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1
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
Ms. GEETHU.R
FIRST YEAR M.SC (NURSING)
MEDICAL SURGICAL NURSING
YEAR 2011-2013
ADITYA COLLEGE OF NURSING
# 12, KOGILU MAIN ROAD, YELAHANKA
BANGALORE – 560 064
2
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
1.
2.
3.
4.
5.
Ms. GEETHU.R
NAME OF THE CANDIDATE AND 1ST YEAR M.Sc. (NURSING)
ADITYA
COLLEGE
OF
ADDRES
NURSING,
#12 KOGILU MAIN ROAD,
YELAHANKA, BANGALORE –
560 064
ADITYA
COLLEGE
OF
NAME OF THE INSTITUTION
NURSING,
BANGALORE560064
COURSE OF THE STUDY AND 1ST YEAR M.Sc. (NURSING),
MEDICAL SURGICAL
SUBJECT
NURSING
DATE OF ADMISSION TO THE
15/06/2011
COURSE
“ A STUDY TO EVALUATE
THE
EFFECTIVENESS
OF
TITLE OF THE STUDY
POSTURAL DRAINAGE ON
EXPECTORATION OF MUCUS
FROM AIRWAY’S AMONG
PATIENT WITH PNEUMONIA
IN SELECTED HOSPITALS AT
BANGALORE..”
3
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
The Pneumonia are the infectious diseases affecting the Lower Respiratory tract
(LRT)which includes trachea, bronchi, bronchioles, alveolar ducts and alveolar sacs.
Most of the acute and chronic diseases affecting these parts of the lungs induce lots of
mucus to be secreted, which gets impacted within the lungs and unable to be
expectorated, will lead to structural and physiological damage of the lungs. Among the
pneumonia’s, the most common and important superlative diseases are tuberculosis,
bronchiectasis, chronic bronchitis, lung abscess, and cystic fibrosis and others.1
People
with
infectious
pneumonia
often
have
a productive
cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest
pain during deep breaths, confusion, and an increased respiratory rate. In the elderly,
confusion may be the most prominent symptom. The typical symptoms in children under
five are fever, cough, and fast or difficult breathing. Fever, however, is not very specific,
as it occurs in many other common illnesses, and may be absent in those with severe
disease or malnutrition. Additionally, a cough is frequently absent in children less than 2
months old. More severe symptoms may include: central cyanosis, decreased thirst,
convulsions, persistent vomiting, or a decreased level of consciousness.2
Some causes of pneumonia are associated with classic, but non-specific, clinical
characteristics.
Pneumonia
caused
by Legionella may
occur
with
abdominal
pain, diarrhea, or confusion, while pneumonia caused by Streptococcus pneumonia is
associated with rusty colored sputum, and pneumonia caused by Klebsiella may have
bloody sputum often described as "currant jelly."3
4
Typically, oral antibiotics, rest, simple analgesics, and fluids are sufficient for
complete resolution. However, those with other medical conditions, the elderly, or those
with significant trouble breathing may require more advanced care. If the symptoms
worsen, the pneumonia does not improve with home treatment, or complications occur,
hospitalization may be required. Worldwide, approximately 7–13% of cases in children
result in hospitalization while in the developed world between 22–42% of adults with
community acquired pneumonia is admitted. The CURB-65 score is useful for
determining the need for admission in adults. If the score is 0 or 1 people can typically be
managed at home, if it is 2 a short hospital stay or close follow up is needed, if it is 3–5
hospitalization is recommended. In children those with respiratory distress or oxygen
saturation's of less than 90% should be hospitalized. The utility of chest physiotherapy in
pneumonia has not yet been determined. Over the counter cough medicine has not been
found to be effective.4
Because pneumonia affects the lungs, people with pneumonia often have
difficulty breathing, sometimes to the point where mechanical assistance is required.
