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DISSERTATION PROTOCOL 1 NAME OF THE CANDIDATE AND Mrs.SUCHETA PRABHAKAR MANE ADDRESS FLAT NO 1,SARGAM B.SHRIPAL COMPLEX,VIRAR(WEST) TAL-VASAI,DIST-THANE MAHARASHTRA PIN CODE :401303 2 NAME OF INSTITUTION S.B. COLLAGE OF NURSING, YELAHANKA NEW TOWN, BANGALORE-64 3 COURSE OF STUDY AND SUBJECT M.Sc. NURSING COMMUNITY HEALTH NURSING 4 5 DATE AND ADMISSION TO COURSE 25.10.2009 TITLE OF THE TOPIC: “ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME (STP) ON THE EFFECT OF HYPOTHYROIDISM AMONG ADOLOSCENT GIRLS IN A BANGALORE,RURAL TALUKA”. 1 SELECTED PU COLLEGE AT 6:BRIEF RESUME OF THE INTENDED WORK 6.1 : Needs for the study The internal environment of the body is partly controlled by the nervous system and partly by the endocrine system. The endocrine system is primitive system. The secretion of endocrine gland is called hormone which is directly poured into the blood and while circulating, picked up by target organ. The hormone is a chemical substance. The exact amount of hormones are necessary to maintain sound physiology of the body. The less or excess amount of secretion manifest physiological disorder.1 The thyroid is an one of endocrine gland situated in front of the neck,just below the voice box or at the spot where a bow tie would rest.It is highly vascular, brownish red with left and right halves(called lobes) that look like a butterfly, wings. It is light a butterfly, too, and usually weighs less than an ounce. As small as it is, though the thyroid has an enormously important job to do , especially for teen. It manufactures the hormone that help control metabolism and growth. To do, its job, the thyroid needs a chemical element called iodine that the body absorbs from the foods we eat and water we drink. The entire body contains about 50 milligrams of iodine. About 1/5 to 1/3 of that supply(10 to 15milligrams) is stored in your thyroid. The thyroid combines the iodine with tyrosine (an essential amino acid) to make important hormones.2 Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can not make enough thyroid hormones to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. The common causes are autoimmune disease, surgical removal of part of the thyroid gland, radiation treatment ,congenital disorder that child may born without or only a partly formed or ectopic thyroid gland.Thyroditis usually caused by autoimmune disease or viral infection. Certain medicine such as lithium and too much or too little iodine, damage to pituitary gland and rare disorder that infiltrate the thyroid. 3 What kinds of complaints characterize an underactive thyroid system? Low energy and fatigue or tiredness, especially in the morning, is frequent in these patients. Difficulty losing weight, a sensation of coldness--especially of the hands and feet, depression, slowness of thought processes, headaches, swelling of the face or fluid retention in general, dry coarse skin, brittle nails, and chronic constipation are also common. In women, menstrual problems--such as PMS and menstrual irregularities including heavy periods and fertility problems are further signs and symptoms. People with an underactive thyroid may also have stiffness of joints, muscular cramps, shortness of breath on exertion, and chest pain. Be aware that a person with a low functioning thyroid doesn't have to have all of these symptoms; he may have only a few. 4 2 In areas with relatively high iodine intake, the incidence rate of hypothyroidism is several-fold higher than that of hyperthyroidism. Recently, we found a similarly high prevalence rate of subclinical hypothyroidism compared with hyperthyroidism in a high iodine intake area, while a relatively low prevalence of subclinical hypothyroidism was observed in a low iodine intake area. In the present study we compared the incidence rate (newly diagnosed in primary care and at hospital) of overt hypothyroidism with that of hyperthyroidism in a well-defined geographical area in Jutland, Denmark, with an iodine intake around 60 microg/day. The number of personsxyears studied was 569,108. Data on hyperthyroidism have been published previously. The overall incidence of hypothyroidism was 13.5/100,000 per year (F/M 22.9/3.6), hyperthyroidism 38.7/100.000 per year (F/M 63.0/13.0). The incidence of hypothyroidism was steadily increasing with age up to 80/100,000 per year in