Download the effectiveness of nursing care on patient with chronic renal failure

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
Mrs. SMITHA VARGHESE
I YEAR M. Sc NURSING
MEDICAL SURGICAL NURSING
(2012 –14 BATCH)
SRI SHANTHINI COLLEGE OF NURSING
#188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE,
LAGGERE MAIN ROAD, LAGGERE,
BANGALORE -560058
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
DISSERTATION.
01
NAME OF THE
CANDIDATE AND
ADDRESS
Mrs. SMITHA VARGHESE
1st YEAR M.SC NURSING,
SRI SHANTHINI COLLEGE OF NURSING
#188/B,PARVATHI NAGAR, OPP:SUB
REGISTRAR OFFICE,
LAGGERE MAIN ROAD,
LAGGERE,BANGALORE -560058.
02
NAME OF THE
INSTITUTION
SRI SHANTHINI COLLEGE OF NURSING ,
#188/B,PARVATHI NAGAR,
OPP:SUB REGISTRAR OFFICE,LAGGERE
MAIN ROAD, LAGGERE,
BANGALORE -560058.
03
04
05
COURSE OF THE
STUDY AND
SUBJECT
DATE OF
ADMISSION TO
COURSE
TITLE OF THE
TOPIC
MASTER DEGREE IN NURSING
MEDICAL SURGICAL NURSING
28/06/2012
THE EFFECTIVENESS OF NURSING CARE
ON PATIENT WITH CHRONIC RENAL
FAILURE
6 . BRIEF RESUME OF INTENDED WOR
INTRODUCTION
"A man too busy to take care of his health is like a mechanic too busy to take care of his
tool"
- Spanish Proverb 1
The power of love to change bodies is legendary, built into folklore, common
sense, and everyday experience. Love moves the flesh, it pushes matter around.
Throughout history, "tender loving care" has uniformly been recognized as a valuable
element in healing. A bodily disease, which we look upon as whole and entire within
itself, may, after all, be but a symptom of some ailment in the spiritual part. 2
Every human being is the author of his own health or disease.”The secret of
health for both mind and body is not to mourn for the past, nor the worry about the future,
but to live the present moment wisely and earnestly. Health is defined as a state of
complete physical, mental and social well being and not merely an absence of disease and
infirmity.3
Chronic Renal Failure involves progressive irreversible destruction of the
nephrons in both the Kidneys. It is defined as either kidney damage or Glomerular
filtration rate less than 60 milliliters per minute. Kidney damage is defined as pathologic
abnormalities or makers of damage actions from proceeding stages.4
The causes of Chronic Renal Failure is generally progressive and mediated by
several factors that operate in combination in progression of renal disease example,
volume disorders infection, nephritic proteinuria and high protein phosphorous intake.
Number of evidence suggests that ameliorating hypertension, reducing proteinuria slow
the progression of chronic renal failure5
The incidence and prevalence of Chronic Renal Failure at various countries in the
Asian pacific region and reported that there was an average increase in incidence rate of
1.2 to 14.1 percentage and average prevalence rate of 4.2 to 17.3 percentage each year.
Every year almost one lakh fresh cases of Kidney failure are reported nationwide and the
cumulative base of such cases run nearly 4.5 lakhs in a given year and over two lakhs
population die every year in India.6
World Health Organization reported that the most common causes of death are
infectious diseases (43 percentage); disease of the circulatory system (24 percentage)
perinatal and other unknown causes (10 percentage) cancer (nine percentage) and
Chronic Renal Failure (14 percentage).End stage renal disease may be caused by
systemic diseases, such as diabetes mellitus; hypertension; chronic glomerulonephritis,
pyelonephritis obstruction of the urinary tract; hereditary lesions, such as in polycystic
kidney disease; vascular disorders; infections; medications; or toxic agents.