Non-invasive breathing assistance may be helpful, such as with a bi-level positive airway
pressure machine. In other cases, placement of an endotracheal (breathing tube) may be
necessary, and a ventilator may be used to help the person breathe.5
Pneumonia can also cause respiratory failure by triggering acute respiratory
distress syndrome (ARDS), which results from a combination of infection and
inflammatory response. The lungs quickly fill with fluid and become very stiff. This
stiffness, combined with severe difficulties extracting oxygen due to the alveolar fluid,
creates a need for mechanical ventilation.6
5
Pneumonia places a considerable strain on the health budget and are generally
more serious than upper respiratory infections. Since 1993 there has been a slight
reduction in the total number of deaths from Pneumonia. However in 2002 they were still
the leading cause of deaths among all infectious diseases, and they accounted for 3.9
million deaths worldwide and 6.9% of all deaths that year.7
As, in case of bronchiectasis, chronic bronchitis, pulmonary tuberculosis, the
condition and changes are irreversible, the treatment whatever we give is symptomatic
and temporary and if at all any patients needs permanent relief he has to sacrifice a part
of his lung, which is damaged, by surgical intervention. This reduces lung volumes,
capacity, and reduces the oxygen saturation of blood and increases the complications like
hemoptysis, empyema and others. This not only disturbs the patient’s life style but also it
reduces the productivity of the patient in terms of employment and income generation.5
Instead of that, if a patient is subjected to postural drainage to drain the mucus /
sputum out of lungs / bronchial tree, it reduces the frequent attacks of infections,
decreases the breathing difficulty, increases the air flow, improves the lung volumes,
reduces the cost of drug therapy and even it can postpone the need for surgical
intervention.4
Various studies on postural drainage have shown the above fact that it clears the
lungs, so that good air entry will occur, reaching the alveolar level where the oxygen
exchange occurs. In most of the studies, postural drainage is combined with various other
methods of chest physiotherapy. In some other studies, it is combined with other
modalities of treatment like heat therapy, positive expiratory pressure therapy, and there
6
are many other studies where postural drainage compared with other modalities of
therapies to clear the airways.4
There are studies to evaluate the effectiveness of postural drainage to clear the
airway in term of amount of expectoration of sputum in cases of Bronchiectasis, chronic
bronchitis, lung abscess, pulmonary tuberculosis patients, who are having mild to
moderate symptoms.
6.1 NEED FOR THE STUDY
The lower respiratory tract diseases are the conditions, where the lung undergoes
reversible to irreversible damage because of recurrent pulmonary infections. The repair of
lung parenchyma occurs with cavitations, fibrosis of bronchi. The lung parenchyma is
further damaged with loss of drainage mechanism of the various mucoidal fluids which
are formed within the alveoli and bronchi. As repeated infections occur, the naturally
occurring cilia, and the regular drainage assisting mechanism is lost. This un-drained
mucus accumulation gets secondarily infected, very commonly, which makes the life of
such patients miserable.8
As, in case of bronchiectasis, chronic bronchitis, pulmonary tuberculosis, the
condition and changes are irreversible, the treatment whatever we give is symptomatic
and temporary and if at all any patients needs permanent relief he has to sacrifice a part
of his lung, which is damaged, by surgical intervention. This reduces lung volumes,
capacity, and reduces the oxygen saturation of blood and increases the complications like
hemoptysis, empyema and others. This not only disturbs the patient’s life style but also it
reduces the productivity of the patient in terms of employment and income generation.9
7
Indian Information
The Prevalence of Chronic Lower Respiratory diseases is estimated to be 32
million including 15 million undiagnosed, which comes to Prevalence Rate
approximately 1 in 8 or 11.76%. Undiagnosed prevalence rate of pneumonia’s is
approximately 1 in 18 or 5.51%.10
According to CDC- centre for communicable diseases, Deaths from Chronic
lower respiratory diseases are 124,181 annual deaths (5.2% of total deaths) (CDC/1999).
5th top cause of death in 1999 is "Chronic Lower Respiratory Disease" in India (CDC).10
Extrapolation of Prevalence of Chronic Respiratory diseases in India is
125,302,421 and undiagnosed prevalence is 58,735,509 among the 1,065,070,607
population studied.
