RESEARCH PROPOSAL-MEDICAL

SURGICAL NURSING

PRESENTED BY :
K.Mangaleshwari
MSC (N) 2 nd year
Sri Aurobindo college of nursing
Karur.
INTRODUCTION:
Each breath is like a little rebirth, a renaissance that can only
be celebrated if we recognize that it’s happening.

-Cristen Rodgers

• Asthma is a serious global health problem with wide differences in prevalence and severity in countries
throughout the world. It is a chronic respiratory disease characterized by airflow obstruction, bronchial
hyper-responsiveness, and underlying airway inflammation. The interaction of these characteristics varies
among susceptible individuals leading to differences in disease progression and symptoms over time. The
burden of asthma is increasing causing severe socioeconomic strain.

• Many potential asthma triggers, such as pollen, house, dust mite, mold, small particulate matter, or respiratory
viruses, do not have a phenomenal appearance that is easy to perceive. Therefore, presence of these triggers is
often inferred from the occurrence of cues that are associated with these triggers, such as trees in summer, or
the indicative of upper respiratory infection.
 Asthma is a common chronic respiratory disease in the population with symptoms of cough,
wheezing, shortness of breath and chest tightness. If asthma control is not effective, long-term asthma will
cause various complications, impair health, and affect the patient’s quality of life such as chest deformity,
vanity of mind, respiratory infection, emphysema, pneumothorax, pneumomediastinum, collapsed lung and
respiratory failure.

One example of an evidence-based intervention is the use of care bundles. These are simple tools used
with the aim of reliably achieving delivery of clearly specified elements of care.
Care bundles are sets of evidence- based interventions, elements of which are known to optimise
clinical outcomes. A bundle is a structured way of improving the process of care and thereby improving patient
outcomes.

Respiratory care bundle respiratory care bundle comprises oral care, deep breathing exercises,
nebulization, positions, and incentive spirometry which will reduce the level of dyspnoea among patients with
bronchial asthma and it can be utilized as a non- pharmacological management in respiratory rehabilitation.
 Gargling and rinsing mouth with salt water provide a range of health benefits including maintenance of
the natural pH level, clears mucus and relieves nasal congestion, treats dry cough, prevents upper respiratory
tract infection, and cleanses mouth.

Breathing exercises aim to control the symptoms of asthma and can be performed as the Buteyko
breathing technique, deep diaphragmatic breathing or any other similar intervention that manipulates the
breathing pattern. The training of breathing usually focuses on tidal and minute volume and encourages
relaxation, exercise at home, the modification of breathing pattern, nasal breathing, holding of breath, lower rib
cage and abdominal breathing.

Nebulization is a process of administration of drugs through inhalation in the form of a mist into the lungs
to improve the breathing. Nebulization is commonly used for the treatment of cystic fibrosis, asthma, COPD
and other respiratory disease or disorder. Nebulisation improves the breathing pattern of the patient
 Body posture has long been identified as a very important factor having an impact on lung volumes. The
effective patient positioning may be associated with marked improvement in PaO2 and plays an important role
in the conservative management of pulmonary dysfunction by reducing the effect of shunt or dead space.

Moreover, relatively supine positions may be detrimental to asthmatics since such postures are known to
reduce pulmonary sufficiency even in healthy individuals. Alterations in body positions are also known to result
in hydrostatic pressure changes, which affects both the systemic and pulmonary circulation.

Incentive spirometers gently exercise the lungs and aid in keeping the lungs as healthy as possible. The
device helps retrain lungs how to take slow and deep breaths. Incentive spirometer helps to increase lung
capacity and improves patients‟ ability to breathe.
DUST MITE ALLERGEN EDUCATION AND AVOIDANCE MEASURES:

 Education:

Dust mites are microscopic in size. Found in woven materials such as mattresses, pillows, stuffed
animals, bedding, upholstered furniture and draperies. The highest level of allergen are typically found in
the mattress. Increased humidity above 50% increase growth.

 Avoidance:

Encase the pillow and mattress with a pore diameter no larger than 10 microns. Wash bedding weekly
in hot water and dry in a heated drier. Remove upholstered furniture, drapery, carpeting or rugs.

PET ALLERGEN EDUCATION AND AVOIDANCE MEASURE:

 Education:

Cat and dog allergen is found on the skin, hair and saliva. Cat allergen may take 4 months to
denature.
 Avoidance:

Thoroughly clean upholstered furniture, walls and carpet. Removal of furniture and carpet is ideal. Remove
pet from the bedroom and other rooms.

RODENT [COCKROACH AND MOUSE] EDUCATION AND AVOIDANCE MEASURES:

 Education:

Cockroach allergen is found in the saliva, fecal material, secretions, cast skins and debris. The highest levels
of allergen are typically found in the kitchen.

 Avoidance:

Store food in sealed containers. Avoid exposed pet food. Remove clutter. Seal holes or cracks in the home to
prevent re-infestation. Wash bedding, curtains and clothing.
POLLEN AND MOLD EDUCATION AND AVOIDANCE MEASURES:

 Education:

Trees typically pollinate from march through June. Grasses typically pollinate from may
through early June. Outdoor mold spores typically peak in June and decrease after the first frost. Mold
spores are found in soil, seeds, and vegetable matter such as grass or leaves. Indoor molds are prominent
in humid environments.

 Pollen avoidance:

Keep windows closed. Bath to remove allergens from hair and body.

 Mold avoidance:

Clean moist areas as these are prone to mold growth. Repairs leaks.
Foods to eat:

 If you have asthma then it will be imperative for you to stick to a healthy diet. You need to eat enough
fresh fruits, vegetables, whole grains, legumes, and pulses. Moreover, food rich in omega-3 fatty acids
such as salmon, tuna, sardines, and flaxseed can be beneficial for those with asthma. Have rice, bell
peppers, broccoli, beetroots, potato, carrots, methi leaves, coriander leaves, spring onions, onions, garlic,
ginger, oranges, barriers, grapes, pears, pomegranate, kiwis, and cherries.

Foods to avoid:
 Cut down on your consumption of fast, junk, oily, processed, and canned food as they can further
worsen one’s symptoms like coughing and inflammation. Even colas, sodas, cakes, pastries, candies,
sweets, juices, and other foods with artificial sweeteners, preservatives, and flavours should be avoided
as having them can worsen your condition and your lungs.
Follow up:

 Follow up is the act of making contact with a patient or caregiver at a later, specified date to check on
the patient’s progress since his or her last appointment. Appropriate follow up can help you to identify
misunderstandings and answer questions, or make further assessments and adjust treatments. In
addition, follow up helps to promote a good working relationship between you and your patients. For
example, you can follow up to: monitor health. Reinforce knowledge and action plans. Confirm
medicine regimens. Schedule appointments. Verify follow through on referrals. Share lab results.
NEED FOR THE STUDY:

According to global asthma report (2014), asthma affects approximately 334 million people
worldwide and responsible for 345,736 deaths annually (1 in 150 deaths worldwide) around 14% of
world’s children and 8.6% of young adults had experienced asthma symptoms.

Parvaiz A koul & Dharmesh patel (2015) reported that the burden of asthma is immense, with
more than 300 million individuals currently suffering from asthma worldwide, about a tenth of those
living in india. The prevalence of asthma has been estimated to range 2-12% in adults, being the
commonest chronic disorder. Among 85.105 men and 84,470 women from 12 urban and 11 rural sites in
india estimated the prevalence of asthma in india to be 2.05% among those aged more than 18 years,
with an estimated national burden of 18million asthmatics.
According to the global burden of disease (GBD) in 2016: the global burden of disease estimated
that there were 339.4 million people worldwide affected by asthma. Asthma across all ages, contributes
23.7 million disability adjusted life years (DALYs)
 Global burden of disease study 2017 to describe trends in mortality and disability adjusted
(DALYs) – a combined measure of quantity and quality of life – due to chronic respiratory diseases, by age
and sex, across the world during 1990-2017.

Between 1990 and 2017, the number of deaths due to chronic respiratory diseases increased by
18% from 3032 million in 1990 to 3.91 million on 2017.

The global burden of disease (GBD) collaboration estimated that in 2019, 461,000 people in the
world died from asthma – more than 1000 per day.

Subodh kumar (2023) reported that the total of 2864 patients reported that the out patient
department of which 1187 were diagnosed as cases of asthma. He showed a slight female preponderance
(51.77) among asthma patients. The highest number of cases were belonging to the age group between 18-
30 and 31-45 years of age, together constituting about 63% of patients.
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of respiratory care bundle on improvement of breathing pattern
and lung volume capacity among patients with bronchial asthma in government medical college and
hospital at karur.
 OBJECTIVES:

• Assess the pre intervention level of breathing pattern and lung volume capacity among patients with bronchial
asthma in experimental and control group.

• Assess the post intervention level of breathing pattern and lung volume capacity among patients with
bronchial asthma in experimental group interventional and control group.

• Compare the pre intervention and post intervention level of breathing pattern and lung volume capacity in
experimental and control group.

• To find the association between the pre intervention level of breathing pattern and lung volume capacity
among bronchial asthma patients with their demographic variables.
HYPOTHESIS:

• H1: there will be significant difference between difference between the pre intervention and post

intervention level of breathing pattern and lung volume capacity among patients with bronchial asthma in

experimental group.

• H2: there will be significant difference between post intervention level of breathing pattern and lung

volume capacity among patients with bronchial asthma in experimental and control group.

• H3: there will be significant association between the pre intervention level of breathing pattern and lung

volume capacity with selected demographic variables among patients with bronchial asthma in

experimental and control group.

ASSUMPTION:
 Respiratory care bundle may improve the breathing pattern and lung volume capacity among patients with
bronchial asthma.
OPERATIONAL DEFINITION:
 Evaluate:
o It refers outcome or change in level of breathing pattern after respiratory care bundle among asthma patients.

 Respiratory care bundle:

o Breathing exercise is the process of inhale deeply to a count of two, breathing in through your nose with your
mouth closed.

o Nebulization turns liquid medicine into a mist that can be easily inhaled.

o Posture is as the way in which we hold our bodies while standing, sitting, or lying down.

o Incentive spirometer measures the volume of the air inhaled into the lungs during inspiration.
 Bronchial asthma:
o Asthma is result of chronic inflammation of the conducting zone of the airways.

 Breathing pattern:
o It is the process of both taking and expelling of air into the lungs.

 Lung volume capacity:

DELIMITATION:
o Study limited to the bronchial asthma patients with mild and moderate symptoms among 60 members. The
breathlessness and cough is assessed with the help of mMRC (modified medical research council)
dyspnoea scale and cough severity score.
METHODOLOGY:
 RESEARCH APPROACH:

Evaluative approach.

 RESEARCH DESIGN:

Pre test post test control group design.

 STUDY SETTINGS:

The study will be conducted in government medical college and hospital at karur.

 SAMPLING TECHNIQUE:

Purposive sampling technique.

 SAMPLE SIZE:
30- experimental group

30- control group

 INCLUSION CRITERIA:

Patients who are agreed to participate in the study of both sexes; who have 20-60 years of age
suffering from bronchial asthma and admitted into selected hospital at karur.

Patients who are on regular treatment[medication, inhalers] for bronchial asthma.

 EXCLUSION CRITERIA:

Patients with mental illness.

Patients with acute health problems as cardio-pulmonary problem or any co-morbid conditions.

Severe form of bronchial asthma on admitted in ICU/ER.