Download study related to electrolyte imbalance in renal failure

PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON
KNOWLEDGE REGARDING MANAGEMENT OF ELECTROLYTE IMBALANCE IN
PATIENTS WITH RENAL INSUFFICIENCY
AMONG STAFF NURSES IN SELECTED
HOSPITALS AT TUMKUR”.
SUBMITTED BY:
Mr. PRASHANTH PAWAR.K.S
FIRST YEAR M.Sc.NURSING,
MEDICAL SURGICAL NURSING.
SRI RAMANAMAHARSHI COLLEGE OFNURSING,
TUMKUR.
(2010-2011)
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTAION.
1.
NAME OF THE CANDIDATE Mr.PRASHANTH PAWAR.K.S.
AND ADDRESS.
FIRST YEAR M.Sc. NURSING,
SRI RAMANAMAHARSHI COLLEGE OF NURSING,
TUMKUR.-572106,
KARNATAKA.
SRI RAMANAMAHARSHI COLLEGE OF NURSING,
2.
NAME OF THE INSTITUTION.
TUMKUR-572106,
KARNATAKA.
3.
COURSE
OF
STUDY
AND FIRST YEAR M.Sc. NURSING,
MEDICAL SURGICAL NURSING.
SUBJECT.
4.
DATE
OF
ADMISSION
TO
COURSE.
5.
TITLE OF THE TOPIC.
“EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON
KNOWLEDGE REGARDING MANAGEMENT
OF ELECTROLYTE IMBALANCE IN
PATIENTS WITH RENAL INSUFFICIENCY
AMONG STAFF NURSES IN SELECTED
HOSPITALS AT TUMKUR”.
2
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“Awareness of risk factors and the need for screening can go a long way toward early
detection and prevention of kidney disease”
~ Allan Collins
Health is the general condition of a person in all aspects. It is also a level of functional or
metabolic efficiency of an organism, often implicitly human. Diseases are “expression of
discomfort” due to structural and functional abnormalities. Human diseases disturb or damage the
functioning of cells, tissues, organs, or systems. They are usually characterized by specific signs
and symptoms and can be mild and short lasting – such as the common cold – or severe enough to
kill millions such as renal failure. These abnormalities can be caused by various agents. The
factors causing diseases may be internal or external in nature.1
Renal insufficiency is the state in which kidneys unable to perform function at its optimum
level, it includes mainly two types, acute renal failure and chronic renal failure.Chronic Renal
Insufficiency (CRI) is a disease that slowly and gradually destroys the filtering capacity of the
kidneys. It is sometimes referred to as progressive renal insufficiency which is irreversible,Acute
renal failure (ARF) is a rapid loss (breakdown or decrease) of renal function due to damage to the
kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste
products that are normally excreted by the kidney2.
Body fluid is composed primarily of water and electrolytes.Electrolytes are defined as
inorganic substances that form ions in an aqueous solution. The body is equipped with homeostatic
mechanisms tokeep the composition and volume of body fluids within narrow limits2.
Our body needs electrolytes; when these substances are present in sufficient quantities body
functions normally. During electrolyte imbalance normal cellular functions are impaired. The
degree of impairment, the symptoms and the severity of this depends on the degree that body has
exceeded the normal limits. Electrolytes have several functions.They are used to conduct
3
electricity, the central nervous system sends electrical impulses throughout the body, they can act
as secondary messengers, skeletal muscle fibers will respond to a larger than normal electrical
stimulus and electrolytes can serve also as catalysts for enzymatic reactions2.
Electrolytes or essential ions should always be in the state of homoeostasis. The Normal or
standard range of electrolytes reflects the normal functional status of our kidneys. Our kidneys
play a vital role in preserving the internal environment while excreting the waste products of
metabolism, extra water and electrolytes. There is two way selectivity between the cause and effect
between the electrolytes and renal disorder i.e electrolyte imbalance may cause renal failure or
renal failure may leads to electrolyte imbalance2.