Worldwide Information
During 1993 and 1994, the Hospital Infection Society conducted its Second
National Prevalence Survey of infections in patients in British hospitals. The prevalence
rates for hospital-acquired (HA) and community-acquired (CA), Pneumonia (Pneumonia)
were 2.4% and 6.1%, respectively; this shows an increase over that reported in the First
National Prevalence Study. The prevalence rate of HA infections for ventilated patients
were 18.6%. The prevalence was greater in males, odds ratio (OR, 95% CI) for HAPneumonia (1.4, 1.1-1.6) and CA-Pneumonia (1.2, 1.1-1.3) than in females. In the case of
both HA-Pneumonia and CA-Pneumonia, there was an increase in prevalence in patients
with age >75 years, (HA-Pneumonia 1.7, 1.3-2.2; CA-Pneumonia 1.7, 1.0-2.7). Results of
multivariable logistic regression analysis showed an increased risk of HA-Pneumonia in
patients who had a nasogastric tube (3.6, 2.3-3.6), were ventilated (2.3, 1.6-3.2), trauma
8
patients (2.2, 1.5-3.0), chronic obstructive airway disease (COAD), (1.9, 1.5-2.3), a
tracheostomy (1.9, 1.3-2.7), prior blood transfusion (1.5, 1.2-1.8), smokers (1.4, 1.1-1.6)
or on systemic corticosteroid therapy (OR 1.3, 1.1-1.6). Community-acquired Pneumonia
were positively associated with cystic fibrosis (33.7, 19.1-59.3), HIV (9.8, 6.5-14.8),
COAD (4.8, 3.8-4.8), systemic corticosteroid therapy (2.5, 2.2-2.8), tracheostomy (1.8,
1.1-2.9), males (1.2, 1.1-1.3) and smoking (1.2, 1.1-1.4).11
According to the World Health Organization (WHO), nearly 2 billion people—
one third of the world's population—have been exposed to the tuberculosis pathogen.
Annually, 8 million people become ill with tuberculosis, and 2 million people die from
the disease worldwide. 10
AS PER GLOBAL TUBERCULOSIS CONTROL - EPIDEMIOLOGY,
STRATEGY, FINANCING WHO REPORT 2009, WHO/HTM/TB/2009.411, THERE
WERE AN ESTIMATED 9.27 MILLION INCIDENT CASES OF TB IN 2007. THIS IS
AN INCREASE FROM 8.3 MILLION CASES IN 2000 AND 6.6 MILLION CASES IN
1990. 10
The five countries that rank first to fifth in terms of total numbers of cases in 2007
are India (2.0 million), China (1.3 million), Indonesia (0.53 million), Nigeria (0.46
million) and South Africa (0.46 million). The average prevalence of all forms of
tuberculosis in India is estimated to be 5.05 per thousand, prevalence of smear positive
cases 2.27 per thousand and average annual incidence of smear-positive cases at 84 per
1,00,000 annually.11
9
6.2 REVIEW OF LITERATURE
According to Burns (1997), the literature review is an essential component of the
research as it aids researcher in formulating the research plan. By definition, the review
of literature is broad, comprehensive, in-depth, systematic and critical, audiovisual
material and personal communication. The primary purpose of the literature review is to
give broad background knowledge or understanding of limitation that is available related
to research problem of interest. It is also help the researcher to conduct his or her actual
study. The literature review include both research and non research literature.21
For the present study the review of literature is organized under the following
headings.
1. Literature related to prevalence of pneumonia
2. Literature related to management of pneumonia
3. Literature relate to effectiveness of postural drainage on expectoration of
mucus from airway’s
1. Literature related to prevalence of pneumonia
Janet S.M., (2000), conducted a study o obtain quantitative information from
published data on the association between environmental tobacco smoke (ETS) exposure
and the prevalence of serious Pneumonia in infancy and early childhood. The results of
community and hospital studies are broadly consistent and show that the child of a parent
who smokes is at approximately twice the risk of having a serious respiratory tract
infection in early life that requires hospitalization.12
M. Lanari MD, (2002), this study was designed to collect data on the prevalence of
respiratory syncytial virus (RSV) infection in Italy in infants hospitalized for Pneumonia.
