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6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Attention to overall kidney health
Which is essential if you have healthy
Kidneys, take care of them.
Kidney stones or calculi are common codition and also an incredibly painful
one. kidney stones are hardened mineral deposits that form into the stones over time.
The medical term for this condition is nephrolithiasis or renal stone disease.
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The
kidney filters waste products from the blood and adds them to the urine that the
kidneys produce.1
For most people kidney stone are like dandelions in the lawn they can be
eliminated, but they will be back another year. Therefore a major part of the
treatment is aimed at preventing recurrence. Health promotion and illness prevention
activities are important components of primary prevention. It can be provided to an
individual or to generan population. Or it can focus on individuals at risk for
developing specific problems.1
Nursing lays emphasis on health promotion and ill ness prevention activities
as important aspects of health care. Health promotion and ill ness prevention are
closely related concepts in practice and overlap to some extent. 2
Nurses provide health promotion services where people live work, and play as
well as in traditional health care settings. Nurses make a positive impact through
their own healthy life styles, teaching and assisting with behavior change. Tom
promote health, prevent diseases and ameliorate symptoms of existing diseases,
Individuals need to learn how to modify there lifelong pattern ( style). The consistent
integrated way of life of an individual and their life styles is often described as a
person’s lifelong styles. These styles are strong, developed over many years and not
easily modified. A comprehensive plan is needed to help the individuals to make
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them to modify their behavior in a realistic way, which is by definition, means to
make radically defferent.3
The modification is a more acceptable term to those involved in this process
also, life style modifications implies application of new thoughts, beliefs and
attitudes that accompany the modified behavior.
Back ground of the study
Kidney stones affects 240,000 to 720,000 people in us. Each year and account
for 7 to 10 of every 1000, hospital admissions. Renal calculi are 2.5 times more
common in men,than women and in persons between the ages of 20-50 years old.
Approximately 50% persons, who develop renal calculi,have a recurrence with in 5
years.The life time incidence of renal stones in men is about 10%.8
Calculi are a common cause of morbidity. In india approximately 12% of males
and 5% of females will have an episode of renal calculi during their lifetime. The
recurrence rate is approximately 30% with in 6 yrs15. The peak incidence of calculus
formation is in the third to fifth decades in life. In 1981,coeemphasized that renal
stones should always be seen as evidence of identifiable metabolic abnormalities,
particularly if recurrence occurs. 4
According to Author Judith A withworth mentioned in his study that there is
significant tendency for recurrence of renal calculi, due to lack of life style
modifications after a definite treatment.
The incidence of recurrence as follows
14% with in Ist year
35% with in IInd year
56% with in 10 year.
The incidence of stone disease in the adult population is relatively high and varies
with geographic location and family history. The prevalence of calculi in 4.5 per
1000 population and about 25% of those affected are hospitalized each year.A higher
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recurrence of stone diseases is present in those with a family history of stone diseases
and those who had their first occurrence by the age 25 yrs. 2
In present trend, the health care settings adopts the policy of “Short Hospital
Stay’ where the health education can be given in the form of written instruction
materials to the clients, to impart the knowledge on the preventive measures.
Meena kaila (1999) has discussed on General Health and Lifestyle, stated that
who practice a sedentary lifestyle, unsatisfactory diet, inadequate hydration and
decreased physical activity are all the ingredients of a lifestyle behavior, which
makes up a perfect recipe for the recurrence of the diseases (renal calculi).
6.1 NEED FOR THE STUDY
Prevention of renal stone disease depends on the type of stone
produced,underlying urinary chemical risk factors and the patients ‘’willingness”to
undergo a long-term prevention plan. 5The patient may be asked to make life style
modifications such as increased fluid intake and changes in diet.
Based upon the views of healthcare consumer,holistic and humanistic
health care is being emphasized today,people want comprehensive care.consumers
today are more aware and knowledgeable about the effects of life style changes on
health as a result they desire to have more information and health services related to
health and illness prevention. 6
Health education,promoting wellness behavior and the prevention of diseases,
often focusing in groups and communities.It is an integral part of the nurses role in
health promotion. Nurses apply skills in teaching as they provide information to the
client or individuals.Health is being able to function fully and domains of ones life.
Health protection involves preventing diseases,where as health promotion
involves,enhancing well being. 11
3
12% have stone in their lifetime.
12% of men will suffer from kidney stone by age of 70
5% of women will suffer from kidney stone by age of 70
50% have recurrence with in 5-10 yrs
Highest incidence of kidney stone is in 30-45 years of age group, and
incidence declines after age of 50
7-10 of every 1000 hospital admission is of renal stone
.
