“A STUDY TO ASSESS THE KNOWLEDGE REGARDING POSTURAL DRAINAGE THERAPY AMONG BRONCHIECTASIS PATIENTS ADMITTED IN HARSHA HOSPITAL, NELAMANGALA WITH A VIEW TO DEVELOP AN INFORMATION GUIDE SHEET.”
PROFORMA FOR REGISTRATION
OF
SUBJECT FOR DISSERTATION
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
HARSHA COLLEGE OF NURSING
NELAMANGALA
Rajiv Gandhi University of Health Science , Karnataka
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the Candidate and Address / JINU XAVIER1st YEAR MSC NURSING
HARSHA COLLEGE OF NURSING
NELAMANGALA,BANGALORE
2 / Name of the Institution / Harsha College of Nursing
Nelamangala,Bangalore
3 / Course of the Study and
Subject / 1st Year M.Sc Nursing
Medical Surgical Nursing
4 / Year of the Admission / 2010
5 / Title of the Topic
“A Study to Assess the Knowledge Regarding Postural Drainage Therapy Among Bronchiectasis Patients Admitted In Harsha Hospital Nelamangala ,With a view to Develop an Information Guide sheet”
1. INTRODUCTION AND BACKGROUND
“Breath is the bridge which connects life to consciousness, Which unites your body to your thoughts”
Thich Nhat Hanh
When we breathe our lungs take in oxygen from the air and deliver it to the blood stream. The cells in our body need oxygen to work and grow . Chronic respiratory diseases represent a public health challenge in both industrialized and developing countries , because of their frequency and economic impact in developing countries, where poverty and non communicable respiratory disease have long been linked. Most patients have poor access to health care , this is even true of the poorest minorities in industrialized countries. In developing countries however an additional problem is that health planners have limited resources.1
Bronchiectasis is a chronic lung disease , state defined by localized, irreversible dilation of the bronchial tree . it is classified as an obstructive lung disease, involved bronchi are dilated, inflamed and easily collapsible resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders , but it usually results from necrotizing bacterial infections such as infections caused by the staphylococcus or klebisella species or bordetella pertussis . The hall mark of Bronchiectasis is a chronic cough with mucopurulent or purulent sputum , lasting for months to years and may progress to chronic respiratory failure .
Treatment of Bronchiectasis is aimed at controlling infections and bronchial secretions, relieving airway obstruction and preventing complications. In active case of Bronchiectasis includes fighting the infection with an antibiotic and eliminating the fluid with postural drainage therapy.2
Postural drainage therapy is a component of bronchial hygiene therapy it consist of postural drainage, positioning and turning and is some times accompanied by chest percussion and or vibration. Cough or airway clearance techniques are essential components
of therapy. When postural drainage is intended to mobilize secretions. Postural drainage therapy is often used in conjunction with aerosol administration and other respiratory care procedures . this procedure has been commonly referred to as chest physiotherapy , chest physical therapy ,postural drainage and percussion, and percussion and vibration
Postural drainage therapy is designed to improve the mobilization of bronchial secretions and the matching of ventilation and perfusion and to normalize functional residual capacity based on the effects of gravity and external manipulation of the thorax . This includes turning , postural drainage , percussion, vibration and cough
Turning is the rotation of the body around the longitudinal axis to promote unilateral or bilateral lung expansion and improve arterial oxygenation.
Postural drainage is the drainage of the secretions by the effect of gravity from one or more lung segments to the central airways where they can be removed by cough or mechanical aspiration
Percussion is also referred to us cupping , clapping and tapotement .The purpose of percussion is to intermittently apply kinetic energy to the chest wall and lungs .
Vibration involves the application of a fine tremorous action (manually performed by pressing in the direction that the ribs and soft tissues of the chest move during expiration) over the draining area.
The following should be assessed together to establish a need for postural drainage therapy , they are excessive sputum production, effectiveness of cough, history of pulmonary problems treated successfully with PDT(Postural Drainage Therapy) Example: Bronchiectasis, Cystic fibrosis, lung abscess, decreased breath sounds or crackles or bronchi suggesting secretions in the airway, abnormal chest x-ray consistent with atelectasis, mucus plugging and deterioration in arterial blood gas values or oxygen saturation.3
NEED FOR STUDY
“Life is not measured by the number of breaths we take but by the movement that take our breath away”
HillaryCooper
Bronchiectasis is an uncommon disease that results in the abnormal and permanent distortion of one or more of the conducting bronchi or airways bronchiectasis is usually is the result of an infection or other condition that injures the wall of the airways or prevents the airways from cleaning mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust ,bacteria and other small particles. In bronchiectasis the airways slowly lose their ability to clear out mucus when mucus can’t be cleared it builds up and creates an environment in which bacteria can grow. This leads to repeated, serious lung infections. Bronchiectasis can lead to serious health problems such as respiratory failure, atelectasis and heart failure4.
Bronchiectasis is a major cause of respiratory morbidity especially in developing countries. Respiratory exacerbations in people with bronchiectasis are associated with reduced quality of life accelerated pulmonary decline hospitalisation and even death. It is a shocking and alarming fact that approximately 973 deaths are occurring per year of the total population that is 3%of all patients suffering from respiratory diseases .Bronchiectasis is related to which of three types of the condition are present (i ) fusiform (cylindrical) bronchiectasis (ii) varicose bronchiectasis (iii) cystic (saccular) bronchiectasis
Bronchiectasis most often begins in child hood as a complication from infection or inhaling foreign object , it affects people of both sexes and all ages with proper treatment, most people can lead normal lives without major disability5.
Today treating the problem seems easy but when we think about the cost of medication and the side effects of antibiotics may lead to think natural ways to help the
bronchiectasis patient to provide airway clearance and to start breathing better. Postural drainage technique is one of the best technique to get the mucus out and provide airway
clearance .A recent consensus statement describes airway clearance techniques is a cornerstone for the management of bronchiectasis.
Brignall K , Jayaraman B,BirringSS.(2007oct.) Journal lung anatomy conducted an explorative study at the department of respiratory medicine, king’s college hospital, London Uk. According to these researchers the chronic cough and bronchiectasis are the common causes of considerable physical and psychological morbidity. The physical symptoms of cough are readily apparent, however, the psychosocial symptoms are often overlooked , there fore there is a need for questionnaire and measures to assess cough, and bronchiectasis. Specific quality of life which can be used as an ideal tool to assess physical and psychosocial aspects6.
K.Lavery, B.ONeill J.S Eiborn, J.Reilly and J.M Bradley (2006 April) conducted an explorative study at the department of respiratory medicine queen’s university Belfast Uk. The aim of the study were to assess the physical and psychosocial impact of bronchiectasis , to determine whether the patients require self management and to indentify any obstacles or sources to support for a disease specific self management programme. The data was collected from thirty two patients with diagnosis of bronchiectasis attended four focus group. Each focus group was subjected to qualitative analysis using the grounded theory approach. After the study it was found that patients have the potential to self manage with strategies including self regulation of medication and airway clearance technique. The perceived obstacles to self management include lock of information and guidance, so it was concluded that the patients has to provide information and guidance for the specific self management. So there is a need for study to assess the knowledge regarding self management for airway clearance technique in bronchiectasis patients7.
Pappalettera M, Alibertis, castellotti P, (2009) conducted an explorative study on bronchiectasis, according to these researchers bronchiectasis is the abnormal and irreversible
dilation of the bronchi associated with chronic productive cough, airway obstruction and recurrent infections, the prevalence seems to increase with age form 4.2 per 100000 parsons aged 75 years older and the therapy is aimed to improve quality of life. This study concluded by says bronchiectasis still remain a significant health problem and further studies are required to improve the management of this condition.8
I have observed my neighbour friend, who was suffering from bronchiectasis and also found that the airway clearance was improper due to inadequate knowledge of the patient regarding postural drainage. So this inspired me to conduct a study to assess the knowledge regarding postural drainage which is an easy and natural way for airway clearance and help him to lead a better life and easy breathing.
2. REVIEW OF LITRATURE
“Research is what I am doing when I don’t know what I am doing “
Wernher Vonbraun
“Literature review refers to the activities involved in identifying and searching for the information on a topics and developing a comprehensive picture of the state of knowledge on that topic”
Review literature is considered as an essential step of research processes. It involves the systematic identification, location, seriating and survey of return material that contain information on a research problem. The over all process review of literature is to develop a strong knowledge is to carry out a research and other scholarly education and clinical practice activities. It helps to determine the gaps consistencies and in consistencies in the literature about a particular subject under study. Review of literature guides the investigator to design the proposed study in a scientific manner so as to achieve the desired result, the literature for the present study been reviewed under following headings.
1. Literature on Bronchiectasis
2. Literature on postural drainage
3. Literature on chest physiotherapy.
1. Literature on Bronchiectasis
Sethi GR, Batra.V,(2000Feb) conducted a study at Lok Nayak hospital New Delhi on bronchiectasis causes and management and according to these researchers, Bronchiectasis is a condition representing abnormal and permanent dilation and distortion of bronchi. Bronchiectasis is very common condition in developing countries as a sequel to pulmonary tuberculosis, whooping cough and severe measles with symptoms of chronic cough and
expectoration of foul smelling sputum. Treatment include management of airway secretions and control of airway hyper activity9.
S. Rajasekharan, R. Bhanusree, V. Vallingyagi V.Gopal and S. Nirmala devi (1997) conducted a study at Thanjavur Medical College and Govt. Raja Mirasudar Hopital Thanjavur India to diagnosis and assess the bronchiectasis patients . Fifty patients with clinical features suggestive of bronchiectasis were selected for this study. All these patients had productive cough for more than six months and audible persistent coarse crepitations on pulmonary auscultation and diagnosed as the commonest organism producing secondary infection was H. influenzas, S pneumoniae and Beta haemolytic streptococci. The study concluded that bronchiectasis may lead to respiratory failure and most of affected patients are being managed with episodal drug treatment and physiotherapy.10
Kolbe J, wells Au (1996dec.) department of respiratory medicine green land hospital ,Auckland Newland conducted a study regarding neglected cause of respiratory morbidity and mortality due to bronchiectasis. According to these researchers bronchiectasis is progressive condition characterized by irreversible destruction and dilation of airways generally associated with chronic bacterial infections. There is a high prevalence in indigenous population in the region and factors such as poverty, substandard housing, malnutrition, barriers to medical care and inadequate education in management are all likely to have a major impact on prevalence and out come of bronchiectasis. The study concluded that the morbidity and mortality due to bronchiectasis is to be prevented by proper management and therapeutic goals.11
Dogreu D,Nik-Ain A,KiperN,Gocmen, Ozceliku, YalcinE,Asian At (2005dec.) department of paediatrics, pulmonary medicine unit, Hacettepe university, Turkey conducted a study on Bronchiectasis and the researchers reported that bronchiectasis is a common disease in developing countries and the study was aimed to evaluate the risk factors and to emphasize early diagnosis and treatment. There were204 patients whose most common
presenting symptoms were cough ,sputum expectoration and dyspnoea. The cause could not be determined in 49% of patients. among the identified causes ,infection was present in most
patients. It is possible to prevent bronchiectasis in children with vaccination and improved nutrition in developing countries. After the study it was concluded that early diagnosis and treatment will increase the quality of life and survival of patients with bronchiectasis which has irreversible and progressive complications if untreated.12
KingP,Hold S, worths Freezer N, HolmesP,(2007march) department of respiratory and sleep medicine monash medical centre melbourne Australia conducted a study on bronchiectasis. According to these researchers bronchiectasis can be considered as a heterogeneous condition characterized by irreversible airway dilation with chronic bronchial infection or inflammation. It is a major cause of respiratory morbidity with clinical findings of chronic productive cough , rhinosinusitis, fatigue and bi-basal crackles. The common pathogens are non-typeable haemophilus influenzae and pseudomonas aeruginosa which is diagnosed by high resolution computed tomography scanning. After the study it was concluded that bronchiectasis should be treated with proper regimens which may lead to decline in respiratory function despite treatment.13
2.Literature on postural drainage
Mutalithas K, Watkin G,(2008june) institute for lung health department respiratory medicine leicester, UK,did a research regarding improvement in health status among bronchiectasis patients after physiotherapy by using a new method called broncho pulmonary hygiene physical therapy .The data was collected by using leicestar cough questionnaire regarding cough. The total number of patients were 53 and during pre test the major symptom was cough . after pre tests the patients was subjected to chest physiotherapy and postural drainage therapy. After this the same questionnaire was administered to the patients and it was found that cough and other symptoms decreased among 35 patients and moderately reduced among 15 patients. so it was concluded that postural drainage and chest physiotherapy can lead to improvement in cough and other symptoms among bronchiectasis patients .14