10
Thirty-two centers throughout Italy participated in the study. Over a 6-month period
(November 1, 1999 to April 30, 2000), they evaluated all children < 2 years of age
hospitalized for Pneumonia. The collected data show that, in Italy, RSV is an important
cause of Pneumonia in infants. Gestational age, birth order, birth weight, and exposure to
tobacco smoke affected the prevalence and severity of RSV-related lower respiratory
tract disease.13
Gabi Schulgen, (2000), conducted a study to assess the Prevalence and Risk Factors
for Nosocomial Pneumonia in German Hospitals. The study included 14,966 patients in
72 representatively selected hospitals with departments of general medicine, surgery,
obstetrics, gynecology, and intensive care units (ICU). The result showed that The
overall prevalence of hospital-acquired pneumonia was 0.72% with the highest rate in
hospitals with more than 600 beds (1.08%) and among the patients on intensive care units
(9.00%). Ventilator-associated Pneumonia rates were highest in patients on ICUs
(13.27).14
Nino Khetsuriani, (2006), conducted a study to assess Prevalence of viral respiratory
tract infections in children with asthma. The aim of the study was to determine the
prevalence of respiratory tract infection in children with asthma. Respiratory specimens
from children aged 2 to 17 years with asthma exacerbations (case patients, n = 65) and
with well-controlled asthma (control subjects, n = 77), frequency matched by age and
season of enrollment, were tested for rhinoviruses, enteroviruses, respiratory syncytial
virus, etc. this study revealed that Symptomatic rhinovirus infections are an important
contributor to asthma exacerbations in children.15
11
M.C Kelsey, (2008), the Hospital Infection Society conducted its Second National
Prevalence Survey of infections in patients in British hospitals. The prevalence rates for
hospital-acquired (HA) and community-acquired (CA), Pneumonia were 2.4% and 6.1%,
respectively; this shows an increase over that reported in the First National Prevalence
Study.16
Carme Puig, (2008), conducted a study to evaluate Incidence and risk factors of
lower respiratory tract illnesses during infancy in a Mediterranean birth cohort. The
objective of the study is to investigate the incidence rate, viral respiratory agents and
determinants of lower respiratory tract illnesses (pneumonia) in infants younger than 1
year. A total of 487 infants were recruited at birth for the Asthma Multicenter Infant
Cohort Study in Barcelona (Spain). Cases of Pneumonia were ascertained through an
active register including a home visit and viral test in nasal lavage specimens during the
first year of life. This study showed that Viral Pneumonia is frequent in infants younger
than 1 year of age and there is an inter-relationship between maternal asthma, siblings,
breast feeding and socioeconomic status.17
2. Literature related to management of pneumonia
C. Raherison, (2007), conducted a study on the management of Pneumonia in
patients aged 15–65 yrs by general practitioners (GPs) in France. To obtain real-time data
recording, practitioners were required to submit an anonymous copy of their drug
prescriptions. They were then interviewed over the telephone. This study demonstrates
the Pneumonia encountered by general practitioners is usually mild. However, antibiotic
prescription was more systematic than in previous studies and the prescription of
nonspecific symptomatic treatments was twice as frequent.18
12
Laurent Kaiser, (2000) conducted a study to assess the Impact of Oseltamivir
Treatment
on
Influenza-Related
Lower
Respiratory Tract
Complications
and
Hospitalizations. he aim of this study was to assess the effect of oseltamivir treatment on
the incidence of LRTCs leading to antibiotic treatment and hospitalizations following
influenza illness. They analyzed prospectively collected data on LRTCs and antibiotic use
from 3564 subjects (age range, 13-97 years) with influenzalike illness enrolled in 10
placebo-controlled, double-blind trials of oseltamivir treatment. This study showed that
Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and
hospitalization in both healthy and "at-risk" adults.19
Matthias Briel, (2008), Procalcitonin-Guided Antibiotic Use vs. a Standard
Approach for Acute Respiratory Tract Infections in Primary Care. Fifty-three primary
care physicians recruited 458 patients, each patient with an acute respiratory tract
infection and, in the physician's opinion, in need of antibiotics. Patients were centrally
randomized to either a procalcitonin-guided approach to antibiotic therapy or to a
standard approach. This study revealed that as an adjunct to guidelines, procalcitoninguided therapy markedly reduces antibiotic use for acute respiratory tract infections in
primary care without compromising patient outcome.20
E. Michael Sarrell, (2002), conducted a study to assess the effectiveness of
Nebulization of 3% Hypertonic Saline Solution Treatment in Ambulatory Children With
Viral Bronchiolitis Decreases Symptoms. The objective of the study was to determine the