Urinary stone constitute one of the commonest diseases in our country and pain
due to kidney stones is known as worse than that of labour pain. In India,
approximately 5 -7 million patients suffer from stone disease and at least 1/1000
of Indian population needs hospitalization due to kidney stone disease.
Thus, the disease is as widespread as it is old, particularly in countries with dry,
hot climate. These "stone belt regions" of the world are located in countries of
Middle East, North Africa, the Mediterranean Regions, North Western state of
India and Southern State of USA and areas around the great lakes.
In India, the "stones belt" occupies parts of Maharashtra, Gujarat, Punjab,
Haryana, Delhi and Rajasthan. In these regions, the disease is so prevalent that
most of the members of a family will suffer from kidney stones sometime in
their lives. Surgery for removal of urinary stones forms one of the commonest
operations in hospitals in these regions. 21
The investigator felt the need for proper education on life style modifications to
prevent the recurrence of renal calculi after treatment.
Evidenced based research article suggest that leaflets are useful resource for
providing information to the client, which will impart the knowledge on prevention
aspects (kubba)
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Thus the investigator is motivated to formulate a patient information leaflet on
lifestyle modifications to prevent the recurrence of renal calculi,which can be used to
educate the individuals.
6.2 REVIEW OF LITERATURE
This chapter is discussed under the following headings
1. General information related to renal calculi and non invasive management.
2. Related studies
1. General information related to renal calculi and non invasive management
Kidney stones often move through the Urinary Tract, and leave the body without any
symptoms, such stones are called as ‘silent ‘ stones and one usually small in size.
The stone is called calculus and the formation of stone is called lithiasis and the
presence of stone in the kindly is called Nephrolithiasis. A kidney stone is a hard
mass developed from crystals, which are separated from the urine and formed in the
inner surface of the kidney. 10
The kidney stones are made up of different types of crystals such as:
1. Calcium oxalate
2. Calcium phosphate
3. A combination of both
4. Magnesium ammonium phosphate
5. Ureic acid
6. Cystine
Although calculi can form anywhere in the Urinary Tract and the most frequent site
in the kidney. The stone may traveled down in the Urinary Tract, lodge anywhere
along the Urinary Tract and cause obstruction and tissue damage, or they may stay in
the kidney. About 80% of the kidney stone are made of Calcium oxalate or Calcium
phosphate, 10% of kidney stone are made of Magnesium ammonium and Phosphate,
10% kidney stone on made of Uric acid and less than1% of kidney stone one made of
chemical substances called cystine. 9
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The majority(>.90%) of stones in the kidney can be treated by ESWL. Conservative
management for kidney stone when the stone size is less than 6mm is treated by
ESWL. Nearly 70-80% of renal calculi are treated by lithotripsy. ESWL or exera
corporeal shack wave lighotriphy is the treatment of choice for upper ureteeric
calculi. This procedure involves aiming shock waves from a spark generator, piezoelectric dish or electromagnetic plate directly on to the stone and under x-ray or ultra
sound control. ESWL
procedure can be performed in IV sedation or fall one
anesthesia. Duration for the procedure is 1 to 2 hrs, the stone is usually visualized
with fluoroscopy and once centered for treatment. Approximately 500-1500 shocks
are generated, that penetrates the nearly and acts upon the stone. After the shocks are
given, the stone gradually pulverizes, and the fragments are passed spontaneously
within days to weeks. 12 ESWL is a noninvasive technique, which is the treatment of
choice for stone less than 2cm in diameter(80% of stones fall into this category)
ESWL is the high energy shock waves are directed at the kidney and the stone
disintegrating into minute particle that passes in the urine.
During the procedure the client is placed in a specially designed table and immersed
in a water bath on an adjustable stretcher where they are positioned over a cushion of
water.
a) In the water bath module, waves travel through waters surrounding the patient.
b) In cushion model, a large amount of gel like substance lies between the
stretcher and water in which shocks waves passed through the cushion and gel.
2.Related studies
A number of research studies have demonstrated that, by adopting life style
modifications can prevent the recurrence of renal calculi.
A study on “ A complementary approach to urolithiasis prevention” conducted
by aderson RA, he explains about the risk factors for the stone formation. Which
includes a positive family history of renal caculi nutritional factors such as high
intake of animal protein, fat, sugur, oxlate, alcohol, salt and vitamin D and also
author suggest about that proper education on dietary modification with the help of
defined protocols, will decreases the incidence of stone formation. 13
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A study on “ Treating and preventing kidney stones” by Shellen Berger.T,
Krouse A, he explained about the formation of renal calculi and also the prevention
approaches. 14
a) Dietary modifications.
