الفهرس 
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Abstract
Patients admitted to Medical Intensive Care Units were susceptible to hypoxemia associated with hepatic diseases and ascites. Hypoxemia was defined as a partial pressure of oxygen in the arterial blood (PaO2) of less than 80 mm Hg, which was equivalent to a saturation of 95% . Hypoxemia should be detected at early stage to prevent serious consequences. Untreated hypoxemia may lead to other complications in the body such as the body could not optimally function, brain damage and brain death, heart problems, lung complications and kidney problems (Scaglioneet al.,2015; Lenz et al.,2015). Aim of study: - This study aimed to evaluate the effect of implementing nursing measures about hypoxemia for critically ill patients suffering from ascites at medical intensive care unit. Research hypothesis: Study group who were received nursing measures to decrease hypoxemia was exhibited early detection of hypoxemia and it complications, decreasing severity of hypoxemia, dyspnea and chest pain compared to control group who did not received. Research design: A quasi- experimental research design was utilized. Research settings: This study was conducted at Medical Intensive Care Unit at Tanta Main University Hospital affiliated to Ministry of Higher Education and Scientific Research. This unit contains three rooms and each room had 6 beds. Subjects and method : A purposive sample of 80 patients divided into two groups 40 patients in each group from the above previously mentioned setting was selected. The subjects were divided into two groups: group I (Control group): Consisted of (40) patients had been received routine ICU care by critical care nurses. group II (Study group): Consisted of (40) patients had been received nursing measures of care as designed and implemented by the researcher. Patients were selected according to the following criteria: Inclusion Criteria. - Adult patients aged 21 to 60 years, of both sex. - Oxygen saturation <95% - Newly admitted patients to ICU - Conscious, able to communicate and participate - Patients with hepatic diseases - Moderate and severe ascites which determined by ascites symptom inventory-7scale (ASI-7) Tools of data collection: Data were collected using the following tools: Tool (I): Critically Ill Hepatic Patients Assessment Tool: It was developed by the researcher after reviewing of relevant literature to collect data pertinent to the current study. It consisted of three parts . Part (a): Patients’ Bio-Sociodemographic characteristics: This part was used to cover patient’s age, gender, diagnosis, weight, past and present medical history, medication history and measuring abdominal circumference. Part (b): Physiological Parameters Assessment: It was used to assess patient’s vital signs: (heart rate, body temperature, respiration and blood pressure). Part (c): Respiratory Assessment : It was used to assess breathing pattern (rate, depth, rhythm and abnormalities), skin color for development of cyanosis and assess for use of accessory muscle, site, character ,radiation of chest pain and oxygen saturation. Tool (II): Hypoxemia Indicators Assessment Tool: It was used to assess the presence of hypoxemia. It consisted of two parts: Part (a) : Numerical Rating Scale for Chest Pain Assessment: This part was developed by Akyrou D et al (1995) and adopted by Nugent S et al (2021) to measure severity of chest pain. The amount of pain that a patient felt ranges across a continuum from none to an extreme amount of pain. This scale was usually a horizontal line, 10 cm in length, the patient marked on the line the point that they felt represents their perception of their current state. The score was determined by measuring in centimeters to the point that the patient marked. Part (b): Numerical Rating Scale for Dyspnea Assessment: This part was developed by Gift A et al (1998) and adopted by stevens J et al (2019) to measure severity of dyspnea. It was a categorical scale with a score from 0 to 10, where (0) corresponds to the sensation of normal breathing (absence of dyspnea) and 10 correspond to the subject’s maximum possible sensation of dyspnea. Tool III: The Ascites Symptom Inventory-7 (ASI-7) Scale Assessment : This tool was developed by Neijenhuis M et al (2018) and adopted by Kawaratani H et al (2021). The ASI-7 was used to assess the severity of ascites. It was consisted of seven items on a 5-point Likert scale: 0, does not apply; 1, slightly applies; 2, somewhat applies; 3, strongly applies; and 4, very strongly applies. The seven items were arranged in a sequence from mild to severe symptoms, facilitating clinical interpretation. The cumulative score was calculated by summing up the scores of each of the 7 items (0-4 points), which can range from 0 to 28 points. The scale of the ASI-7 scoring system showed asymmetric distribution within a range of 0- 28 points. Results:- The main findings of this study revealed that: The study revealed that, near two third (60.00%) of both control and study group aged from (50-60) years and more than half of patients in control and study group were males. Regarding body mass index, it was found that more than one third (40.00% & 42.5% ) of patients in both control & study group were over weight. In relation to past medical history, it was noticed that, more than one third (35.00% and 37.50%) of patients in control and study group had diabetes mellitus Also, more than two third (70.00% ) of patients in control group and the majority (75.00%) of patients in study group had diuretics. Regarding vital signs, The present study showed that, there was a statistically significant difference between patients in the study group regarding body temperature. Concerning depth of respiration and use accessory muscle, the study reported that there was a statistically significant difference between patients in the control and study groups specially in 2nd week . Concerning rhythm of respiration, the study reported that there was a statistically significant difference between patients in the control and study groups at the end of 1st week & at the end of 2nd week. Regarding chest pain and oxygen saturation, the study revealed that, there was a statistically significant difference between patients in the study and control group throughout periods of study specially in 2nd week. Concerning numerical rating scale (NRS) for chest pain, The present study showed that, there was a statistically significant difference between patients in the study and control group throughout periods of study specially at 1st week &2nd week. Regarding numerical rating scale (NRS) for dyspnea and ascites, the study revealed that, there was a statistically significant difference between patients in the study and control group throughout periods of study specially in 2nd week. The present study showed that, the highest mean scores of chest pain ,dyspnea and ascites were reported among age group (40-<50) years old through out period of the study (on admission, at the end of 1st week & at the end of 2nd week) . Regarding gender, the highest mean scores of chest pain , dyspnea and ascites were reported among male patients through out period of the study (on admission, at the end of 1st week & at the end of 2nd week). Concerning body mass index (BMI), the highest mean scores of chest pain, dyspnea and ascites were reported among obese patients through out period of the study (on admission, at the end of 1st week & at the end of 2nd week). Concerning correlation between, the study reported that there was a positive and highly significant correlation was observed between numerical rating scale for chest pain, dyspnea and ascites symptom inventory scale on admission and in 2nd week in control group. Also, there was a positive and highly significant correlation was observed between numerical rating scale for chest pain, dyspnea and ascites symptom inventory scale on admission and in 2nd week in study group. Conclusion: Based on findings of the study, it can be concluded that: The present study showed that, there was an improvement in respiratory rate and heart rate in study group than control group in 2nd week. There was a statistically significant difference between patients in the study group regarding body temperature. Also, there was a statistically significant difference between patients in the study and control group regarding respiratory assessment (depth, rhythm of respiration and use accessory muscle) and characters of chest pain on admission, post a week and post 2 weeks. There was a statistically significant difference between patients in the study and control group regarding oxygen saturation, dyspnea and chest pain assessment. Additionally, there was positive correlation between numerical rating scale for chest pain , dyspnea and ascites symptom inventory scale on admission and in 2nd week. Finally, concluded that, the nursing measures had positive effect on decreasing hypoxemia by improving oxygen saturation, physiological parameters and reducing severity of dyspnea and chest pain. The important recommendations inferred from the study results were: For nurses - Studying hypoxemia resulting from hepatic ascites more broadly in the nursing specialty. For patients - Scheduling appropriate time and duration between performing nursing care activities for patient to avoid hypoxemia. - Continuous monitoring for vital signs and oxygen saturation with cardiac monitor and pulse oximeter. - Assess for early signs of hypoxemia. For further research - Replication of the same study on larger probability sample at different geographical locations for results generalizability. - Future studies should target diverse populations in order to test whether similar factors are similarly important for occurrence of hypoxemia. Limitation of the study:- - Shortage number of cases - Death of cases after working with them.