Depletion of Sodium (Na+) or Potassium (K+) or Calcium (Ca++) through excessive urinary
excretion may cause renal failure or renal failure may lead to depletion of these ions or electrolytes
in the blood plasma,Normal Na+concentration ranges from 135-145meq/L. Hyponatremia refers to
a serum sodium level less than 135meq/L, similarly hypernatremia is higher than normal serum
sodium level i.e exceeding 145meq/L. The normalserum potassium concentration ranges from 3.55.5meq/L, if it is below normal serum k+ concentration indicates hypokalemia & if it is greater than
normal called as hyperkalemia. A high intake of potassium can cause severe hyperkalemia in
patients with impaired renal function. The normal total serum ca+ level is 8.6-10.2mg/dl.its
deficiency is termed as hypocalcemia& excess of ca+ in the plasma is known as hypercalcemia,
these imbalances may significantly affect renal function and result in renal failure3 .
Fluid and electrolyte disturbances commonly occur in acuterenal failure. The type of fluid
derangement is often a functionof urine output or volume. With oliguria, urine output is
usuallydefined as being less than 400-500 mL/day (or < 30mL/hour if being measured by a bladder
catheter). Withoutappropriate declines in fluid intake or institution of dialysis,fluid overload may
occur. The excessive fluid in the body mayinitially be linked to cosmetic changes such as
peripheraledema, but uncorrected, may result in more detrimental problemssuch as pulmonary
edema. While decreased or absent(anuria is usually defined as a urine output < 50-100
mL/day)urine output is often considered to be a hallmark of acute renalfailure, in the initial stages
of most forms of acute renal failurethe urine volume remains unchanged or may even increase.2
4
6.1 NEED FOR THE STUDY
The kidneys, which are generally smaller than a person's hand, are required to filter
approximately 1700 liters of blood every day Because of the role of the kidneys in maintaining
homeostasis in the body, kidney failure leads to derangements of fluid, electrolyte, and acid-base
balance. In renal failure the kidneys fail tooutput urine and can result in increased concentrations
of all electrolytes normallyexcreted in the urine.The intake of water and electrolytes is inseparable
from the ingestion of nutrients by normal or artificial means. Recent reports have agreed in
criticizing the poor standards of practice and of training in the management of fluid and electrolyte
balance, resulting in a large amount of avoidable morbidity, particularly in the elderly who are
more vulnerable to fluctuations in body composition.4
The most effective therapy of a uremic crisis is careful management of fluid balance, which
involves thoughtful assessment of hydration, a fluid treatment plan personalized for the specific
patient, repeated and frequent reassessment of fluid and electrolyte balance, and appropriate
changes in the treatment plan in response to the rapidly changing clinical situation of the patient
that has renal failure. Disorders of sodium, chloride, potassium, calcium, and phosphorus are
commonly encountered in renal failure and may be life threatening.5
Recent findings that Ageing is associated with impaired physiological reserve and a reduced
ability to compensate for fluctuations in environmental conditions. These changes include reduced
cardiac and renal reserve, making the elderly more vulnerable to changes in water and electrolyte
gain or loss with a resulting increase in morbidity and mortality. The ability to cope with errors in
prescriptions is correspondingly diminished. Often to failures in detection and appropriate
management by health care personals in hospital patients, is also common and results in impaired
recovery & may lead to mortality and morbidity. Hyponatraemia and Hyperkalemia are an
important clinical problem in hospital. Better training in the detection, prevention and management
of fluid and electrolyte imbalance is needed to reduce common and serious morbidity associated
with this problem.6
The recent study conducted, that reveals,sARF(Severe acute renal failure) occurred in 240
patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (≥65
5
years of age). Risk factors for development of sARF included previous heart disease, stroke,
pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction,
and electrolyte imbalance. The annual mortality rate was 7.3 per 100,000 population with rates
highest in males and those ≥65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%,
60%, and 64%, respectively and need for continuous renal replacement therapy were
independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of
survivors at 1 years ARF is common and males, older patients, and those with underlying medical
conditions are at greatest risk. Although the majority of patients with sARF will die, most
survivors will become independent from renal replacement therapy within ayear7
Recent studies says that Around 40,000 people die of kidney failure each year in Bangladesh
as about 95 per cent people cannot afford kidney treatment due to high cost,. Number of kidney
