanam College of Nursing,
Rajamundry.
6. Dr.Vijayaragavan,M.B.B.S (Intensivist)
Sai Hospital,
Chennai.
APPENDIX-IV
Place:
Date: signature:
APPENDIX-V
This is to certify that the tool developed by Mr. M.Selvam, M.Sc nursing II year
Signature
APPENDIX-VI
SECTION-1
Demographic Variables
Sample No.
1. Age in Years
a. 21-30 year
b. 31-40 year
c. 41-50 year
d. Above 60 year
2. Sex
a. Male
b. Female
3. Education
a. Primary
b. Secondary
c. Higher Secondary
d. Graduate
e. Post graduate
4. Occupation
a. Student
b. Unemployed
c. Self employed
d. Labour
e. Office Worker
a. Rs. 2001-5000
b. Rs. 5001-10,000
6. Personal habits
a. Smoking
c. Consumption of alcohol
d. Nil
7. Weight of patient
a. 35-45 kg
b. 46-55 kg
c. 56-70 kg
d. Above 70 kg
8. Height of patient
a. 145-150 cm
b. 151-155 cm
c. 156-160 cm
d. Above 160 cm
9. Duration of hospitalization
a. 7 days
b. Above 7 days
b. Joint
SECTION –II
PART-A
Absent
Exudate Present
Absent
Polyps Present
Absent
Deviation in
nasal Present
septum Absent
Symmetrical Present
Absent
Absent
Ulceration Present
Absent
Exudate Present
Absent
Moisture Present
Absent
Masses Present
Absent
Absent
Inflammation Present
Absent
Absent
Exudates Present
Absent
Ulceration Present
Absent
Swelling Present
Absent
Absent
Absent
Tracheal Present
deviation Absent
Palpable Present
Absent
movement Absent
Transverse Present
anteroposterior
diameter
Chest Present
retraction Absent
Symmetrical Present
thoracic Absent
excursion
Abnormal Present
dullness Absent
Labored Present
respiration Absent
Normal Present
respiration Absent
Normal Present
respiratory Absent
rate, rhythm
and effort
Vesicular Present
PART-B
Description D1 D2 D3 D4
1 Fever Present
Absent
Absent
Absent
Absent
Absent
6 Tachypnea Present
Absent
Absent
Absent
Absent
Absent
Absent
13 Cyanosis Present
Absent
Absent
Absent
Absent
SECDTION – III
D1 D2 D3 D4 D5
R L R L R L R L R L
Absent
Absent
3. Tingling or Present
legs Absent
Absent
muscles Absent
SECTION – III
Modified Wound Assessment Parameter Scoring Tool
1. Depth
a. Wound closed and well approximated
b. Partial thickness
c. Full thickness
d. Not visible
e. Bone involvement
2. Edges
a. Wound closed and well approximated
b. District border, attached to wound base
c. Defined, not attached to wound base
d. Rolled under thickened
e. Thickened and indurated, red, edematous
3. Undermining
a. None
b. Less than 2cm
c. Greater than 2cm but less than 4cm
d. Greater than 4cm
e. Involves adjacent structures or organs
4. Necrotic tissue
a. None
b. White gray loosely adherent
c. Yellow, loosely adherent slough or fibrous tissue
d. Loosely adherent brown or black devitalized tissue
e. Adherent black eschar
5. Exudate amount
a. None
b. Scanty
c. Mild
d. Small
e. Moderate
f. Large
6. Odour
a. None
b. Mild
c. Offensive
d. Foul
e. Extreme
7. Treatment zone skin colour
a. Normal for skin colour
b. Red
c. Pallor or gray
d. Ecchymotic
e. Cyanotic
8. Treatment zone in duration
a. None
b. Minimal demonstrated, easy to blanch
c. Mild demonstrated, spongy tissue
d. Moderate demonstrated, firm and warm
e. Severe demonstrated, hard red and hot
9. Necrotic tissue amount
a. None
b. Up to 25%
c. 25% - 50%
d. 50% - 75%
e. 75% - 100%
10. Exudate type
a. None
b. Serous
c. Serosanginous
d. Bloody