Environmental and occupational agents that have been implicated in chronic renal failure
include lead, cadmium, mercury, and chromium. Dialysis or kidney transplantation
eventually becomes necessary for client survival.7
6.1 NEED FOR THE STUDY
Renal disease is a major largely unrecognized health issue. It produces
uncertainties and an enhanced need for social support. In the united states at the end of
2002, over 3.45.000 individuals with End Stage Renal Disease were dialysis clients and
more than 1,00,000 had a functioning kidney transplant. Over the past five years, the
number of clients with kidney failure has averaged about 80,000 annually, this number of
clients with End Stage Renal Disease is expected to reach 6,60,000 by 2010. Each year
about 70,000 people die from causes related to renal failure. AT least 40 million
Americans are at risk of Chronic Renal Failure.8
Homeremith, reported that there are currently 5000people in the United kingdom
receiving haemodialysis and according to the U.S department of health and human
services by the end of 2000, an estimate 20,000 Americans suffered from end stage renal
disease and the prevalence climbs by more than nine percentage per year. Currently more
than 300,000 people have end stage renal disease in U.S. and the number increases
annually by seven
percentage.9
Chronic Renal Failure is one of the most common illnesses in India. One Lakh
people were diagnosed to have kidney failure in India. Nearly 1,00,000 clients every year
require renal transplantation. It is estimated that there is one End Stage Renal Disease
client in every 2000 families. We believe that in India, there are many clients who are at
potential risk of End Stage Renal Disease. If proper care is not taken today, this estimated
statistics is going to rise. The prevalence and incidence of End Stage Renal Disease has
drastically increased over past decade.10
Chronic Renal Failure is a major public health problem. Early diagnosis and
treatment are basic for its prognosis, and it will be fundamental for the future necessity of
substitutive renal treatment. For this purpose, determining the etiology of chronic renal
failure may be helpful. This study was conducted in the Nephrology Department at the
Central Military Hospital in Sana’a, Yemen from 2004 to 2007; to determine the etiology
of chronic renal failure in 334 clients (211 men and 123 women) on regular
haemodialysis.11
In global wide, the incidence rates of end-stage renal disease have increased
steadily internationally since 1989. The United States has the highest incident rate of End
stage renal disease, followed by Japan. The mortality rate of chronic renal failure in
United States is about 14,482 deaths and in Japan, it is about 8,688 deaths. 39,480 people
died from nephritis, nephrotic syndrome and nephrosis each year in the US 2001 (Deaths:
Final Data for 2001, NCHS, CDC)12
6.2 REVIEW OF LITERATURE.
The review of literature in a research report is a summary of current knowledge about a
particular practice problem and includes what is known and not known about the problem. The
sources to obtain the information on the topic were books, journals, abstracts, Medline,
unpublished dissertations and internet.
The available literatures were given in the following sections.
6.2.1 Literature related to causes of chronic renal failure
6.2.2 Literature related to nutritional therapy of chronic renal failure
6.2.3 Literature related to complications of chronic renal failure
6.2.4 Literature related to nursing management of Chronic Renal Failure
LITERATURE RELATED TO CAUSES OF CHRONIC RENAL FAILURE
Malekman, L has conducted as study on causes of chronic renal failure among
Iranian haemodialysis clients. The result shows that the mean KT/V > 1.2 was achieved
only 32.1percentage (203/633) of all clients. The mean BMI was 24 + 4.5. The most
common causes of Chronic Renal Failure were hypertension (30.5 percentage) and
diabetes mellitus (30.1 percentage). In conclusion, most common causes for Chronic
Renal Failure in this region were hypertension and diabetes mellitus. Better management
of hypertension and diabetes could prevent clients from ending up with end stage renal
disease.13
Jose, LR has conducted a study on chronic renal failure in Military hospital
Sana’a Yemen. The study shows that the hypertensive Nephropathies (24 percentage)
was the commonest cause of chronic renal failure. Diabetic Nephropathies (20
percentage), Obstructive Nephropathy (16 percentage); Chronic Pyelonephritis,
Glomerulo Nephritis, Polycystic Kidney, Schistosomiasis were less common. The mean
range of clients was 42 years old. Hypertension, late referral, smoking were the
commonest co-morbid causes and act as a risk factor to progression of End-stage Renal
Disease in clients with chronic renal failure.14
LITERATURE RELATED TO NUTRITIONAL THERAPY OF CHRONIC
RENAL FAILURE
Anees, M. conducted a cross-sectional study on the evaluation of nutritional
status of clients on haemodialysis at sheikh Zayed hospital, Lahore, Pakistan. A sample
of 51 clients was studied. Nutritional status was checked by laboratory data,
anthropometric measurements, mid arm circumference, triceps skin fold thickness and
mid-arm muscle circumference. Findings reveal that haemoglobin and hematocrit was
normal only in 14 percentage of clients, other 86 percentage were anaemic.15
