SUBMITTED BY:

Ms.HANNA.P.SAM

1STYEAR M.SC.NURSING

MEDICAL AND SURGICAL

NURSING,

2012-2014 BATCH

SARVODAYA COLLEGE OF

NURSING

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. HANNA.P.SAM
1ST YEAR M.SC. NURSING,
SARVODAYA COLLEGE OF NURSING,
11/2,/MAGADI MAIN ROAD,
AGRAHARA, DASARAHALLI,
BANGALORE-560079
2 / NAME OF THE INSTITUTION / Sarvodaya college of nursing,
11/2, magadi main road,
agrahara, dasarahalli,
bangalore-560079
3 / COURSE OF THE STUDY AND SUBJECT / 1st year m.sc nursing
medical and surgical nursing
4 / DATE OF ADMISSION / 18/06/2012
5 / TITLE OF THE TOPIC / “A study to assess the effectiveness of structured teaching programme on knowledge regarding diabetic retinopathy among clients with diabetes in selected hospitals,Bangalore”.
6 / BRIEF RESUME OF THE WORK
6.0 INTRODUCTION
6.1 NEED FOR THE STUDY
6.2 REVIEW OF LITERATURE
6.2.1 STATEMENT OF THE PROBLEM
6.3 OBJECTIVES OF THE STUDY
6.3.1OPERATIONAL DEFINITIONS
6.3.2 ASSUMPTIONS
6.3.3HYPOTHESIS
6.3.4 SAMPLING CRITERIA
1) INCLUSION CRITERIA
2)EXCLUSION CRITERIA / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7 / MATERIALS AND METHOD
7.1 Source of data: Data will be collected from selected hospitals, Bangalore
7.2 Method of data collection: Structured questionnaire
7.3 Does the study require any investigations or intervention to be conducted on the
Patients or other human being or animal? No
7.4 Has ethical clearance has been obtained from your institution? Yes
8 / LIST OF REFERENCE : Enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms. HANNA.P.SAM
1ST YEAR M.SC. NURSING,
SARVODAYA COLLEGE OF NURSING,
11/2,/MAGADI MAIN ROAD,
AGRAHARA DASARAHALLI,
BANGALORE-560079
2 / NAME OF THE INSTITUTION / SARVODAYA COLLEGE OF NURSING,
11/2,/MAGADI MAIN ROAD,
AGRAHARA DASARAHALLI,
BANGALORE-560079
3 / COURSE OF THE STUDY AND SUBJECT / 1st YEAR M.Sc NURSING
MEDICAL AND SURGICAL NURSING
4 / DATE OF ADMISSION / 18/06/2012
5 / TITLE OF THE TOPIC / “A study to assess the effectiveness of structured teaching programme on knowledge regarding diabetic retinopathy among clients with diabetes in selected hospitals,bangalore”.

6.BRIEF RESUME OF INTENDED WORK

6.0.INTRODUCTION

“No one can lie,no one can hide anything, When he looks directly into someone’s eyes” -Paulo Coelho

Health is the wealth of wealth as it is the harmony within the mind, body and soul. Illness is a disenabling response, a mismatch between a person’s needs and resources available to meet those needs, it signals that the present is not working. Health and illness are dynamic patterns that change with time and social circumstances as they are not mutually exclusive and it fluctuates within a range of optimal well-being to various levels of dysfunction.

The term diabetes refers to a group of diseases that affect the way the body regulates blood glucose or ,as it is commonly known blood sugar. Glucose is very important to the overall health because it is the predominant source of energy for the cells that makes up the muscles and the tissues. If a person has diabetes it means that there is too much glucose in his blood. Which is a serious health problem symptoms of diabetes include, frequent urination, unquenchable thirst blurred vision, inability to heal and in men erectile dysfunction1.

Diabetes mellitus has emerged as a major health care problem in India. According to diabetes atlas published by international diabetic federation (IDF)there were estimated 40 million people with diabetes in 2007 and this number is predicted to rise to almost 70 million people by 2025.The countries with largest number of people with diabetes will be in India ,china, and USA by 2030, that means every 5th person in India will have diabetes2.

About 50% of persons with diabetes are unaware that they have the condition, although about 2 million deaths every year are attributable to complication of diabetes .The patient with diabetes often develop ophthalmic complications, such as corneal abnormalities, glaucoma, iris neovascularization, cataract and neuropathies. Blindness is the most common among these complications. After 15 years, about 2% of persons with diabetes become blind, and about 10%develop severe visual loss. After 20 years, more than 75% of patient will have some form of diabetic retinopathy3

Diabetic retinopathy is a micro-vascular complication of diabetes and it remains a major cause of new onset of visual loss in the United States and other industrialized nation. It is caused by changes in the blood vessels of the retina. In some people, with diabetic retinopathy blood vessel may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light sensitive tissue at the back of the eye. Healthy retina is necessary for good vission4

There are mainly two types of diabetic retinopathy, non proliferative and proliferative. Non proliferative diabetic retinopathy is the early stage diabetic retinopathy which is identified by deposits of cholesterol or other fats in the retina. It can occur at any time after the onset of diabetes. Often no visual symptoms are present, but examination of retina can reveal micro aneurysms. The proliferative diabetic retinopathy has also the greatest risk of visual loss.

The symptoms of diabetic retinopathy are fluctuating vision, eye floaters and spots shadow in the field of view, blurry and distorted vision, corneal abnormalities such as slow healing of wound due to corneal abrasions, double vision and eye pain etc. The etiology of diabetic retinopathy involves higher fat intake, sedentary life style changes and decreased physical activity5

The patient with diabetes must have regular dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. The most common form of treatment for diabetic retinopathy are early photo coagulation of retina, cryotherapy and vitrectomy photo coagulation by destroy the ischemic areas of the retina that produce growth factor that encourage neovascularization there by preventing further visual loss6

Preventive measures of diabetic retinopathy include activities like keeping blood glucose within normal limits, monitoring blood pressure and keeping it under good control, maintaining a healthy diet, doing regular exercise, avoid smoking and undergoing a regular eye examination5.

6.1. NEED FOR THE STUDY

According to WHO report in the year 2000, the incidence of diabetes was 171 million and estimated to increase to366 million by the end of year 2030. At present India is considered as the diabetic capital of the World. There are approximately 3.5 crore diabetes in India, and this figure is expected to increase up to 5.2 crore by 2025.Around 3.2 million deaths every year are attributable to complications of diabetes. India tops the list of top 10 countries, in number of sufferers. In Karnataka 22 to 26 percent people are diabetic.7

. According to the US centers for disease control (CDC) reported that diabetic retinopathy is responsible for 4.8% of the 37 million cases of blindness due to eye diseases throughout the world (i.e. 1.8 million persons).Currently more than 5 million Americans aged 40 and older have diabetic retinopathy due to type 1 or type 2 diabetes and that numbers will grow to about 16 million by 2050.Around 12000 and 24000 new cases of blindness related to diabetic retinopathy occur in each year 5

A cross sectional study was conducted to assess the “Prevalence of diabetic retinopathy in India”. The objective of the study was to estimate the prevalence of diabetic retinopathy in an urban Indian population older than 40 years. Result of this study reported that age- and gender-adjusted prevalence rate of diabetes in an urban Chennai population was 28.2% (95% confidence interval [CI], 27.0-29.3), and the prevalence of diabetic retinopathy in general population was 3.5% (95% CI, 3.49-3.54). The prevalence of diabetic retinopathy in the population with diabetes mellitus was 18.0%8 .

Retinopathy is a process of micro vascular damage to the retina. It can develop slowly or rapidly and lead to blurred vision and progressive vision loss. Retinopathy is most often associated in adults with diabetes mellitus and hypertension. Diabetes retinopathy is the leading cause of vision disability and blindness in persons with long standing uncontrolled diabetes6.

Although originally thought to be a disease of an urban population, the prevalence of diabetes mellitus increasing in rural area as well. The socio economic burden resulting from visual impairment or burden caused by diabetic retinopathy particularly in working age group is a serious concern 9.

A study was conducted on “awareness and practices related to diabetic retinopathy among non-medical person in south Indian population”. Face to face interviews conducted using a semi structured questionnaire with 200 randomly selected paramedical person and 204 non-medical persons. In this community over half of the respondent were aware of risk factor of diabetic retinopathy and every one fifth of paramedical and one tenth of person from the community were aware of risk factor for diabetic retinopathy ,over 755 of respondent were not aware of surgical methods of diabetic retinopathy as an intervention for retinopathy10

A study was conducted to evaluate the baseline level of knowledge and awareness of diabetic patients about their disease and its complications. The study included 1040 patients who were interviewed to know their knowledge, attitude and practices about diabetes using a structured questionnaire. The awareness about the disease in majority of diabetic patients was not adequate in this study and routine individual teaching and counseling represents an effective educational model. The result revealed that the awareness complication of diabetes mellitus11.

A study was conducted on incidence and risk factors of diabetic retinopathy among 549 diabetic clients (161 male and 388 female).The mean age of the participants was 45.7(9.3)years with a mean duration of diabetes of 6.9(5.7)years at initial registration. The incidence of diabetic retinopathy was 89.4 in males and 86.6 in females per 1000 person –years based on 2786 person –years of follow up. The incidence rate of diabetic retinopathy was 60% greater among insulin-treated than non- insulin-treated clients. The incidence of diabetic retinopathy was greater with older age ,longer duration of diabetes, higher diastolic blood pressure and poor metabolic control. In the insulin-treated group, fasting blood glucose was also a significant predictor of retinopathy12

On the basis of the above facts and studies it is quiet evident that early detection of diabetic retinopathy is very much important to prevent blindness and other complications. Moreover investigators grandmother is also suffering from loss of vision since many years due to diabetic complications. Therefore the knowledge regarding diabetic retinopathy among clients with diabetes is essential to detect any early manifestation and thereby we can prevent further complications

6.2. REVIEW OF LITERATURE

Review of literature is an important step in the development of researcher project. It involves systematic identification, location, scrutiny and summary of written materials that contain information on researcher problems.

Review of literature is a systematic and critical review of the important published scholarly literature on a particular topic .This helps the investigator to find out what is already known, and what problem remains to be solved.

LITERATURE RELATED TO,

1. LITERATURE RELATED TO THE INCIDENCE AND THE PREVALANCE OF DIABETIC RETINOPATHY

2. LITERATURE RELATED TO THE RISK FACTORS OF DIABETIC RETINOPATHY

3. LITERATURE RELATED TO THE KNOWLEDGE OF CLIENTS WITH DIABETES REGARDING DIABETIC RETINOPATHY

1. LITERATURE RELATED TO THE INCIDENCE AND THE PREVALANCE OF DIABETIC RETINOPATHY

A study was conducted to find out the prevalence of diabetic retinopathy among clients with diabetes, who were on treatment to find out the presences of associated risk factor. To determine the knowledge of diabetic retinopathy among patients with diabetic mellitus. It was estimated that 21% of patients with known case of diabetes had evidence of various grade of diabetic retinopathy. Although 75.38% of patient had history of diabetes mellitus less than 10 years associated risk factor were present in 66.4% however only 50% of clients with diabetes had the knowledge of diabetic retinopathy13

In a study to assess the prevalence of retinopathy in newly diagnosed patients attending a diabetic center, 448 diabetic patients attending the MV Diabetes Specialties in Chennai were taken. Out of the 438 patients with assessable photographs, 32 (7.3%) had retinopathy. One patient with retinopathy and 28 patients without retinopathy had reduced vision mainly from non-diabetic causes such as cataract or central retinal vein occlusion. The two patients with mature cataract subsequently underwent cataract extraction and neither had diabetic retinopathy4.

A study was conducted to assess the association of diabetic retinopathy and other micro vascular complications in cases of diabetic mellitus. The study included 129 diabetic patients and cases were divided into 3 groups according to their duration, type of diabetes mellitus and non-compliance to management. The result of study shown that, prevalence of retinopathy in Group 1 was 34.4%, in group 2 was 12.4% in type-II diabetes mellitus as compared to type-I and group 3 which was 25.5%. The difference was statistically significant showing that diabetic retinopathy is associated with all the types of diabetes mellitus with more incidences in type-I diabetes mellitus. As duration increases prevalence of diabetic retinopathy also increases. It was 8.9% in <5 years duration and 89.0% in 11-15 years and 100% in cases with >15 years of diabetes14.

A study was conducted regarding prevalence of retinopathy related to the age of onset of diabetes. The main aim was to compare the prevalence of diabetes retinopathy & risk factors in patients with known onset of diabetes before 40 years & after 40 years of age. 1414 diabetic patients were recruited as samples. The result of the study shows that prevalence of diabetic retinopathy (DR) was 33.3%. In the group with age of known onset of diabetes ≤ 40 years, the risk factors, related with diabetic retinopathy, were poor glycemic control or insulin uses. The prevalence of diabetic retinopathy was almost twice more in those subjects who developed diabetes before the age of 40 years than those who developed it later12.

2. LITERATURE RELATED TO THE RISK FACTORS OF DIABETIC RETINOPATHY

A study was conducted to evaluate the influence of elevated level of nocturnal blood pressure on diabetic retinopathy. A total of 88 diabetic retinopathy patients were divided according to the stage of diabetic retinopathy. They underwent 24 hour ambulatory blood pressure monitoring and opt homological evaluation and their average level of fasting blood glucose as well as their glycemic control index were calculated .The finding of the study suggested that the absence of normal pressure rhythm can interfere with the prevalence and severity of diabetic retinopathy15.