utility of inhaled hypertonic saline solution to treat ambulatory infants with viral
bronchiolitis. Sixty-five ambulatory infants (mean ± SD age, 12.5 ± 6 months) with viral
bronchiolitis received either of the following: inhalation of 0.5 mL (5 mg) terbutaline
13
added to 2 mL of 0.9% saline solution. This therapy was repeated three times every day
for 5 days. They conclude that in nonasthmatic, nonseverely ill ambulatory infants with
viral bronchiolitis, aerosolized 3% saline solution plus 5 mg terbutaline is effective in
decreasing symptoms as compared to 0.9% saline solution plus 5 mg terbutaline.21
Brenda M,(2003) conducted a study to assess the effectiveness of Chest
physiotherapy in Adult with pneumonia. We aimed to compare the effectiveness of
standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy
regimen without head-down tilt (MPT) in Adult with pneumonia. Twenty newly
diagnosed Adult with pneumonia (mean age, 25 yrs; range, 50yrs) were randomized
to SPT or MPT. Parents kept a detailed symptom and treatment diary for the
following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2½
years, and 5 years after diagnosis, were assessed using the Brasfield score. This
study revealed that standard postural drainage chest physiotherapy (SPT) is more
effective for reducing the symptoms of pneumonia.22
Chris L. Kjolhede , (2000), conducted a study to assessed the effectiveness of
vitamin A as adjuvant treatment for Pneumonia. The objective of the study was to To
test the efficacy of a high dose of vitamin A as adjuvant treatment for radio graphically
confirmed cases of acute Pneumonia (ALRI). Sequential sample of 263 patients vaged 3o
to 40 years, identified in the emergency departments and admitted to the hospital in
Guatemala City. Vitamin A (200,000 IU) or placebo in addition to standard treatment for
ALRI which included antibiotics, oxygen, bronchodilators, and intravenously
14
administered solutions. This study showed that Vitamin A administration is very effective
in reducing the symptoms of pneumonia.23
3. Literature relate to effectiveness of postural drainage on expectoration of
mucus from airway’s
J E Patterson, (2007), conducted a study to assess the effectiveness of postural
drainage. The purpose of this study was to compare the efficacy of the test of incremental
respiratory endurance (TIRE) with active cycle of breathing techniques (ACBT)
[incorporating postural drainage (PD) and vibration] as methods of airway clearance in
adults with bronchiectasis. :A randomized crossover study in which a single session of
ACBT (incorporating PD and vibration) was compared to a single session of TIRE was
carried out in 20 patients (14 female) with stable, productive bronchiectasis. This study
concluded that ACBT (incorporating PD and vibration) is a more effective method of
airway clearance in bronchiectasis than TIRE during single treatment sessions.24
B.A. Webber, (2003), conducted a study to assess the Effects of postural
drainage, incorporating the forced expiration technique, on pulmonary function in cystic
fibrosis. Detailed pulmonary function tests were performed on 12 patients with cystic
fibrosis (CF) before and after 3 days treatment with postural drainage incorporating the
forced expiration technique. The results following treatment showed a statistically
significant improvement in FEV1 (P<0.001), FVC (P<0.001), PEFR (P<0.001), PIFR
(P<0.001), and VEmax50 (P<0.025). The study demonstrates objective benefit from this
form of physiotherapy in cystic fibrosis patients with copious bronchial secretions.25
John W. Wong,, (2000), conducted Aanoninvasive, radionuclide imaging
technique for measuring the rate of mucus clearance in the trachea (RT), was used to
study gravitational effects on mucus clearance in 13 patients with cystic fibrosis (CF),
15
average age 17 years; 7 normal, nonsmoking adults, average age 26 years; and a normal
subject who was recovering from an acute upper respiratory tract infection (URTI). The
results of the study indicate that the force of gravity can be a major influence on tracheal
mucus clearance in CF and URTI subjects. This conclusion supports the use of postural
drainage as an effective form of therapy in patients with cystic fibrosis.26
J.A. Pryor, (2010), conducted a study postural drainage and percussion: Airway
clearance in people with cystic fibrosis. Seventy-five people with cystic fibrosis entered
the prospective, randomized controlled trial of these five different ACTs. The primary
outcome measure was forced expiratory volume in one second (FEV1). Secondary
outcome measures included exercise capacity and health related quality of life. Using
intention to treat, data were available on 65 subjects at the end of the study period. There
were no statistically significant differences among the regimens in the primary outcome
measurement.27
16
6.3(A) STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of postural drainage on expectoration of mucus
from airway’s among patients pneumonia in selected hospitals at Bangalore.