patients across the world was increasing gradually and nearly 1.80 crore people were affected by
chronic kidney disease in the country. . It is estimated that currently there are over 1 million people
worldwide who are alive on dialysis or with a functioning graft. Almost 66% kidney failure occurs
due to hypertension or diabetes.8
There are more than 2,000,000 patients with renal failure in the country. Every year,
in India, there are 1,00,000 new patients with end-stage renal failure (ESRD) who require
treatment. Of these patients alone, 9,00,000 patients will require dialysis, apart from the
already existing patients. In India 90% patients who suffer from kidney disease are not able to
afford the cost of treatment.9
Electrolytes, or ions, are the charged particles in body fluids that help transmit electrical
impulses for proper nerve, heart, and muscle function. The number of positive ions, called cations,
and negative ions, called anions, is supposed to be equal. Anything that upsets this balance can
have life-threatening consequences.There's a long list of conditions that lead to electrolyte
imbalances, including dehydration, diabetic ketoacidosis, cancer, and even head injury. But renal
disease is at the top of the list. It's the kidneys' job to control fluid, electrolyte, and acid-base
balance. Because too much or too little of any one of the electrolytes quickly becomes a major
problem of its own, doing everything possible to maintain the proper balance is a vital component
6
of patient care. Therefore, monitoring electrolytes and checking for signs of an imbalance should
be an integral part of your nursing assessment.10
Patients whose condition deteriorates in clinical areas often become shocked or shut down
because of an inability to provide oxygen and core nutrients to the tissues. Preventing shock
requires an adequate cardiac output and adequate circulating volume (Hand, 2001a) otherwise
organ failure will result. Often, the first organ to fail is a kidney (Adam and Osborne, 1997),
resulting in fluid and electrolyte imbalances11
A study was conducted by Ramesh Kumar, Mary G. Mcgeon to know electrolyte imbalance
as risk factor for developing acute renal failure. Researcher conducted a study on 122 elderly
patients, they found that factors(electrolyte imbalance) were present in 50% of the cases. The
mortality was 57·3% and this corresponds with the overall mortality in acute renal failure,
irrespective of age. Thus they concluded that there is an need for management electrolyte
imbalance in order to prevent the development of acute renal failure.12
Early recognition of and intervention for fluid and electrolyte disturbances may help prevent
functional disability and mortality in older adults.2,4 Prevention of imbalances requires proactive
education of the older adult and caregiver to foster adequate fluid and nutritional intake and
adherence to periodic laboratory and clinical screening for early detection and correction of
disorders. 13
From the above mentioned research studies and the available statistical data, it is evident that
management of electrolyte imbalance in renal insufficiency is very much needed and the
investigator is interested in taking the present study.
7
6.2 REVIEW OF LITERATURE
The purpose of review of literature is to obtain comprehensive knowledge base and in
department of information from previous studies.
The review of literature is presented in the following sub headings:1) Studies related to acute and chronic renal failure
2) Studies related to electrolyte imbalance in renal failure.
3) Studies related to self-instructional module on renal failure.
STUDIES RELATED TO ACUTE AND CHRONIC RENAL FAILURE
 J Prakaash, AS Murthy, R Vohra e.t al:Conducted a study on Acute Renal Failure in
the Intensive Care Unit(ICU) is associated with high mortality ofPatients who developed ARF
during the ICU stay were included in the study. The clinical and laboratory data were collected at
admission and then on daily basis. Data recordedincluded; patient characteristics, underlying
medical conditions responsible for ICU admission, dialyticstatus, need for ventilation, total
duration of ICU stay, APACHE-III score and final outcome, and these datawere analyzed for
predicting survival using univariate and multivariate analysis .Results shows that Twelve hundred
and fifteen (1215) patients were admitted to ICU from September 2005 to January,2007 and 46
(3.79%) patients developed ARF after admission to ICU. Mean age of patients was 44.9 ± 17 years
and 56.5% were males. Comorbidity was seen in 24 (52%) patients; hypertension (34.7%),
diabetes mellitus(28.3%), coronary artery disease (30.4%) and chronic kidney disease (13%). ARF
had developed complicating medical and surgical conditions in 33 (71.7%) and 11 (23.7%)
patients respectively. The etiology of ARF was multifactorial and included; hypotension (71.74%),
volume depletion (17.4%), nephrotoxic drugs (67.39%),and sepsis (69.5%). Multiple organ system
failure (MOSF) was noted in 63% of cases and dialysis was required in 25 (54.3%)patients.