Mesas P, Meragella M in his study on “ Different dietary calcium intake and relative
super saturation of calcium oxalate”, has identified that the dietary calcium
restriction, which is efficient practice in reducing urinary clcium extraction. In
conclusions, that data reinforce that dietary calcium restriction has potentially
reduced the risk of stone formation, which is one of the life style modification to be
controlled to prevent the recurrence of renal calculi. 15
Various studies have demonstrates “ nutrition” as a key factors, for the
prevention of renal calculi Sicener R, Hesse A in his study on “efficacy of selective
treatment” has identified the effect of different food forms on the change of urine
composition and with risk of calcium oxalate stone formation. 16
b) The Adequate Hydration.
In their study conducted by Siner R, S. Nicolony C, Hessa on “ efficacy of selective
treatment and risk factors for relapse in recurrent calcium oxalate stone patients”
which was p;erformed to examine the efficacy of a selective treatment guidelines for
the prevention of recurrence of stone formation and to assess the risk factors for
stone formation. In conclusion findingsd indicated that compliance with adequate
hydration, alkalization therapy and regular bowel elimination was highest among the
patients without recurrence and they were comparied with all other therapeutic
measures. 17
c)
Bladder elimination
Harkness Dinecher in his study on “ Non invasive management for
renal calculi”. He also stress about the importance of adequate hydration after the
treatment the clients is instructed to drink 3-4 liters of water everyday, which is one
of the life style modifications to be followed after the lithography( lithotripsy)
procedure to flush the sones out and also to prevents the recurrence of renal calculi. 18
d)
Prevention of Urinary tract infection.
A study on “Relationship between urinary tract infection and stone
formation” conducted by Hiranos, O hikawa M et.al. In their study, which was
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conducted to identify the relationship between infection and renal stone formation.
Nearly 19 patients with renal calculi were treated by surgical approach, they were
investigated and initially the stones analyzed and identified that most of the stone
cores consists of calcium phosphate and organic materials, such as bacteria fibers,
finally the study conducted , that prevention of infection is also one of the life style
modification to be followed to prevent the recurrence of renal calculi. 19
e) Effect of instructional material.
Kubha 2000 has mentioned in his study on “Evidence based research” that the
leaflets are a useful resource fort information provision does the clients which will
definitely impart the knowledge on prevention aspects of the diseases. 19
Another study by Laeurm E, Murtagh J. on “renal colic and recurrent urinary
calculi management and prevention”. Suggested about the formulating instructional
material on preventive approaches after the definite treatment, such as the changes in
the diet, adequate hydration and prevention of infection. 20
The related literature and the research findings have supported need for
structured educational programmes in the form of information leaflet for patients who
have been posted for lithotripsy. This will encourages the patient to follow the life
style modifications to prevent the recurrence of renal calculi after lithotripsy. Hence
the study proposes to identify whether the structured patient information leaflet on life
style modification will increase to know on life style modification to prevent the
recurrence of renal calculi in patients who have been posted for lithotripsy.
6.3 PROBLEM STATEMENT
“A study to assess the effectiveness of patient information leaflet on life style
modifications to prevent recurrence of renal calculi in patients who are posted for
lithotripsy at a selected hospital in, Tumkur.”
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6.4 OBJECTIVE OF THE STUDY

To assess the existing knowledge on life style modifications to prevent
recurrence of renal calculi in patients who are posted for lithotripsy.

To assess the post intervention knowledge on life style modifications to
prevent recurrence of renal calculi in patients who are posted for lithotripsy.

To associate the post intervention knowledge on life style modifications to
prevent recurrence of renal calculi in patients who are posted for lithotripsy
with selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
 Effectiveness
Significant in the level of knowledge of the patient on life style
modifications to prevent the recurrence of renal calculi.
 Patient information leaflet
It refers to organized self learning content in form of a leaflet, which will
provide well defined area of knowledge on life style modifications to prevent
recurrence of renal calculi in patients who are posted for lithotripsy.
 Life style modifications
It refers to alteration in behavior with regard to diet, hydration, bladder
elimination and prevention of infection.
 Renal calculi
It refers to presents of stones or calculi in the kidney.
.
 Lithotripsy
Lithotripsy is a non surgical procedure in which it breaks the renal
stones into tiny particles using high frequency sound waves delivered through an
electronic probe inserted into the ureter.
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6.6 HYPOTHESIS
The patient information leaflet will significantly increase the knowledge
on life style modifications to prevent the recurrence of renal calculi in
patients who are posted for lithotripsy.