6.4(B) OBJECTIVES OF THE STUDY
1. To assess the pre-test ability of expectoration of mucus from airways in patients
suffering with pneumonia.
2. To evaluate effectiveness of postural drainage on expectoration of sputum from
airways in patients with pneumonia.
3.
To find out association between postural drainage on expectoration of mucus
from airway among patients with pneumonia with selected demographical
variables.
6.5(C )OPERATIONAL DEFINITION
Effectiveness:
It refers to the extent to which the teaching programme had brought about the
result intended and measured in terms of significant knowledge gained in posttest.
Postural drainage:
It is a type of chest physiotherapy which is pertained to the position applied for
the systematic withdrawal of fluids and discharges from cavities. It utilizes the gravity of
earth for the drainage of fluids or discharges like mucus.
Expectoration of Mucus
The act of ejecting phlegm or mucus from the throat or lungs, by coughing,
hawking, and spitting.
17
Pneumonia
It refers to an infection of the lungs that is caused by bacteria, viruses, fungi, or
parasites. It is characterized primarily by inflammation of the alveoli in the lungs or by
alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that absorb
oxygen).
6.6(D) RESEARCH HYPOTHESIS
H1: There is significant relationship between the postural drainage and expectoration of
mucus from airway.
H2: There is significant difference between expectoration of mucus from airway before and
after giving postural drainage in patients with pneumonia.
H3: There is a significant association between performances of postural drainage with
selected demographic variables.
6.7(E) LIMITATION
 The study is limited to the age group 15 to 55 years.
 The sample size was limited to 60 male and female persons.
 The study is limited to 6 weeks only.
 The study was conducted in selected hospital only.
6.8 ASSUMPTIONS
1. Regular chest physiotherapy will improve air entry in to the lungs and air way
clearance.
2. Sputum expectoration will improve following postural drainage.
3. PEFR will improve following postural drainage.
18
7. MATERIALS AND METHODS
This chapter gives a description of the research approach, research design,
variables, the setting of the study, population, sampling, research tool, methods of data
collection and plan for data analysis.
7.1 Sources of data
Data will be collected from patient with pneumonia admitted in selected hospitals
at Bangalore.
7.2 Methods of data collection
I.
Research design
Quasi experimental method
II.
Research approach
Evaluative approach.
III.
Research variables
a. Independent variables
Independent variables are the variable that stand alive and is not dependent on any
other variables. In present study the independent variable is postural drainage
19
b. Dependent variables
In this study the dependent variable refers to sputum production, PEFR of the
patient
c. Demographic variables
Characteristics of patients such as Age, educational status, socioeconomic status
and income.
IV.
Setting
Study is planned to conduct in selected hospitals at Bangalore..
V.
Population
The patient with Pneumonia admitted in selected hospitals at Bangalore.
VI.
Sample
The patient with Pneumonia admitted in selected hospitals at Bangalore.. For pilot
study sample size will be 6. For main study the sample size will be 60.
VII.
criteria for sample selection
a) Inclusion criteria
 Patient with Pneumonia admitted in select hospitals at Bangalore.
 Patient with Pneumonia who can communicate freely in Kannada or English.
 Male and female Patients who are between 15 to 55 years age group.
 The patients who are diagnosed as pneumonia.
 The patients who are expectorating more than 30 ml per day sputum.
20
b) Exclusion criteria
 Patient who are not willing to participate in the study
 The patient who are under the age of 15 years
 Patients who suffer with hemoptysis
 Patients who have sputum positive for Mycobacterium tuberculosis.