Mortality occurred in 63% of patients. MOSF and sepsis were found to be significant adverse
prognostic factors when multiple logistic regression analysis was done.: ARF was seen in 3.79% of
cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE
– III scores and ventilation need were correlated with higher mortality in ARF patients in the
intensive care unit14.
8
 J.A GRAHAM . A.M PEATON AND L.LINTON: conducted a study to know the need
for muscle biopsy in patients. He took 12 patients out of which 11 patients with untreated ARF
and1 patient in diuretic recovery phase Researcher found 2 main types of imbalance one group
shown decreased sodium in ECF and normal concentration of sodium in ICF, another group shows
over hydration with increased sodium in ECF and ICF ,with decreased potassium in ICF ,where
the patient in diuretic recovery phase shown loss of sodium and chloride which emphasizes
necessity to replace urinary electrolyte losses at the diuretic stage .thus researcher concluded that
muscle biopsy analysis are isotope dilution studies may be required before accurate replacement
fluid therapy15.
 Harbir s. Kohli, madhu c. Bhaskaran et.al: conducted (2006)study related
to,Treatment-related acute renal failure in the elderly a hospital-based prospective study.Samples
were All elderly patients (>60 years) admitted over a 12-month period were screened prospectively
throughout their hospital stay for the development of ARF. Results shows. Of 31860 patients
admitted, 4176 (13%) were elderly. Of these 59 (1.4%) developed ARF in the hospital.
Nephrotoxic drugs contributed towards development of ARF in 39 (66%), sepsis and hypo
perfusion in 27 (45.7%) each, contrast medium in 10 (16.9%) and postoperative ARF occurred in
15 (25.4%) patients. These pathogenetic factors were responsible for ARF in different
combinations. Amongst these combination of pathogenetic factors, radio contrast administration
(partial χ2 28.1, P<0.0001), surgery (partial χ2 14.89, P=0.001), and drugs (partial χ2 6.22,
P=0.0126) predicted ARF on their own. Nine patients (15.23%) needed dialytic support. Of 59
patients, 15 (25.4%) died, of those who survived, 38 (86.3%) recovered renal function completely
and six (13.6%) partially. Mortality in the elderly with ARF was significantly higher than in those
without ARF (25.4 vs 12.5%; χ2 8.3, P=0.03). Sepsis (odds ratio 43), oliguria (odds ratio 64), and
hypotension (odds ratio 15) were independent predictors of poor patient outcome on logistic
regression analysis. The study concluded as Incidence of treatment-related ARF in the elderly was
1.4%, with more than one pathogenetic factor playing a role in the development of ARF in the
majority. Sepsis, hypotension, and oliguria were the independent predictors of poor patient
outcome16.
9
 Cécile Couchoud, Nicole Pozet, Michel Labeeuw e.t al (2008): conducted study
regarding Screening early renal failure. Researcher used methodsto identify the suitable
values;curves were constructed based on the data of 984 laboratory assessments of renal
function. The glomerular filtration rate was measured with inulin clearance. Three levels of
renal impairment were analyzed. An index that gave the same weight to false positive and false
negative results was used to determine the thresholds. Robustness of the results was tested
using a "bootstrap" technique. Results revealed that considering an inulin clearance of less than
80 ml/min/1.73 m2, the cut-off value for serum creatinine was 115 mol/liter for men and 90
mol/liter for women. The cut-off value for a clearance of less than 60 ml/min/1.73 m2 was
137
mol/liter for men and 104
mol/liter for women. For a clearance of less than 30
ml/min/1.73 m2, the cut-off value was 177 mol/liter for men and 146 mol/liter for women.
Researcher concluded that this method is useful to determine a cut-off value for serum
creatinine in epidemiological studies concerning early chronic renal failure screening. 17.
10
STUDY RELATED TO ELECTROLYTE IMBALANCE IN RENAL FAILURE
 LINDNER G, KNEIDINGER N, HOLZINGER U, DRUML W: Conducted a study
regarding Tonicity balance in patients with hypernatremia acquired in the intensive care unit.