e. Purulent
PART –A
Scoring Key
1. 1.1 Absent 1
1.2 Absent 1
2. 2.1 Present 1
2.2 Present 1
2.3 Absent 1
2.4 Absent 1
2.5 Absent 1
2.6 Absent 1
2.7 Present 1
3. 3.1 Present 1
3.2 Absent 1
3.3 Absent 1
3.4 Present 1
3.5 Absent 1
4. 4.1 Present 1
4.2 Absent 1
5. 5.1 Present 1
5.2 Absent 1
5.3 Absent 1
5.4 Absent 1
5.5 Absent 1
6. 6.1 Present 1
6.2 Absent 1
6.3 Absent 1
7. 7.1 Present 1
7.2 Present 1
7.3 Present 1
7.4 Absent 1
7.5 Present 1
7.6 Absent 1
7.7 Absent 1
7.8 Absent 1
7.9 Absent 1
7.10 Present 1
SECTION –II
PART –B
S. No Answer Score
1. Absent 0
2. Absent 0
3. Absent 0
4. Absent 0
5. Absent 0
6. Absent 0
7. Absent 0
8. Absent 0
9. Absent 0
10. Absent 0
11. Absent 0
12. Absent 0
13. Absent 0
14. Absent 0
15. Absent 0
16. Absent 0
SECTION –III
S. No Answers Score
1. Absent 0
2. Absent 0
3. Absent 0
4. Absent 0
5. Absent 0
6. Absent 0
7. Absent 0
8. Absent 0
HEALTH EDUCATION
ON
Overall Objective
At the end of the teaching the patients gain knowledge regarding post operative exercises, develop a positive attitude and
skills in performing the post operative exercises individually and actively in day to day life.
Behavioural Objective
procedure can disrupts the patients, personal, professional, economic life and
physical body. For a patient after abdominal surgeries have many respiratory,
operative Post operative period is the period after the surgery is completed. In this nursing
Period care continues to be a critical element in returning the client to an optimal level
of functioning
complications of post Post operative complications are conditions that occur in clients who had
operative period undergone any kind of surgeries that are risk inherent in surgical procedures.
Shock
Haemorrhage
Pulmonary complications
Atelectasis
Aspiration
Pneumonia
Pulmonary embolism
Urinary retention
Intestinal obstruction
Wound infection
Post operative excises are the exercises that has to be performed after the surgery
for early recovery, prevention of complications and returning the client to the
PURPOSES
Turning Exercise
Life flat with your back on the right side of the bed
Keep left leg straight and flex right knee up over left leg
Grasp left side of bed with right hand, pull towards left and roll on to left side
Duration
Turning and reposition should be done every 1-2 hours during post operative
period
Benefits
respiratory complications
Respiratory Exercises
Deep Breathing
Lie down on bed with your back and body up to hip elevated from the
Place palms of hands across along the lower borders of anterior ribcage
Hold the breath, for 3-5 seconds and then slowly exhale through the mouth
Duration
Deep breathing should be done 5-10 times every hour during post operative
period of immobilization.
Benefits
Deep breathing helps to expand collapsed alveoli in lungs and prevents post
Coughing Exercise
Lie on bed with your back in semi fowlers position or if possible sit at
Take two slow deep breath, inhaling through nose and exhaling through
mouth
Inhale deeply third time and hold breath to couth of three. Cough fully
Duration
Cough 2-3 times every two hourly while awake in the post operative period.
Benefits
Coughing helps to remove retained chest secretions from bronchi and large
airways.