subjects older than 70 years of age, but apart from congenital hypothyroidism it was lower than that of hyperthyroidism at all ages. The majority of patients (79%) was diagnosed to have spontaneous autoimmune hypothyroidism (16% with goiter, 84% with no thyroid visible or palpable). In conclusion, in an area with moderately low iodine intake, hypothyroidism was considerably less common than hyperthyroidism. This is in contrast to findings in high iodine intake areas. The iodine intake of an area seems to be of major importance for the pattern of thyroid disorders observed. Underactive thyroid disorders are common and it remains undiagnosed till severe manifestation of disease. so I want to create awareness regarding hypothyroidism among the adolescence girls. As a early diagnosis is very important to prevent further complications. Hence the investigator this topic for the study. 6.2 Review of literature An underactive thyroid produces too little thyroid hormone, resulting in hypothyroidism. ("Hypo" means "under" or "below.") When the amount of hormone released into the bloodstream is below normal, the body uses up energy more slowly, and chemical activity (metabolism) in the cells slows down.A person with mild hypothyroidism may feel just fine — in fact, the condition might cause no symptoms at all. However, symptoms can become more obvious if hypothyroidism progresses2 People with underactive thyroidsmight feel depressed and sluggish. They might gain weight, even though they're not eating more or getting less exercise than usual. Teens with hypothyroidism also might have slow growth in height, slow sexual development, irregular menstrual periods in girls, muscle weakness, dry skin, hair loss, poor memory,anddifficultyconcentrating.Hashimoto'sthyroiditis (pronounced: hah-shemoe-toes thy-roy-dye-tiss) is also an autoimmune disease and is the most common cause of hypothyroidism in teens. In this condition, the body's immune system attacks the cells in the thyroid gland, preventing it from producing enough thyroid hormone. The thyroid responds by working harder to make enough hormones. This can make it become enlarged and may result in a goiter.Hypothyroidism is usually easily diagnosed with a 3 physical examination and blood tests, and treatment with thyroid hormone replacement pills can restore normal levels of thyroid hormone in the blood. This treatment is pretty simple, but it does require doctor visits once or twice a year for an examination, blood tests, and medication adjustments as needed. Heavy Periods / Menorrhagia: Menorrhagia is defined as excessively heavy or prolonged menstrual bleeding, for example, soaking through pad every hour for several hours. Hypothyroidism is associated with menorrhagia More Frequent, Longer Periods: Hypothyroidism is known to cause periods to come more frequently - for example, some women will find their 28 day cycle shortens to a 25 day cycle, and their normally 5 days long mensetruallasts6or7days.PainfulMenstruation,Dysmenorrhea: Hypothyroidism is associated with painful menstrual periods, known as dysmenorrhea. Dysmenorrhea can include an achy or stabbing low backache,nausea,legaches,feelingsofullness,headaches,andboweldisturbances. Some women with extremely heavy periods, can benefit from iron supplementation during the menstrual period. A typical dosage may be approximately 100 mg of iron per day. Note: if you are on thyroid hormone replacement, allow for at least 4 hours between taking thyroid hormone and iron. Some herbs may help bring on a delayed menstrual period, including parsley, ginger, yarrow, sage, and feverfew. Some herbs that are thought to help with painful menstruation include chamomile, red raspberry, lemon balm, red clover, catnip, and comfrey root.Hypothyroidism in adults causes and incidence (professional guide to diseases(English edition)) Hypothyroidism result from inadequate production of thyroid hormone usually because of dysfunction of the thyroid gland due to due to surgery (thyroidectomy), irradiation therapy (particularly with 131I), inflammation 4 chronic autoimmune thyroiditis autoimmune thyroiditis Hashimoto’s disease) or, rarely, conditions such as amyloidosis and sarcoidosis. It may also result from pituitary failure (pituitary failure) to produce thyroid-stimulating hormone (TSH), hypothalamic failure to produce thyrotropin-releasing hormone thyrotropin-realeasing