Researcher took 45 patients of medical ICU for his study. For inclusion in the study, patients
needed to show an increase in serum sodium concentration to greater than 149 mEq/L from an
initial concentration of less than 146 mEq/L. the measurements were: The daily mass balance of
sodium, potassium, and water over 1- to 3-day intervals was measured while serum sodium levels
were increasing. Results revealed that During the study period, 69 of 981 patients (7%) acquired
hypernatremia after admission to the ICU. Of these, 45 had sufficient data for evaluation.
Maximum serum sodium levels were 150 to 164 mEq/L. The average duration of hypernatremia
was 2 days (range, 1 to 10 days), with an average onset on day 5.9 +/- 4.3 of the ICU stay. Patients
were classified as having a positive solute balance (n = 17; 38%), negative fluid balance (n = 20;
44%), or both (n = 8; 18%). The most important extrarenal factors contributing to hypernatremia
were fever (45%) and diarrhea (18%). Polyuria was observed in 38% of patients and 35% had
acute renal failure. Hypertonic solutions were administered to 27% of patients. The ICU-acquired
hypernatremia is associated with multiple factors associated with negative fluid and positive solute
balance18.
 Langston C (2008) conducted study on managing fluid and electrolyte disorders in renal
failure and he states that Because of the role of the kidneys in maintaining homeostasis in the body,
kidney failure leads to derangements of fluid, electrolyte, and acid-base balance. The most
effective therapy of a uremic crisis is careful management of fluid balance, which involves
thoughtful assessment of hydration, a fluid treatment plan personalized for the specific patient,
repeated and frequent reassessment of fluid and electrolyte balance, and appropriate changes in the
treatment plan in response to the rapidly changing clinical situation of the patient that has renal
failure. Disorders of sodium, chloride, potassium, calcium, and phosphorus are commonly
encountered in renal failure and may be life threatening. Treatment of metabolic acidosis and
nutritional support are frequently needed19.
11
 Lisa Nanovic, DOconducted study onElectrolytes and Fluid Management in
Hemodialysis andperitonealdialysisand she states that The kidney is a complex and vital organ,
regulating the electrolyte and fluid status of the human body. As hemodialysis (HD) and peritoneal
dialysis (PD) are forms of renal replacement therapy and not an actual kidney, they do not possess
the same physiologic regulation of both fluid and electrolytes. In this review, fluid status of both
HD and PD will be examined, as well as sodium, potassium, phosphorous, and calcium. Each
electrolyte will be analyzed by its physiological significance, the complications that arise when a
proper balance cannot be maintained, Ultra filtration a modality used in both forms of renal
replacement therapy, will be defined, along with its impact on fluid status. Fluid assessment will be
addressed, along with proper maintenance of fluid homeostasis. By having an understanding of the
pathophysiology behind the fluid and electrolyte abnormalities that occur in end-stage renal
disease, one can direct proper management with medications, diet, and alterations in dialysis to
provide patients with the most optimal form of renal replacement therapy available20.
 RAVINDRA L. MEHTHA(2006) conducted study on Acid-Base and Electrolyte
Management in Continuous Renal Replacement Therapy and result shows that Continuous renal
replacement techniques are often utilized to manage acid-base and electrolyte problems in the
critically ill patient. These techniques have an inherent capacity to manipulate the plasma
composition and can be utilized efficiently to maintain homeostasis and metabolic control. In most
instances complications can be prevented by recognition of the operating principles and careful
attention to detail21.
STUDIES RELATED TO SELF INSTRUCTIONAL MODULE ON RENAL FAILURE

KATJA STROHFELDT AND DANIEL T. GRANT(2010): Conducted a studyon student
nurse with an objective to know the effectiveness of SIM on improving their cognitive skill,
Researcher used tick box as design& assessment was done by peer review, they found an
improvement in cognitive skill, Thus researcher Concluded that. The proposed instructional model
achieved the desired learning outcomes with appropriate student nurse feedback, while promoting
skills that are essential for the students’ future careers as health care22.
12

Another study was published to know the anxiety levelin patients undergoing dialysis for
first time,where researcher took 82 patients and divided in to intervention and controlled group, An
intervention is given to intervention group. The data were collected by checking blood pressure,
The results suggest that predialysis care interventions can reduce blood pressure in hemodialysis
patients first, heart rate fluctuations, reduce patient anxiety and help to improve the compliance of
hemodialysis patients23.