7. ASSUMPTION
The patients who have undergone lithotripsy in the selected hospitals not
have adequate information to enhance Knowledge about the life style
modifications to prevent the recurrence of renal calculi.
Projected outcomes
1, The Patient information leaflet will help the patient to acquir knowledge of
life style modifications to prevent the recurrence of renal calculi.
2, The Patient information leaflet can be used by the health care professional to
educate the patient on life style modifications to prevent the recurrence of renal
calculi after lithotripsy.
7.1 MATERIAL AND METHODS
7.2 SOURCES OF DATA
7.2.1 Research approach
:
Research approach for this study is
evaluative in nature.
7.2.3 Research design
:
A Quasi-experimental, one group preTest and post- test design.
7.2.3 Setting of study
:
The study will be conducted in urology
In patient department at selected
Hospitals, Tumkur,
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.
7.2.4 Sample size
:
50
7.2.5 Sampling Technique
:
non probability convenient sampling
:
patient information leaflet on life
7.2.6 Selected variables:
Independent
Style modifications after lithotripsy
Procedure.
Dependent
:
knowledge on life style modifications
To prevent recurrence of renal calculi
after lithotripsy procedure.
7.2.7 Sample Criteria
Inclusion Criteria

Patients who are posted for the lithotripsy procedure for the
first time in hospital.

Patients who are in the age group between 20 to 60 years.

Patients who know Kannada or English.
7.2 METHOD OF DATA COLLECTION
7.2.1Data collection technique: Structured interview
Schedule.
7.2.2Tool for data collection
:
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Structure Questionnaire.
7.3METHODS OF DATA ANALYSIS ND INTERPRETATION
The researcher will use appropriate statistical technique for data analysis
and present in the form of tables, graphs and diagrams.
7.4 Duration of the study
:
6 weeks
7.4 Does the study require any investigations or interventions to be conducted on
the patient or other human beings or animal?
The study does not require any investigation and interview on patients and
other human beings or animals.
7.5 Has ethical clearance been obtained from your institution?
YES
Ethical clearance has been obtained from Institution.
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8. REFERENCES
1. Arelene L, polastic and suzannee,”Luckmanns care principles and practice of
medical surgical nursing” wb sauders company, philadelpia, 6th edition,
2001,,Page.No.820-873.
2. Alan.E.Read,johns, Essential medicine” published by Churchill living stone,
1st edition, p.no 230-231
3. Briony Thomas “manual of dietitianBlackwell scientific publication, 1988, 1st
edition p-463-464.
4. Chirstensen knockrow “Adult health nursing” mosby publication, 4th edition,
p- 428.
5. Dorthy J.Brundage “Renal disorders” mosby clinical nursing series p-99-100.
6. Dons smith suddarth “ The Lippincott manual of nursing practice” Jb lippincot
company Philadelphia 5th edition p-684.
7. Carol Taylor Carol Lillis, prisure, “ Fundamentals of nursing the art and
science of nursing care” Lippincot, Philadelphia, Newyork,1997 3rd edition, p44.
8. Harkness Dineher “ Medical surgical “ published by mosby INC. 10th edition
1149.
9. Grrdner long Deyoung “ foundation and clinical applications of nutrition in
nursing approach”, 3 rd edition, mosby publications p- 620-627
10. Joan Luckman, care Keteswerney “saunders manual of nursing” published by
wb saunders 1st edition, p-1216.
11. Joan M.stanleny “Advanced practice emphasing common nursing roles”
published by FA Davis company Philadelphia, 2nd edition.
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12. Joan Blaudy “Urology” library of congress cataloging in Philadelphia data, 5th
edition,1999, p-80-82.
13. Aderson RA, “ A complementary approach to urolithiasis prevention”
14. Shellen Berger.T, Krouse A, “ Treating and preventing kidney stones”
15. Mesas P, Meragella M “ Different dietary calcium intake and relative super
saturation of calcium oxalate”,
16. Sicener R, Hesse A “efficacy of selective treatment”
17. Siner R, S. Nicolony C, Hessa “ efficacy of selective treatment and risk
factors for relapse in recurrent calcium oxalate stone patients”
18. Harkness Dinecher “ Non invasive management for renal calculi”.
19. Kubha 2000 “Evidence based research”
20. Laeurm E, Murtagh J. “renal colic and recurrent urinary calculi management
and prevention”.
21. http://www.dilipraja.com/stone.htm
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9. Signature of the Candidate
:
10. Remarks of the Guide
:
11 Names 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
:
12.1 Remarks of the Chairman
and Principal.
:
12.2 Signature
:
12.
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