hormone, in born errors of of thyroid hormone synthesis, the inability to synthesized hormone because of iodine deficiency (usually dietary) or the use of antithyroid medications such as propylthiouracil(propylthiouracil). In patients with hypothyroidism, infection, exposure to cold, and sedatives may precipitate myxedema coma (myxedema coma). Worldwide, iodine deficiency remains the foremost cause of hypothyroidism. In the United States and other areas of adequate iodine intake, autoimmune thyroid disease is most common. The prevalence of antibodies is higher in women, and increases with age. Postpartum thyroiditis: Up to 10% of postpartum women may develop lymphocytic thyroiditis in the 2-10 months after delivery. The frequency may be as high as 25% in women with type 1 diabetes mellitus. The condition is usually transient (2-4 mo) and can require a short course of treatment with levothyroxine (LT4), but postpartum patients with lymphocytic thyroiditis are at increased risk of permanent hypothyroidism. The hypothyroid state can be preceded by a short thyrotoxic state. High titers of anti-TPO antibodies during pregnancy have been reported to be 97% sensitive and 91% specific for postpartum autoimmune thyroid disease.7 NEW YORK, Feb 10 (Reuters Health) — Patients with hypothyroidism show greater improvements in mood and brain function if they receive treatment with two types of thyroid hormones instead of one, according to a report in the February 11th issue of The New England Journal of Medicine. Hypothyroidism, where the gland has ceased to function or has been removed, is usually treated with daily doses of thyroxine hormone. But the researchers found that substituting another thyroid hormone, triiodothyronine, for some of the thyroxine dose led to improvements in mood and in neuropsychological functioning.8 The overall incidence rate of hypothyroidism increased during the study period: baseline, 38.3/100,000·yr; voluntary IF, 43.7 (not significant vs. baseline); early mandatory IF, 48.7 [vs. baseline, rate ratio (RR) = 1.27; 95% confidence interval (CI) = 1.10–1.47]; and late mandatory IF, 47.2 (vs. baseline, RR = 1.23; 95% CI = 1.07–1.42). There was a geographic difference because hypothyroidism increased only in the area with previous moderate ID: Aalborg, late mandatory IF vs. baseline, 40.3/29.7 (RR = 1.11; 95% CI = 1.11–1.66); Copenhagen,56.7/51.6 (RR = 1.10; 95% CI = 0.90–1.34). The increase occurred in young and middle-aged adults. 9 5 Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones. In some parts of the world, iodine deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the United States. Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. In addition, some of the causes of hypothyroidism — such as autoimmune disorder — also impair fertility. Treating hypothyroidism with thyroid hormone replacement therapy may not fully restore fertility. Other interventions may be needed, as well. 10 6.3: STATEMENT OF PROBLEM: To assess the effectiveness of structural teaching programme (STP) on the effect of Hypothyroidism among adolescent girls in a selected rural PU College at Bangalore, rural taluk. 6.4: OBJECTIVES OF THE STUDY: 1. To assess the knowledge on the effect of Hypothyroidism among the adolescent girls. 2. To evaluate the effectiveness of structural teaching programme on effect of hypothyroidism among the adolescence girls based on the pre and post test score. 3. To find out the association between post test knowledge scores of the adolescent girls with their selected demographic variables. 6.5: RESEARCH HYPOTHESIS H1: There will be significant difference between the pre and post test scores on the effect of hypothyroidism on PU adolescent girls H2: There will be significant association between post level knowledge with the selected demographic variables. 6.6: OPERATIONAL DEFINITION: ASSESS: It refers to the statistical measurement of effectiveness of structured teaching programme on the level of knowledge regarding the effect of hypothyroidism among the adolescent girls. 