ISAF ALTUN 1 ( 2010) conducted a study to determine the efficacy of workshop on
body fluids in health and diseases and its impact on nursing training. The researcher collected data
through MCQ test from 36 nurses prior to the lecture and repeated MCQ test after the lecture .the
researcher found the significant improvement in the mean post- test scores, thus he concluded that
lecture based interactive workshop on body fluids in health and disease helps in improvement of
nurses knowledge24
13
STATEMENT OF THE PROBLEM:
“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL
MODULE ON KNOWLEDGE REGARDING MANAGEMENT OF ELECTROLYTE
IMBALANCE IN PATIENTS WITH RENAL INSUFFICIENCY AMONG STAFF
NURSES IN SELECTED HOSPITALS AT TUMKUR”.
6.3 OBJECTIVES OF THE STUDY:
1. To assess the pretest knowledge of nurses regarding management electrolyte imbalance in
patients with renal insufficiency
2. To develop and implement self instructional module.
3. To assess the post test knowledge score regarding managementof electrolyte imbalance in
patients with renal insufficiency
4. To find out significant difference between pre and post test knowledge scores.
5. To determine the association between post test knowledge score and demographic
variables.
6.4 OPERATIONAL DEFINITIONS:
 ASSESSMENT: It refers to gathering information regarding the management electrolyte
imbalance in patients with renal insufficiency.
 EFFECTIVENESS: It refers to the extent to which the self instructional module on
management of electrolyte imbalance achieves desired effect in improving the knowledge
of staff nurses as evidence from gain in knowledge score.
 SELF INSTRUCTIONAL MODULE: It refer to the written material designed for staff
nurses in order to provide information regarding the management of electrolyte
imbalance.
14
 KNOWLEDGE: It refers to response of the staff nurses to the questions stated in the
questionnaire regardingthe management of electrolyte imbalance
 ELECTROLYTE IMBALANCE: It is a state of health there is an imbalance in the
homeostasis of electrolyte distribution in the body fluids.
 RENAL INSUFFICIENCY: It is an medical state of health where kidneys are unable to
excrete nitrogenous waste and maintain homeostasis.
6.5 HYPOTHESES:
H1: There will be significant difference between pretest and posttest knowledge scores
regarding the management of electrolyte imbalance in patients with renal
insufficiency
H2: There will be a significant association between posttest knowledge score with
selected demographic variables.
6.6ASSUMPTIONS
 Staff nurses may have minimal knowledge regarding management of electrolyte
imbalance in renal insufficiency.
 SIM provides an opportunity for learning and better understanding regarding management
of electrolyte imbalance in patients with renal insufficiency.
 Nurses could positively utilize the knowledge regarding management of electrolyte
imbalance, as an effective means of to reduce risk factors.
6.7 DELIMITATIONS OF THE STUDY:.
 Nurses who are available at the period of study.
 Effectiveness of Self-instructional module in terms of knowledge.
 Measurements of scores for knowledge once before and after Self-instructional
module.
15
6.8VARIABLES
Variables are an attribute of a person or object that varies or takes different values
 INDEPENDENT VARIABLE: Self instructional module on management of
electrolyte imbalance.
 DEPENDENT VARIABLES: Knowledge level of nurses regarding management of
electrolyte imbalance.
6.9 PILOT STUDY
The pilot study will be conducted on 10 samples.
The purpose of pilot study is to:

Find out feasibility of conducting the final study.

Determine the method of data analysis.

Assess the practicability of carrying out the main study
7. MATERIALS AND METHODS OF THE STUDY :
7.1.1 SOURCE OF DATA COLLECTION:
The data will be collected from the staff nurses of selected hospitals at Tumkur.
7.1.2RESEARCH DESIGN:
Pre experimental- One group Pre test Post test Research Design.
7.1.3 RESEARCH APPROACH:
An evaluative approach is considered to be appropriate for this study.
7.1.4RESEARCH SETTING:
The Staff Nurses of selected Hospitals at Tumkur.
16
7.1.5POPULATION:
TARGET POPULATION:All Staff nurses working at various hospitals.
ACCESSIBLE POPULATION:The population of present study includes the staff nurses of selected hospitals at Tumkur.
7.1.6 METHODS OF DATA COLLECTION
The data collection procedure will be carried out for a period of three month.
The study will be initiated after obtaining prior permission from concerned authorities.
The data will be collected from the nurses by using structured questionnaire to assess the
pre existing knowledge regarding management of electrolyte imbalance. After distributing
the self instructional module, the data will be collected 7 days later from nurses by using
structured questionnaires to assess the improvement in the knowledge.
7.2.1SAMPLING TECHNIQUE
Non Probability convenient sampling technique for the present study.
7.2.2SAMPLE SIZE
The sample comprised of 100 staff nurses working at various hospitals and who will be
available during the data collection.
17
SAMPLING CRITERIA
7.2.3 INCLUSIVE CRITERIA
 Staff nurses who are willing to participate in the study.
 Staff nurses who are qualified with either diploma or bachelor or master of nursing.
7.2.4 EXCLUSIVE CRITIRIA
 Staff nurses who are not available during the data collection period.
7.2.5 TOOLS FOR DATA COLLECTION
The structured questionnaire is used to collect data from the patients. Content validity will
be established by requesting the experts to go through the developed tool and give their
valuable suggestions.
The structured questionnaire should consist of the following sections.

SECTION A: Questionnaire related to the demographic data.
 SECTION B: Questionnaires to assess the level of knowledgeregarding management of
electrolyte imbalance.
7.2.6 PLAN FOR DATA ANALYSIS
The data collected will be analyzed by means of descriptive and inferential statistics.
(A) DISCRIPTIVE STATISTICS:
Mean products & standard deviationof subject will be used to qualifying the level of
knowledge regarding the management of electrolyte imbalance in renal insufficiency among
staff nurses.
18
(B) INFERENTIAL STATISTICS:

Paired t-test will be used to examine the effectiveness of SIM by comparing pre
and post test scores. And to find out the difference in knowledge between pre and post test.

The chi square will be used to find out the association between socio
demographical variables of staff nurses with pre test knowledge scores. The data will be
planned to present in the form of tables and figures.
7.2.7 TIME AND DURATION OF THE STUDY
The time and duration of study will be limited to three months or as per guidelines of
university.
7.3 DOSE THE STUDY REQURIRE ANY INVESTIGATION OR INTERVERTION
TO BE CONDUCTED ON PATIENT OR HUMAN OR ANIMAL? IF SO PLEASE
DISCRIBE BRIEFLY.
Yes, Self instructional module is the intervention that is going tobe given to the staff
nurses.
7.4:
HAS
ETHICAL
CLEARANCE
BEEN
OBTAINED
FROM
YOUR
INSTITUTIONS?
The pilot study and the main study will be conducted after the approval of the research
committee. Permission will be obtained from the concerned head of the institution. The
purpose and details of the study will be explained to the study subjects and an informed
consent will be obtained from them. Assurance will be given to the study subjects regarding
the confidentiality and anonymity of the data collected from them.
19
8. LIST OF REFERENCES:
1)Dr.Purnima S Rao. A text book of pathology and genetics for nursing, first edition,
banglore,EMMESS Medical Publishers, 2008.
2)Dr C.S Rajat. How electrolyte imbalance causes renal disease or renal disease leads to
electrolyte imbalance.2008; Available from, URL:http://renaldisorder.blogspot.com/2008
3)Bruner and suddarth’s. A text book of medical surgical nursing, eleventh edition, New
delhi,wolterskluwer publishers,2009:vol-1.
4)Available from, URL:http://science.kennesaw.edu
5)Available from, www.ncbi.nlm.nih.gov/pubmed/18402890
6)Allisonsymon.p lobo, Dilip N. Fluid and electrolyte disorder in elderly.2005jun; volume 7:pp 27-33. Available from, www.liipincotwilliams&wilkinson.com
7)Available from, URL:http://ccforum.com/content/9/6/r700
8)Avalaiblefrom,URL:http:// www.indiaenvironmentalportal.org.in
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9.
SIGNATURE
OF
THE
CANDIDATE
10. REMARKS OF THE GIDE
11. 11.1 NAME AND DESIGNATION
OF GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5
HEAD
OF
THE
DEPARTMENT
11.6 SIGNATURE
12. 12.1
REMARKS
OF
THE
CHAIRMAN AND PRINCIPAL.
12.2 SIGNATURE
23