Kalantar Zadeh, K. conducted a study on the role of low iron levels in the poor
outcome of haemodialysis clients at 10 Davita dialysis facilities in Los Angles. A total of
1283 clients were examined 97 percentage of clients were administered erythropoietin
and 60 percentage were administered intravenous iron at least once. During a 12 month
follow up mortality was significantly greater (23 percentage) in the lowest serum iron
quartile compared with other quartiles (10 to 12 percentage).16
LITERATURE RELATED TO COMPLICATIONS OF CHRONIC RENAL
FAILURE
Martin. K, concluded that disturbances in mineral and bone metabolism are
prevalent in chronic kidney disease and are an important cause of morbidity, decreased
quality of life and extra skeletal classification that have been associated with increased
cardiovascular mortality. It is recommended that the term renal osteodystrophy be used
exclusively to define alterations in bone morphology associated with chronic renal
failure, which can be further assessed by histomorphometry and the results reported
based on a parameters of turnover, mineralization and volume.17
Lawrence, A., reported that end-stage renal disease diabetic clients with
peripheral vascular disease have a much higher incidence of foot complications and
increased risk for amputation. Studies have shown that simple techniques such as
identifying those at risk of developing foot ulcers, educating clients about foot care that is
tailored to meet the requirement of individual client needs, educational background and
learning ability can be of obvious benefit to people with diabetes and is cost effective.18
LITERATURE RELATED TO NURSING MANAGEMENT OF CHRONIC
RENAL FAILURE
Channey conducted a study on dialysis access and the impact on body image:
role of the nephrology nurse. The study showed that the end-stage renal disease is a
chronic condition without cure, requiring dialysis therapy to maintain life or
transplantation for those fortunate enough to receive a Kidney. The aim of this article is
to outline the concepts of dialysis and body image, and discuss the role of the nephrology
nurse at the author’s current place of work. It highlights suggestions on how renal nurses
can prepare and educate clients regarding changes in body image following a diagnosis of
end-stage renal disease and emphasized the need for future research in this area.19
Compton, A, conducted a study on the nephrology nurse’s role in improved care
of clients with chronic Kidney disease. The results showed that the case of chronic renal
failure clients is sub optimal. This article discusses how nephrology nurses can contribute
to multidisciplinary clinics that work in collaboration with primary care providers to
identify and manage clients with early chronic Kidney disease. It will describe the
importance of the nephrology nurse as a resource for improved client outcomes and for
the implementation of federal professional and corporate chronic Kidney disease
initiatives.20
STATEMENT OF THE PROBLEM
“A Study to assess The Effectiveness of Nursing Care on Patients with
Chronic Renal Failure in selected Hospitals at Bangalore.”
6.3 OBJECTIVES
1. To assess the effectiveness of nursing care on patients with chronic renal failure,
2. To determine association between the effectiveness of nursing care on patients
and selected demographic variable.
6.4 HYPOTHESIS
H1: There will be significant association between knowledge and care given by health
personals.
H2: There will be significant association between nursing care given and prevention of
complications.
6.5.VARIABLES
Independent variables
A stimulus or activity manipulated by the researcher to create an effect on
dependant variable. The variable in this study is observational check list .
Dependent variables
The response, behaviour or outcome that the researcher wants to predict or
explain. The variable in this study is level of nursing care received.
6.6. OPERATIONAL DEFINITIONS:
In this study the research has define the following terms as
EFFECTIVENESS
It refers to outcome in nursing care and promotes the health status of clients with
chronic renal failure, which are assured and evaluated by standardized tool.
NURSING CARE
The nursing care refers to the complete nursing intervention done by the scholar
such as assessment of vital parameters,administration of oxygen, skin care, fluid and
electrolyte balance,intake and output chart, administration of medications, monitor
dialysis, dietary management, prevention of infection and health education provided by
the scholar to clients with chronic renal failure from admission until the time of
discharge.
PATIENTS
The patients refers to those who are diagnosed as chronic renal failure by the
physician and under haemodialysis therapy.
CHRONIC RENAL FAILURE
It refers to the progressive, irreversible deterioration in renal function in which the
body’s ability to maintain metabolic and fluid and electrolyte balance fails, results in
uraemia or azotemia.
HOSPITAL
It’s an institution for the care, diagnosis and treatment of sick and injured.
6.7. ASSUMPTION
Daily assessment of the clients with chronic renal failure enables a nurse to
gain thorough knowledge about progress in clients.
Proper nursing care among chronic renal failure clients will help to
minimize the risk of complication.