6 EFFECTIVENESS: It refers to the quality of being or able to bring an effect or efficient of structured teaching programme on the level of knowledge or gain more awareness regarding effects of hypothyroidism. STRUCTURAL TEACHING PROGRAMME: It is a systematically planned teaching programme designed to provide information regarding hypothyroidism among the adolescent girls. HYPOTHYROIDISM: Physiological disorder resulting from less secretion of Thyroxin hormone secreted by Thyroid gland and manifestation of abnormal changes in body function, especially metabolism and growth. ADOLOSCENCE: The period of physical and psychological development from the onset of puberty to maturity. PU COLLEGE: The college providing education to the Pre-university Course, 1st and 2nd years for girls. 6.7: ASSUMPTION: 1) Adolescent girls studying in 1st and 2nd year PU College have some knowledge of hypothyroidism. 3) Structured teaching programme will enhance the knowledge of PU students regarding effects of hypothyroidism. 7: MATERIALS AND METHODS: 7.1: SOURCE OF DATA: Adolescent girls who are studying in the 1st and 2nd years in a PU College at Bangalore rural Taluk. 7.2: METHOD OF DATA COLLECTION: The data will be collected by investigator herself by using structured closed-ended questionnaire. 7 7.2.1: RESEARCH DESIGN AND APPROACH: The quasi experimental design will be used by the investigator for the proposed study among the pre-university girl students, for the pre and post test approach without control group. 7.2.2: SETTING: This study will be conducted in a selected PU College at Bangalore rural Taluk. 7.2.3: POPULATION: The population of this study will be adolescent girls of PU College at Bangalore rural Taluk. 7.2.4: SAMPLE SIZE: Sample size will be 100 students. 7.2.5: SAMPLE PROCEDURE: Purposive Sampling Technique will be used for the proposed study. 7.2.6: SAMPLING CRITERIA: INCLUSION CRITERIA: Students who are, • Studying in PU College at Bangalore rural Taluk. • Available during the data collection period. • Able to understand and speak in kannada and English. • Willing to participate. EXCLUSION CRITERIA: The students who are not, • Studying in PU College at Bangalore rural Taluk. • Available during the data collection period. • Able to understand and speak in kannada and English. 8 • Willing to participate. 7.2.7: DATA COLLECTION TOOL: Structured close-ended Questionnaire will be used by the researcher herself to assess the knowledge regarding effect of hypothyroidism among adolescent girls of PU College at Bangalore rural Taluk. The data will be collected in month of March/April 2011. 7.2.8: DATA ANALYSIS METHOD: 1. Appropriate descriptive and inferential statistics will be used for data analysis and presented in form of tables, graphs and figures etc. 2. The effectiveness of pre and post test scores of knowledge level will be analysed by Paired 'T' test 3. The significance of the relationship between the selected demographic variables and knowledge will be analysed by Chi-square test. 7.2.8: DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL? IF SO, DESCRIBE BRIEFELY. ----- YES ----7.3: HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3 Required ethical clearance will be obtained from the concerned authority before the main study. 9 8.LIST OF REFERRANCES 1. Rose and Wilson Anatomy and Physiology 4th edition Nervous system. 2. http://kidshealth.org/teen/diseases_conditions/growth/thyroid.html 3. American thyroid association 1923,www.thyroid.org 4. Michel Sachachter MD,F.A.C.A.M The Diagnosis and Treatment of Hypothyroidism. 5. http://www.thyroid-info.com/articles/menstruation.htm 6. www.wrong diagnosis.com/hypothyroidism/prevalence.htm 7. http://www.e medicine.medscape.com article/122393 8. http://www.metabolism.com/2008/08/23/hypothyroid-benefit-t3-cytomel/ 9. The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 8 3122-3127 10. http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=alterna tive-medicine 10 9. SIGNATURE OF THE STUDENT 10. REMRKS OF THE This research project will be useful for GUIDE improving the Knowledge of adolescent girls regarding effects hypothyroidism. The need for study and literature review is appropriate to the statement of problem. Hence, can be approved for undertaking this study. 11. NAME AND Mr.Nagarajappa.D DESIGNATION OF THE Principal GUIDE S.B. Collage of Nursing Bangalore-560106 11.1 GUIDE SIGNATURE 11.2 HEAD OF THE Mr.Nagarajappa.D DEPARTMENT Principal S.B. Collage of Nursing Bangalore-560106 11.3 12 SIGNATURE REMARKS OF THE The study is based on health problem of CHAIRMAN AND adoloscent girls and the research proposal PRINCIPAL approved by the research committee. Hence ,the study can be conducted 12.1 SIGNATURE 11 12