 Patients who have associated pulmonary conditions like large Pneumothorax,
large pleural effusion, empyema
 Patients who had recent myocardial infarction, cardiac arrhythmias, severe
hypertension, and cardiac surgery.
VIII.
Sampling Technique
Non probability convenience sampling technique.
IX.
Tool for data collection
SECTION I
Demographic Data
Demographic data included age, sex, educational status, income.
SECTION II
1. Change in sputum production:
Sputum production in an optimally hydrated patient with more than 25 ml/day when
compared with base line sputum production after postural drainage therapy.
21
Scoring card for the sputum collection (applicable in both pre and post test collection
of sputum):Amount of sputum collected
Points
Up to 0 to 50 ml
01
50 ml to 100ml
02
100ml to 150ml
03
150ml to 200ml
04
More than 200ml
05
2. PEFR (Peak Expiratory flow rate):
The patient was asked to sit and take a deep breath and advised to blow forcefully
through the mouth piece of peak flow meter at least for 3 times with an interval of 30
seconds. The best of the three readings was taken and measure was recorded.
Scoring cord for the PEFR (applicable in both pre and post test collection of
sputum):Amount of PEFR ( lts/min)
Points
Up to 150
01
150-250
02
250-350
03
350-450
04
More than 450
05
22
SECTION-III
OBSERVATION CHECK LIST:
Various observation check lists have been developed as there is no availability of
standard check lists. These check lists are helpful to observe how correctly the procedure
has being conducted, how the patient is following the instructions. Through the
observation check list, if the patient can be able to perform the procedure as per the steps,
then the values obtained from the procedure can be accepted.
X.
Methods of data collection
After obtaining permission from concerned authority an informed consent from
samples, the researcher will collect data from samples.
Phase 1
During the selection of samples, every alternative patient was allotted for one
group pre test-post test postural drainage on expectoration on mucus from airway. A total
of 60 patients were allotted for this postural drainage.
Investigator has to develop good rapport with patient and consent was obtained
from each patient. Investigator has to collect demographic data. Before administering the
postural drainage from each patient, the parameters such as vital signs, sputum
expectoration, Peak expiratory flow rate (PEFR) were measured.
23
Phase 2
The patient was given full explanation about postural drainage which will be
provided to them in the form of handout or pamphlet and the steps of the procedure how
it will be done.
Each patient was kept in the position for about 10-15 min and was given rest for
10-15 minutes. If the patient can able to tolerate the position, then the procedure can be
repeated again.
Phase 3
After completion of the procedure, again the parameters were measured and recorded.
XI.
Plan for data analysis
The data will be analyzed by means of descriptive and inferential statistics.
a) Descriptive statistics
Mean, median, mode, standard deviation, percentage distribution, will be used to
assess the demographic variables.
b) Inferential statistics
 The obtained measures of parameters before administration of postural drainage
were tabulated, and ‘t’ test was computed to test the effectiveness of postural
drainage.
 To compare the Sputum production, Peak Exploratory flow rate (PEFR), before
and after postural drainage paired ‘t’ test was used.
XII.
Projected outcomes
After the study, the investigator will able to know the ability of patients
expectoration of mucus from airway’s with Pneumonia, based on the findings. Postural
24
drainage will be administered to the patients. It will help them to expectoration of mucus
more easily.
7.3 Does the study requires any investigation or intervention to the patient or other
human being or animal ?
No
7.4 Has ethical clearance been obtained from the concerned authority to conduct the
study ?
Yes
a)
Permission will be obtained from the Director of selected Hospitals at Bangalore.
b)
Informed consent will be obtained from the patient with Pneumonia admitted in
selected hospitals at Bangalore. to participate in the study with their own
knowledge.
25
8. LIST OF REFERENCES
1. API, “Text book of medicine’, seventh edition, 2001, by Gurumukh. S. Sainani,
published by Association of Physician of India. Pp: 308-311 .
2. Black M.J. (1997) “Medical Surgical Nursing Clinical Management for
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9. Signature of the candidate
:
10. Remarks of the guide
:
11. Name and designation of
:
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide
:
11.4 Signature
:
11.5 Head of the department
:
11.6 Signature
:
12. Remarks of the Principal
:
12.1 Signature
: