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A Study to Assess the Respiratory Status of Patients who have undergone Cardio Thoracic and Vascular Surgery during Pretest

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

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Research Article - (2021) Volume 9, Issue 12

A Study to Assess the Respiratory Status of Patients who have undergone Cardio Thoracic and Vascular Surgery during Pretest

AR. Bharathi*

*Correspondence: AR. Bharathi, Department of Nursing, Bharath Institute of Higher Education and Research, Selaiyur, Chennai,Tamil Nadu, India, Email:

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Abstract

The Present study focuses on to evaluate the effectiveness of breathing exercises with the use of devices, and respiratory muscle training in preoperative period of cardiac surgery in reducing postoperative pulmonary complications. A Present study includes to assess the respiratory status of patients who have undergone cardio thoracic and vascular surgery during pretest .There is no significant distinction between the pre test and post test respiratory status of the patients who have under gone cardio thoracic and vascular surgery before and after the administration of respiratory exercise with incentive spirometer, deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation.

Keywords

Assess, Effectiveness, Pulmonary complications, Pretest, Cardio thoracic, Breathing exercises health professionals

Introduction

Cardiovascular disease is a major cause of disability and premature death throughout the world, and contributes substantially to the escalating costs of health care Cardiothoracic and vascular surgery is surgery on the heart and/or great vessels performed by cardiac surgeons. Worldwide cardio-vascular disease is estimated to be the leading causes of death & loss of disabilities– adjusted life style.Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. Historically, respiratory physiotherapy has been used in patients undergoing cardiac surgery in order to reduce the risk of pulmonary complications, such as retention of secretions, atelectasis and pneumonia [1], both in adults and in children [2]. An important moment in the history of medicine of the twentieth century was the performance of the open surgical technique, allowing constant technical advances, including relevant national contributions [3]. Following the path of conquest, surgical treatment remains the best therapeutic modality related to survival of individuals with coronary heart disease, as well as in individuals with valvular dysfunction. Despite numerous advances, the occurrence of complications after cardiac interventions is very common and is a major cause of preoperative morbidity and mortality [4]. Participation in the preparation of physiotherapists and rehabilitation of individuals who are undergoing surgical procedures are relevant, given the great arsenal of techniques available. It is described in the literature, in addition to the relative scarcity, that studies related to the approach of physiotherapy in the preoperative have different techniques [5]. The health professionals who care for the patient should know to evaluate the respiratory status of the patient, considering the effectiveness of deep breathing exercise with incentive spirometer and its outcome with adequate scientific support and evidence.Current economic situation in health care management is changing rapidly so that post operative hospital stay, patients care and recovery is been important factors and currently being reanalyzed. Post operative complications can be a major source of morbidity & mortality and may significantly increase the length of hospital stay & resource utilization. Cardiac surgery by its very nature alters pulmonary and cardiac mechanisms in the post-operative period. Pain can keep the patient away from participating in expected activities such as deep breathing exercise, and getting out of bed. Cardiac surgery can be associated with intense post-operative pain especially during the first POD & high incidence of chronic sternotomy pain has been reported Post operative chest wall pain can be a major factor that inhibits post-CABG recovery in phase 1 patients. It is believed that due to the procedure as well as due to the long term post operative recumbent positioning. It has been said that pain level which is experienced with an activity after surgery reduces the functional capacity & QOL. The main goal of the exercise component of the phase 1 cardiac rehabilitation is to contour the reconditioning effect of prolonged bed rest and prepare the patients for return to normal daily activities. Since the technique works, it is useful to find causes of its effectiveness. Most authors base their ideas on mechanical effects of pursed lip breathing assuming that lungs are influenced, during breath work, by the amplitude of the respiratory movements, stretching of alveoli, prevention of collapse and airway obstruction, reduction of dynamic hyperinflation of the lungs, and so forth. In reality, the change and improvement in lung tissue function is based on biochemical processes. Incentive spirometer is a breathing exercise designed to help to take long, deep breaths, such as yawn. The incentive spirometer shows how well one is taking deep breaths and expanding lungs. Because it makes breathe deeply, it improves the ability to clear mucus from the lungs. It may also increase the amount of oxygen that gets deep into the lungs. Taking long deep breaths may help reverse or decrease the chance of developing breathing (pulmonary) problems. It allows patients to forego cardiopulmonary support. Minimally Invasive Heart Surgery, a technique that reduces the size of the surgical incision, lessens blood loss, and shortens the length of the hospital stay. Thus it was found that the occurrence of many of the pulmonary complications related to surgery can be prevented through simple measures.

Cardiopulmonary exercise testing provides assessment of the integrative exercise responses involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function.. The chest therapy after surgery is directed towards maximal inspiration in an attempt to prevent overt atelectasis and allow for the early re-expansion of collapsed alveoli. Adoption of incentive spirometer as a global method of prophylaxis, however, raises concerns that high risk patients may be receiving inadequate treatment and that important resources are being wasted on low risk patients. The objective of this trial was to evaluate the prevention of respiratory complications by comparing a global policy of incentive spirometer with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometer plus physiotherapy for high risk patients. So they suggested deep breathing exercise along with incentive spirometer as the cheapest method for improving the respiratory status. As far as the researcher’s knowledge goes, no study has been conducted regarding the effectiveness of deep breathing exercise with incentive spirometer in these hospitals.. Endovascular Vein Harvesting, a minimally invasive way to obtain a healthy vein used for coronary artery bypass surgery, offering less pain and quicker recovery.. So the investigator felt that this study would have a greater chance of preventing post operative complications among patients undergone cardio thoracic and vascular surgeries.

Material and Method

Setting of the study

Selection of the area for study is one of the essential steps in the research process. The selection of the hospital for the present study was on the basis of availability of subjects, feasibility of conducting study and economy of time. The study was conducted in department of Medical-Surgical Nursing, Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Population

The target population of the present study was patients who have undergone for cardio thoracic and vascular surgery.

Sample

60 Sample were selected by stratified random sampling technique. The tool for data collection included Demographic variables & Assessment of respiratory status using Respiratory Rate, Modified Borg Dyspnea Scale, Peak Flow Meter and Pulseoxymeter. The sample of the study was patients who have undergone for Cardio Thoracic and Vascular Surgery at Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Sample size

Sample size was 60.

Sampling technique

Samples will be selected by stratified random sampling technique. Patients who have under gone cardio thoracic and vascular surgery at the cardio thoracic and vascular surgery wards of Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu will be selected. Patients who satisfy the inclusion criteria will be selected by lottery method.

Criteria for sample selection

Inclusion criteria

• Patients above 20 years and below 75 years of age who have under gone cardio thoracic and vascular surgery.

• All cardio thoracic and vascular surgery cases like Congenital Defect Correction, Commissurotomy, Coronary Artery Bypass Graft, Thoracotomy, Pneumonectomy, Lobectomy, Segmentectomy.

• Patients who were willing to participate in the study.

Exclusion criteria

• Patients who were critically ill and on ventilator.

• Patients with chronic neurological problems.

• Patients with immediate post operative problems.

• Patients with chronic pulmonary disease.

• Patients who have psychiatric illness and are mentally challenged.

Part A: Quantitative Research approach was used &the research design for this study was Quasi experimental one- group pre-test and post-test design. The study was conducted in Cardio Thoracic and Vascular surgery wards of Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

The target population of the present study was patients who have undergone for cardio thorace and vascular surgery. The samples of the study were patients who have undergone for Cardio Thoracic and Vascular Surgery at Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India.Methods Research design used for the study was quasi experimental one group pre-test post-test design.

Scratified random sampling technique was used. Data collection tool consisted of demographic variables and assessment of respiratory status using Respiratory Rate. Modified Bory Dyspnea Scule Peak Flow Meter and Pulsoxmeter. Data were collected by pre assessment questionnaire and observation method. The collected data was tabulated analyzed and interpreted by using descriptive and inferential statisties

Part B: Assessment of respiratory status using Respiratory Rate, Modified Borg Dyspnea Scale, Peak Flow Meter and Pulseoxymeter.

Respiratory Rate

• <12 breaths/minute-bradypnea

• 12-22 breaths/minute-normal

• 22 breaths/minute- tachypnea

Modified Borg Dyspnea Scale

• Grade 1- slight breathlessness

• Grade Il-moderate breathlessness

• Grade III-severe breathlessness

• Grade IV-maximum breathlessness

Peak Flow Meter

• 81-100%- free of symptoms

• 51-80%- caution

• <50%- danger

Pulse Oximeter

• 91-100% oxygen saturation- normal

• 81-90% oxygen saturation desaturated

• 80% oxygen saturation-hypoxic

During First cycle

After self introduction, the study procedure was explained to the subject and consent was taken from those who were willing to participate. Education regarding deep breathing exercise along with incentive spirometer was given to the subject and demographic data was collected during the pre-operative period.

During Second cycle

In this phase, the pre-test was done with the respiratory status assessment parameters like Respiratory Rate, Modified Borg Dyspnea scale, Peak Flow Meter and Pulseoxymeter on the 2nd post operative day.

During Third cycle

The investigator made the subject to practice deep breathing exercise along with incentive spirometer from 2nd post operative day. The deep breathing exercise was performed 3 times per day i.e. at 8.00 am, 12.00 pm and 4.00 pm. This was continued for 5 days.

During Fourth cycle

Post test was taken in this phase. After finishing the intervention for 5 days i.e. on the 7th post operative day, the investigator had assessed the respiratory status of the subjects with the respiratory assessment parameters like Respiratory Rate, Modified Borg Dyspnea Scale, Peak Flow Meter and Pulseoxymeter.

Results

Association between effectiveness of deep breathing exercise with incentive spirometer on the respiratory status of patients who have under gone cardio thoracic and vascular surgery and demographic variables.

SI No. Demographic variable Respiratory status X2 (d. f.) P value
1 Age in years Adequate Inadequate 0.69(2) 0.708NS
N % N %
A 20-39 5 17.24 0 0
B 40-59 16 55.17 1 100
C 60 and above 7 24.14 0 0

Table 1: shows the association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with age.

The data reveals that 16 (55.17%) subjects who got adequate respiratory status were in the age group of 40-59 years and one (100%) of the subjects who only had inadequate respiratory status was also in the same group. About 7 (24.14%) subjects who were above the age of 60 years had adequate respiratory status. The obtained Chi-Square value of 0.690 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with age. It can be inferred that irrespective of age of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of the patients who have undergone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
2 Sex Adequate Inadequate 1.182(1) 0.467NS
N % N %
A Male 17 58.6 0 0
B Female 13 44.8 1 100

Table 2: shows the association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with sex.

The data reveals that 17 (58.62%) subjects who got adequate respiratory status were males. The remaining subjects were females and among them 13 (44.83%) of them were having adequate respiratory status and only one of them got inadequate respiratory status. The obtained Chi-Square value of 1.182 was not significant at p<0.05.

SI No. Demographic variable Respiratory status X2 (d. f.) P value
3 Residential status Adequate Inadequate 0.905(2) 0.636NS
N % N %
A Rural 13 44.82 1 100
B Urban 1 3.45 0 0
C Suburban 15 51.72 0 0

Table 3: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with residential area.

The data reveals that 16 of the subjects were from rural area and 13 (44.82%) of them were having adequate respiratory status and only one (100%) of them was having inadequate. Only one (3.45%) of the subjects was from urban area and the other 15 (51.72 %) were from suburban area and all of them were having adequate respiratory status. The obtained Chi-Square value of 0.905 was not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with residential area. It can be inferred that irrespective of residential area of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) p value
4 Educational status Adequate Inadequate 2.069 (3) 0.558 NS
N % N %
a Illiterate 1 3.45 0 0
b Primary 15 51.7 0 0
c Secondary 6 20.7 0 0
d Graduate 9 31 1 100

Table 4: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with educational status.

The data reveals that 15 (51.72%) subjects who were having primary education and 6 (20.69%) subjects who were having secondary education were having only adequate respiratory status. About 10 subjects were graduate. Among them 9 (31.03%) of them were having adequate respiratory status and rest of them with inadequate. Only one (100%) subject was illiterate and was having adequate respiratory status. The obtained Chi-Square value of 2.069 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with educational status. It can be inferred that irrespective of educational status of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No Demographic variable Respiratory status X2 (d. f.) p value
5 Occupational status Adequate Inadequate 6.724 (4) 0.151 NS
N % N %
a Unemployed 9 31 0 0
b Self employed 11 37.9 0 0
c Business 6 20.7 0 0
d Retired 3 10.3 1 100
e Government job 1 3.45 0 0

Table 5: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with occupational status.

The data reveals that 11 (37.93%) subjects were self employed and 9 (31.03%) of them were unemployed, were having adequate respiratory status. 6 (20.69%) of them were doing business and one of them was a government employee and had adequate respiratory status. 4 of them were retired and out of that only one subject was having inadequate respiratory status. The obtained Chi-Square value of 2.069 was not significant at p<0.05. Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with occupational status. It can be inferred that irrespective of occupational status, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
6 Type of work Adequate Inadequate 0.791 (2) 0.673 NS
N % N %
A Sedentary 16 55.17 1 100
B Moderate 10 34.48 0 0
C Heavy 2 6.89 0 0

Table 6: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with type of work.

The data reveals that about 17 of the subjects were having sedentary type of work. Among them 16 (55.17%) were having adequate respiratory status and rest of them with inadequate. 10 (34.48%) of them were doing moderate type of work and were having adequate respiratory status. Only two (6.89%) were doing heavy work and had adequate respiratory status. The obtained Chi-Square value of 0.791 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with type of work. It can be inferred that irrespective of type of work of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
7 Family income in rupees Adequate Inadequate 0.517 (3) 0.915 NS
N % N %
A <2000 3 10.3 0 0
B 2001-5000 15 51.7 1 100
C 5001-8000 6 20.7 0 0
D >8001 1 3.45 0 0

Table 7: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with family income.

The data reveals that the highest number were having a family income between 2001-5000 and only one (3.45%) of them had inadequate respiratory status and rest of them had adequate respiratory status. Three (10.34%) of them who had income <2000 and six of them with income in between 5001-8000 were having adequate respiratory status. The obtained Chi-Square value of 0.517 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with family income. It can be inferred that irrespective of family income of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No Demographic variable Respiratory status X2 (d. f.) P value
8 Unhealthy habits Adequate Inadequate 0.905 (3) 0.824 NS
N % N %
A Smoking 2 6.89 0 0
B Alcoholism 1 3.45 0 0
c Drug abuse 0 0 0 0
d Mixed 11 37.9 0 0
e None 19 65.5 1 100

Table 8: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with unhealthy habits.

The data reveals that most of the patients (37.93%) who had mixed bad habits were having adequate respiratory status. 16 of them were not having any bad habits. Among them one of them was having inadequate respiratory status and other 19 (65.52%) were having adequate. Two (6.89%) of them having smoking and one of them having only alcoholism were having adequate respiratory status. The obtained Chi-Square value of 0.905 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with bad habits. It can be inferred that irrespective of bad habits of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
9 Source of health information regarding CTVS and its complication Adequate Inadequate 1.034 (3) 0.793 NS
N % N %
A Family members 4 13.8 0 0
B Peer group 1 3.45 0 0
C Health worker 10 34.5 0 0
D Mass media/news paper 24 82.8 1 100

Table 9: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with source of health information regarding CTVS and its complication.

The data reveals that most of the subjects were from mass media and news paper. Out of them 24 (82.76%) were having adequate respiratory status and one (3.45%) of them got inadequate. Other all subjects had adequate respiratory status. The obtained Chi-Square value of 1.034 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with source of information regarding CTVS and its complication. It can be inferred that irrespective of occupational status of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
10 Previous history of cardio thoracic vascular surgery Adequate Inadequate 0.207 (1) 0.833 NS
N % N %
A Yes 5 17.2 0 0
B No 14 48.3 1 100

Table 10: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with previous history of cardio thoracic and vascular surgery.

The data reveals that 25 of the subjects who had no history of cardio thoracic vascular surgery. Among them only one (100%) was having inadequate respiratory status. The obtained Chi-Square value of 0.207 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with previous history of cardio thoracic vascular surgery. It can be inferred that irrespective of previous history of cardio thoracic vascular surgery patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
11 Presence of co-morbid illness Adequate Inadequate 5.172 (4) 0.27 NS
N % N %
A Diabetes mellitus 4 13.8 1 100
B Hypertension 7 24.1 0 0
C Both diabetes mellitus andhypertension 13 44.8 0 0
D Hyperlipidemia 1 3.45 0 0
E Respiratory diseases 6 20.7 0 0

Table 11: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with presence of co-morbid illness.

The data reveals that the only patient who was having inadequate respiratory status was having diabetes mellitus. Rest of all the subjects were having adequate respiratory status. The obtained Chi-Square value of 5.172 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with co-morbid illness. It can be inferred that irrespective of co-morbid illness of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
12 Specific dietary pattern Adequate Inadequate 2.845(3) 0.416 NS
N % N %
A Fat rich diet 7 24.1 0 0
B Protein rich diet 2 6.89 0 0
C Carbohydrate rich diet 7 24.1 1 100
D Salt rich diet 11 37.9 0 0

Table 12: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with specific dietary pattern.

The data reveals that out of the 30 subjects one who had taken salt rich diet was found with inadequate respiratory status. All the other patients who were taking fat rich diet, protein rich diet and carbohydrate rich diet were having adequate respiratory status. The obtained Chi-Square value of 2.845 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with specific dietary pattern. It can be inferred that irrespective of specific dietary pattern of patients, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
13 Specific alternative therapy for respiratory diseases Adequate Inadequate 0.376(2) 0.829 NS
N % N %
a Ayurveda 4 14 0 0
b Homeopathy 4 14 0 0
c Naturopathy 0 0 0 0
d Siddha 0 0 0 0
e Unani 0 0 0 0
f None 22 76 1 100

Table 13: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with specific alternative therapy for respiratory disease.

Among 22 patients who were not taking any alternative therapy for respiratory diseases only one was having inadequate respiratory status. Rests of all the subjects were having adequate respiratory status. The obtained Chi-Square value of 0.376 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with specific alternative therapy for respiratory diseases. It can be inferred that irrespective of specific alternative therapy for respiratory diseases, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

SI No. Demographic variable Respiratory status X2 (d. f.) P Value
14 Specific respiratory assistance device Adequate Inadequate 0.315 (1) 0.767 NS
N % N %
a Metered dose inhalers 7 24 0 0
b Nebulizers 21 72 1 100
c Rota caps 0 0 0 0
d Nasal sprays 0 0 0 0

Table 14: The association of effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with specific respiratory assistance device.

Among 23 patients who were taking nebulizer one was having inadequate respiratory status. All the other subjects were having adequate respiratory status. The obtained Chi-Square value of 0.315 is not significant at p<0.05.

Hence there is no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with Specific respiratory assistance device. It can be inferred that irrespective of Specific respiratory assistance device, deep breathing exercise with incentive spirometer is effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery. So the null hypothesis H02 is accepted.

Discussion

The Score Interpretation of Part B is the assessment of respiratory status with the help of Respiratory Rate, Modified Borg Dyspnea Scale, Peak Flow Meter and Pulseoxymeter. The criteria for respiratory assessment are adequate and inadequate.

Parameter Criteria
I Respiratory Rate Adequate
b) 12-22 breaths/minute- normal
II Modified Borg Dyspnea Scale
a) Grade I- slight breathlessness
III Peak Flow Meter
a) 81-100%- free of symptoms
IV Pulseoxymeter
a) 91-100% oxygen saturation normal
I Respiratory Rate Inadequate
a) <12 breaths/minute- bradypnea
c) >22 breaths/minute- tachypnea
II Modified Borg Dyspnea Scale
b) Grade II- moderate breathlessness
c) Grade III- severe breathlessness
d) Grade IV-maximum breathlessness
III Peak Flow Meter
b) 51-80%- caution
c) <50%- danger
IV Pulseoxymeter
b) 81-90% oxygen saturation - desaturated
c) 70-80% oxygen saturation - hypoxic

Table 15: Representation of criteria of respiratory assessment from Respiratory Rate, Modified Borg Dyspnea Scale, Peak Flow Meter and Pulseoxymeter.

CONTENT VALIDITY OF THE TOOL

The content validity of the tool was evaluated by three experts. Two of them were experts in Medical-Surgical Nursing and other one is specialized in cardio thoracic and vascular surgery.

Validity and Reliability

Polit et al (2001) describe reliability as “the consistency with which an instrument measures the attribute”. An instrument is said to be reliable if its measures accurately reflect the true score of the attribute under investigation. Reliability coefficients higher than 0.70 are often considered satisfactory, but coefficients greater than 0.80 are far preferable. The pilot study data were analyzed using reliability test calculated from the pre and post test scores. The calculated reliability was 0.82

Pilot Study

Polit and Nancy denote that there should be a small scale version or trial run done in preparation for major study.