6.8. DELIMITATION
The study is delimited to the patients with chronic renal failure present in
the selected hospital.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
Data will be collected from chronic renal failure patient present in the
selected hospital.
7.2 METHOD OF COLLECTION OF DATA
7.2.1. RESEARCH DESIGN
A Experimental research design.
7.2.2. RESEARCH APPROCH
An evaluative research approach.
7.2.3. SETTING OF THE STUDY:
This study will be conducted in selected hospitals at Bangalore.
7.2.4. POPULATION
The population of the study comprises of all clients with chronic renal
failure and on haemodialysis therapy who were admitted in selected hospitals
Bangalore
7.2.5. SAMPLE SIZE
The sample size is 60
7.2.6. SAMPLING TECHNIQUE
Non Probability-Convenient sampling
7.2.7. SAMPLING CRITERIA
INCLUSION CRITERIA
The Patients,
 Who are admitted in nephrology unit and under hemo dialysis therapy.
 Both male and female patients.
 Who can understand the English and Kannada.
 Who are willing to participate in the study.
EXCLUSION CRITERIA
The Patients,
 Who are not willing to participate in the study.
 Who were under peritoneal dialysis therapy.
7.2.8. DATA COLLECTION TOOL
The researcher develops a structured knowledge questionnaire. It consists
of
part-I and part-II.
Part- I:
Selected Demographic variables.
Part-II:
Self administered questionnaire will be used to assess the level of nursing
care received.
7.2.9. DATA ANALYSIS METHOD
The data analysis through descriptive statistics and inferential statistics.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR
ANIMALS?
-Yes7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION:
Permission will be obtained from
The research committee of Sri Shanthini College of nursing.
8. LIST OF REFERENCE
1.
www.quote garden.com
2.
Szeltzer. G, Textbook of Medical Surgical Nursing,
7th edition, Lippincott,
Philadelphia.
3
Barbara, c.,long Medical Surgical Nursing, 3rd edition, published by mosby
publication
4.
Bickerton. J, Medical Surgical Nursing, 1st edition, William Heinemman medical
books limited.
5.
Luckman(1998) Medical Surgical Nursing, 4th edition Saunders Publication.
6.
Our Body Ourselves for the New Century (URL-http/www.feminist.com)
7.
Dugas , Introduction to Patient Care – A comprehensive approach To Nursing 4th
edition, Saunders publications.
8.
www.renal health care.com.
9.
Davidson’s Principles and Practice of Medicine, 19th edition, Churchill
Livingstone.
10.
Driksen.s et.al. Medical Surgical Nursing, Assessment And Management Of
Clinical Problems, 6th edition, mosby publication.
11.
Harrison’s “Principles of Medicine”, 14th edition, McGraw Hill publications.
12.
Fred F Ferri, The Care of the Medical Client, 7th edition Mosby Publications.
13.
Statistics of renal failure care and neglect from, www.renal failure care.
14.
Bennett.P.N Quality nephrology nursing care, American journal of nursing, Jan
35(1):33-7.
15.
Lewis. Medical Surgical Nursing, 7th edition, Mosby publication.
16.
Brondani C.M., Factors that influence treatment adherence in chronic disease
clients undergoing hemodialysis, Dec 29.
17.
Chambers J, K, Fluid and electrolyte problems in renal and urologic disorders,
Nursing journal of India, Dec; 22 (4):
18.
Mohan A Renal anemia recent development and future direction for
improved management, Indian Journal of Nursing Jul - Sep, 33 (3)
19.
Headley C. M , Flash pulmonary edema in patients with Chronic Renal Failure,
Journal for Nephrology Nurses Jan-Feb;34 (1),
20.
Robinson .B.E. Epidemiology of chronic kidney disease and anemia, American
medical directorate association,
9.
SIGNATURE OF THE STUDENT
:
10.
REMARKS OF THE GUIDE
: The study will help the chronic renal
failure patients to know about their
nursing care.
11.
NAME AND DESIGNATION OF
11.1
GUIDE
:
Mrs. Nisa
Associate Professor
11.2
SIGNATURE
:
11.3
HEAD OF THE DEPARTMENT
:
Mrs. Nisa
Associate Professor
11.4
12.
SIGNATURE
REMARKS OF PRINCIPAL
:
: The researcher chosen proper
topic and relevant for further
conducting the study
12.1.
SIGNATURE
: