RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
4TH ‘T’ BLOCK, JAYANAGAR,
BANGALORE – 560041
(KARNATAKA)
PROPOSAL FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED BY :
MR. SATYAVEER YADAV
1 YEAR M.Sc. NURSING
VIVEKANANDA COLLEGE OF NURSING,
B.L. GOWDA LAYOUT, NEAR R.T.O OFFICE,
BASAPPA MULTI SPECIALTY HOSPITAL,
CHITRADURGA – 577501 (KARNATAKA)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MR. SATYAVEER YADAV1st YEAR, M.Sc. NURSING
STUDENT VIVEKANANDA COLLEGE OF NURSING CHITRADURGA
2. / NAME OF THE INSTITUTION / VIVEKANANDA COLLEGE OF
NURSING
3. / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING.
(MEDICAL SURGICAL NURSING)
4. / DATE OF ADMISSION TO COURSE /
10-06-2009
5. / TITLE OF THE STUDY / A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING PREVENTION OF RENAL CALCULI AMONG ADULT PATIENTS IN A SELECTED HOSPITALS AT CHITRADURGA DISTRICT, KARNATAKA.
6. BRIEF RESUME OF INTENDED WORK
Introduction
Bone can break, muscle can atrophy glands can leaf, even the brain can go to sleep, without immediate danger to survival.
But should the kidney fail neither, bone, muscle, gland nor brain could carry on.
Lewis
A good health is one of the happiest things for any person. Health is a dynamic common theme in most culture, in fact all community have their concepts of health, as part of their culture. In our day today life people suffer from diseases some times it subsides but some times it takes more serious form when treatment is not taken properly. If there is recurrence of disease it can be changed into chronic disease1.The disease may affect any system or organ of the body. Among all system of body the urinary system is the structure which is precisely maintain chemical environment of the body, perform various excretory regulatory and secretary function.1
Renal calculi more commonly known as kidney stones which affects excretory and secretary function of the urinary system. Stones are formed in the urinary tract when urinary concentration of substance such as calcium oxalate, calcium phosphate and uric acid increased. This is referred to as super saturation and is dependent on the amount of substance, ionic strength and ph of urine. The different sites of calculi formation in the urinary tract are medulla of kidney, ureter and bladder. Certain factors favour the formation of stone including infection, urinary stasis and period of immobility.2
The first evidence of urinary stone was found in an Egyptian mummy at E1 Amrah – Egypt in 4800 B.C. The Fernstrom described planned endoscopic surgery for the larger kidney stone in 1976.4
About 80% of kidney stone sufferers are men between the ages of 20 and 50 years old. Inherited factors account for 45% of all cases of kidney stones. A study suggested that the higher risk of renal calculi may be due to a higher rate of hypertension and certain dietary habits, particularly lower intake of magnesium and low intake of calcium supplements. Diet plays an important role in the development of kidney stones, especially in patients who are predisposed to the condition. A diet high in sodium, fats, meat, and sugar and low in fibre, vegetable protein, and unrefined carbohydrates increases the risk for renal calculi. Recurrent kidney stones may form in patients who are sensitive to the chemical bio products of animal protein and who consume large amounts of meat. Other risk factor includes are improper diet, hyperparathyroidism, which causes high blood and urinary calcium levels, family history of kidney stones, gout, which is caused by high uric acid levels in the blood, and gives rise to uric acid stones, excess alcohol consumption, geographical living area (southeastern U.S.)3
It is one of the most prevalent types of urinary disorder found in people all over the world. Renal calculi affect 1 in 20 people in USA.4
The overall probability of forming stones varies in different parts of the world. The risk of developing nephrolithiasis in normal adults appears to be lower in Asia (1-5%) than Europe (5-9%) and North America (12% in Canada, 13% in USA). The highest risk was reported in Saudi Arabia (20.1%). In USA approximately 1 million people are affected by renal calculi. Up to 4% of the population in the USA have urolithasis. More than 2, 00,000 Americans require hospitalization for treatment of stone each year. 5
6.1 NEED FOR THE STUDY
Health is viewed as dynamic, ever changing condition that enable person to function at an optimum potential at any given time. The ideal health status is one in which people are successful in achieving their full potential regardless of any disability. A significant amount of information has shown that people by virtue of what they do or fail to do, influence their on health.2
Renal stone or calculus or nephrolithiasis is one of the most common diseases of the urinary tract. It occurs more frequently in men than in women and in whites than in blacks. It is rare in children. Urinary calculus is a stone-like body composed of urinary salts bound together by a colloid matrix of organic materials. It consists of a nucleus around which concentric layers of urinary salts are deposited. Nephrolithiasis occurs in all parts of the world, with a lower lifetime risk of 2-5% in Asia, 8-15% in the West, and 20% in Saudi Arabia. 3
Urolithasis is the third most common urological diseases affecting both male and female. Individual with an incidence rate of 12% in industrialized countries. If not treated recurs in 35% and 50% of patients with calcium oxalate stone. 4
Urinary stone constitute one of the commonest diseases in our country. In India, approximately 5-7 million people suffer from stone disease and at least 7-10/1000 of Indian population needs hospitalization due to kidney stone. 4
In India stone belt occupies parts are Maharastra, Gujarat, Punjab, Harayana, Delhi and Rajasthan. In these regions, the disease is so prevalent, that most of the members of family will suffer from kidney stone some times in their lives. 4
A study conducted that kidney stone frequently affects people age group between 20-40 years; only 31.9% of patients had a positive family history of renal stone. Calcium oxalate stone was the most prevalent type (73.8%). uric acid stone was found in 16.0%. The food frequency questionnaire data showed that 59.7% of patient consumed less then 2 lts of water/ day. In contrast high consumption of rice was obtained in over 65% of stone patients. 4
A study conducted among the tribal population of India to find out the association between the Fluoride & urolithasis in humans. The study results showed that fluoride in vivo may behave mild promoter of urinary stone formation by the excretion of insoluble calcium fluoride, increasing the oxalate excretion and mildly increasing oxidative burden. 5
According to above fact & findings that adult, in age group of 18-35 years are more prone to get renal calculi. The adults do not know more about the prevention of renal stone. Based on his clinical experience, the investigator feels that the adults are lacking knowledge regarding prevention of renal calculi. So investigator would like to explore knowledge and give the teaching.
6.2 Review of related literature
1. Review of literature related to renal calculi.
2. Review of literature related to the knowledge regarding prevention of renal calculi among adult patients.
3. Review of literature related to effectiveness of self instructional module (SIM).
6.2.1 Review of literature related to renal calculi.
Reyes L, Almaguer M, Castro T, Valdivia J. conducted an epidemiological study in a general population to know the frequency, the potential risk factors, and morbidity, social and economical impact of the Urolithasis in Caribbean country. The prevalence rate was 4.64 % and the annual incidence was 0.1%. The study consists between 20 to 29 years in both the genders. The white (5.2%) and the male (6.36%) patients were the most effected. It was highly associated with diabetes mellitus, urinary tract infection and hypotension. Stone formation was related to the warmer season. Procedures for stone removal were needed in 33.8% of subjects. 40% of all patients were admitted to the hospital due to Urolithasis. Urolithasis in this population was the same as has been reported in other studies. It has shown high frequency, increasing incidence, thus same risk factors, high morbidity and high social and economical impact.7
Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Conducted a study to find out relation between dietary calcium intake and the risk of symptomatic kidney stones in a cohort of 45,619 men, 40 to 75 years of age, who had no history of kidney stones. Dietary calcium was measured by means of a semi quantitative food-frequency questionnaire in 1986. During four years of follow-up, 505 cases of kidney stones were documented. Study showed that dietary calcium intake was inversely associated with the risk of kidney stones. Study concluded a high dietary calcium intake decreases the risk of symptomatic kidney stones.9
Italian university conducted a study to find out the association between the drinking water and stone formation. The study result showed that drinking water containing high calcium content carries the risk of stone formation. The calcium content of waters used for hydration may very from very low to relatively high and is an important factor in prevention or additional risk of stone formation.4
A study conducted in Canada to find out the relationship of age, sex, & stone composition. The study result showed that phosphate stones were on average heavier and relatively more common in women, had an earlier peak frequency in women then oxalate stones.4
6.2.2 Review of literature related to the knowledge regarding prevention of renal calculi among adult patients.
Curhan GC, Willett WC, Rimm EB, Stampfer MJ. conducted a study to find out the association between body size (height, weight, and body mass index) and the risk of kidney stone formation. The study included two large cohorts: the Nurses' Health Study (NHS; n = 89,376 women) and the Health Professionals Follow-up Study (HPFS; n = 51,529 men). Information on body size, kidney stone formation, and other exposures of interest was obtained by mailed questionnaires. These results suggest that body size is associated with the risk of stone formation and that the magnitude of risk varies by gender. Additional studies are necessary to determine whether a reduction in body weight decreases the risk of stone formation, particularly in women.10
Asselman M, Verkoelen C F. reported a study that consumption of fructose is independently associated with an increased the risk of kidney stones. What could be the mechanisms underlying the relation between fructose intake and stone risk? And how should we incorporate this finding into the dietary advice that we give to our patients to prevent kidney stone formation? 13
Kacker R, Meeks JJ, Zhao L, Nadler RB. conducted a study to determine whether calcium phosphate stone composition affects the stone free rate of percutaneous nephrolithotomy in 111 patients between 2001 and 2006 and stone fragments were analyzed for calcium phosphate composition. Patients were categorized into groups based on calcium phosphate content. Patients were considered stone-free after percutaneous nephrolithotomy when fragments were 2 mm or less on no contrast computerized tomography. The result of 213 percutaneous nephrolithotomies was performed. An increased percent of calcium phosphate was related to a decreased percutaneous nephrolithotomy success rate (p = 0.005), independent of preoperative stone burden (p = 0.8). High calcium phosphate renal stone content leads to a decreased stone-free rate. Further study is required to determine the mechanism of stone resilience as well as the most appropriate treatment modality in patients with high calcium phosphate composition kidney stones.15
Gasińska A, Gajewska D. conducted a study to analyse nutritional habits of 22 stone formers with special regard to oxalate content as one of the main nutritional lithogenic factors associated with kidney stones. Daily dietary oxalate intake was 354 +/- 261 mg and 406 +/- 265 mg in men and women respectively. The main sources of oxalate in diets were regular tea and coffee (80-85%). Only 15-20% of oxalate was derived from other plant foods. Patients' daily intake of calcium was low and didn't exceed 520 mg. Vitamin C consumption was higher than Polish Dietary Reference Intake (DRI) and vitamin B6 lower than DRI. In the management of stone patients, to lower the risk of recurrence, appropriate diet (according to the type of stone) should be provided by dietitian.16
6.2.3 Review of literature related to effectiveness of self instructional module.
Karagülle O, Smorag U, Candir F, Gundermann G, Jonas U, Becker AJ, Gehrke A, Gutenbrunner C. Investigations in healthy persons have shown that drinking mineral water containing HCO (3) has a positive effect on urine supersaturated with calcium oxalate (SS (CaOx)). The present study evaluates a common setting whether these effects are also relevant in patients with multiepisodic urinary stone formation. A total of 34 patients with evident multiepisodic CaOx- urolithasis were included in the study. In a cross-over design and double-blinded the patients received 1.5 l of a mineral water with 2.673 mg HCO(3)/l (test water) or the same amount of water with a low mineral content (98 mg HCO(3)/l) (control water) daily for 3 days. He was observed the risk of calcium phosphate stone formation increased. It is evident that both water tested are able to lower significantly and to a relevant extent the risk of urinary stone formation in patients with multiepisodic CaOx- urolithasis. In addition, the bicarbonate water increases the inhibitory factors citrate and magnesium due to its content of HCO (3) and Mg. Thus, it can be recommended for metaphylaxis of calcium oxalate and uric acid urinary stones.17