The purpose of the pilot study was:

• To refine the instruments

• To determine the method of data collection

The pilot study was conducted for 10 days from 4/08/2011 to 14/08/2011. Eight samples that fulfilled their inclusion criteria were selected for pilot study using simple random sampling technique. Pre-test was done using the respiratory status assessment tools like Respiratory Rate, Modified Borg Dyspnea Scale, Peak Flow Meter and Pulseoxymeter, for patients who have undergone cardio thoracic and vascular surgery on the 2nd post operative day. The intervention was given from the same day. The investigator made the subjects to perform deep breathing exercise three times per day along with incentive spirometer. Post test was taken after 5 days, i.e. on the 7th post operative day. The result of the pilot study was analyzed and gave the intervention that the tool was reliable and feasible. The data were analyzed to find the applicability of the statistical methods. The data were analyzed using reliability test calculated from the pre and post test scores. The calculated reliability was 0.82. The pilot study result shows that deep breathing exercise along with incentive spirometer was effective in the improvement of respiratory status of the patients who have under gone cardio thoracic and vascular surgery and found that the study was reliable and feasible. So, no changes were made in the tool.

Year Number of cardio thoracic vascular surgeries conducted Number of post operative respiratory complictions
2007 224 72
2008 203 51
2009 314 64
2010 298 53

Table 16: Statistics of post operative respiratory complications in cardio Thoracic and Vascular Surgery at Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai.

Year Number of cardio thoracic vascular surgeries conducted Number of post operative complictions
2007 124 62
2008 214 59
2009 203 71
2010 169 67

Table 17: Statistics of post operative respiratory complications in cardio Thoracic and Vascular Surgery at Sree Balaji Medical College & Hospital Affiliated to Bharath Institute of Higher Education and Research, Chennai.

These statistics show that even though the surgeries are successful, about 30-40 % of they end up in post operative complications. The most prominent complications were related to respiratory dysfunctioning.

Nurses are the ones who spend more time with the patients in the post operative unit. So they can take every action in the prevention of all the pulmonary complications. One of such intervention to prevent pulmonary complication and to improve lung capacity is deep breathing exercise. Simple breathing exercise can produce tremendous changes in the patient’s respiratory status.

Postoperative complications are the most frequent and significant contributor to mortality, morbidity and the increased costs associated with hospitalization. Interestingly, despite the prevalence of these complications in cardiac surgical patients, recognition, diagnosis and management of this problem vary widely. The course of events from pulmonary dysfunction associated with surgery to discharge from the hospital in cardiac patients is largely unexplored. With regard to the effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery, the result shows that deep breathing exercise with incentive spirometerwas highly effective among patients who have undergone cardio thoracic and vasculai surgery. Regarding the association between the effectiveness of deep breathing exercise with incentive spirometer on the respiratory status of patients who have undergone cardio thoracic and vascular surgery and demographic variables, the result revealed that there was no significant association. Hence H02 was rejected. Hence there was no significant association between effectiveness of deep breathing exercise with incentive spirometer on respiratory status of patients who have undergone cardio thoracic and vascular surgery with sex. It can be inferred that irrespective of sex of patients, deep breathing exercise with incentive spirometer was effective in improving the respiratory status of patient who have under gone cardio thoracic and vascular surgery.

Conclusion

The respiratory complications are the major post-operative complications which reduce the projected outcome of most of the cardio thoracic and vascular surgeries. This study reveals that deep breathing exercise along with incentive spirometer and is trying to find out its effectiveness on respiratory status and it can improve the respiratory status of the patients who have undergone cardio thoracic vascular surgery to a great extent. Many of the respiratory complications can be avoided with proper respiratory management. With little effort it can be implemented on all the post operative patients for better respiratory status and for the prevention of respiratory complications. Several studies have demonstrated the effectiveness of breathing exercises with the use of devices considering the individuality of each patient to perform breathing exercises, as noted, different techniques have similar results.. Many studies revealed that deep breathing exercise is very effective in prevention of respiratory complications after surgery. If the study findings projects to be positive, it can be given to all the patients who have undergone cardio thoracic and vascular surgery. It will be highly beneficial because it is cost effective, can be easily done and has no complication. The Nurses and Research fellows can do similar sort of studies regarding breathing exercises that will be beneficial for the entire community.

Acknowledgements

The encouragement and support from Bharath Institute of Higher Education and Research, Chennai is gratefully acknowledged. For provided the laboratory facilities to carry out the research work.

References

Author Info

AR. Bharathi*

Department of Nursing, Bharath Institute of Higher Education and Research, Selaiyur, Chennai,Tamil Nadu, India
 

Citation: AR. Bharathi, A Study to Assess the Respiratory Status of Patients who have undergone Cardio Thoracic and Vascular Surgery during Pretest, J Res Med Dent Sci, 9(11): 196-206

Received: 01-Dec-2021 Accepted: 15-Dec-2021 Published: 22-Dec-2021

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