Leg Exercises
Rotate each ankle in complete circle and draw imaginary circles with big
Do alternate dorsi flexion and plantar flexion of the feet. Repeat it for
five times
Raise and lower the legs alternatively from the surface of the bed,
Benefits
Leg exercises helps to improve circulation, muscle strength and muscle tone
Early Ambulation
Hold the small folded towel against the incisional site or wound
of post operative exercises Assume standing position with the feet flat on the floor
ADVANTAGES
Conclusion
Post operative complications are a risk inherent in surgical procedures. For this
the doctors and nurses should ne alert of all the possible complications which
complications patients should study the post operative exercises pre operatively,
so that the patients can familiarize and practice without any assistance
Early Ambulation
Inhale deeply third time and hold breath
to couth of three. Cough fully for two or Place the legs over the edge of the bed
three consecutive coughs without inhaling Hold the small folded towel against the
between coughs. incision site or wound
First move to a sitting position
Duration : Cough 2-3 times every two Dangle the legs to free them
hourly while awake in the post operative Assume standing position with the feet
period. flat on the floor
Then walk as much as tolerable in the
Benefits : Coughing helps to remove post operative period
retained chest secretions from bronchi Place the legs over the edge of the bed
and large airways. Hold the small folded towel.
Lie flat on bed with your back To improve the circulation of fresh air
Rotate each ankle in complete circle and through out the lungs
draw imaginary circles with big toe. To strengthen the capacity and
Report for five times coordination of the respiratory muscles
Do alternate dorsi flexion and plantar To loosen the respiratory secretions for
flexion of the feet. Repeat it for five times expectoration
Raise and lower the legs alternatively To maintain joint mobility
from the surface of the bed, keeping legs To improve blood circulation
straight. Repeat for five times To prevent thrombus formation
To prevent pulmonary complications
Benefits : Leg exercises helps to improve To Prevent general muscle weakness TEXCITY COLLEGE OF
circulation, muscle strength and muscle NURSING
Mr. Selvam
tone
M.Sc Nursing 2nd Year
Mecical Surgical Nursing
COIMBATORE-23
Texcity College of Nursing
Coimbatore-23
Sky
Respiratory Exercises
Introduction
Deep Breathing
Lie down on bed with your back and
Diseases can be either medical Post Operative Exercises
body up to hip elevated from the bed
intervention of surgical interventions. Post operative excises are the exercises
approximately inclined at 30 degree angle
Surgical procedure can disrupts the that has to be performed after the surgery
(semi fowlers position) or if possible to sit
patients, personal, professional, economic for early recovery, prevention of
at the side of bed
life and physical body. For a patient after complications and returning the client to
Place palms of hands across along the
abdominal surgeries have many the optimum level of functioning.
lower borders of anterior ribcage
respiratory, cardiovascular and other PURPOSES
Take slow deep breaths inhaling
complications. Most of it can be To maintain blood circulation
through the nose
prevented by performing postoperative To stimulate respiratory function
Keep the muscles of upper chest and
exercises. To decrease stasis of gas in the intestine
shoulders relaxed
Post Operative Period To improve muscle tone
Hold the breath, for 3-5 seconds and
To encourage deep breathing
then slowly exhale through the mouth
Post operative period is the period after To relieve pressure areas
the surgery is completed. In this nursing Turning Exercise
Duration : Deep breathing should be
care continues to be a critical element in
done 5-10 times every hour during post
returning the client to an optimal level of Life flat with your back on the right side
operative period of immobilization.
functioning. of the bed
Post Operative Complications Keep left leg straight and flex right knee
Benefits : Deep breathing helps to expand
up over left leg
collapsed alveoli in lungs and prevents
Haemorrhage Grasp left side of bed with right hand,
post operative pneumonia and atelectasis.
Deep Vein Thrombosis pull towards left and roll on to left side
Pulmonary complications
Coughing Exercise
Atelectasis Duration : Turning and reposition should
Aspiration be done every 1-2 hours during post
Lie on bed with your back in semi fowlers
Pneumonia operative period.
position or if possible sit at the sides of the
Pulmonary embolism
bed
Urinary retention Benefits : Turning helps to prevent
Splint incisional areas with your hands or
Intestinal obstruction venous stasis, thrombophelbitis, pressure
a small pillow
Wound infection ulcers and respiratory complications
Take two slow deep breath, inhaling
Wound dehiscence and evisceration
through nose and exhaling through
Psychological disturbances
mouth
Sky