SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECTFOR

DISSERTATION

Ms. MAMTA SINGH PARIHARFIRST YEAR M.SC (NURSING)

MEDICAL SURGICAL NURSINGYEAR 2012-2014

INDIAN ACADEMYCOLLEGE OF NURSING,HENNUR CROSS,

BANGALORE-560043

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

Ms. MAMTA SINGH PARIHAR1ST YEAR M.Sc. (NURSING)INDIAN ACADEMY COLLEGE OF NURSINGHENNUR CROSSBANGALORE

2. NAME OF THE INSTITUTION INDIAN ACADEMY COLLEGE OF NURSINGHENNUR CROSSBANGALORE - 560043

3. COURSE OF THE STUDY AND SUBJECT

1ST YEAR M.Sc. (NURSING), MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION TO THE COURSE

11/06/2012

5. TITLE OF THE STUDY“EFFECTIVENESS OF STP AND PRACTICE ON POSTURAL DRAINAGE ON EXPECTORATION OF MUCUS FROM AIRWAY AMONG PATIENTS WITH ACUTE PNEUMONIA IN SELECTED HOSPITALS AT BANGALORE.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Life is not merely being alive but being well.

In patient with respiratory system infections due to any disorders, there is often a buildup

of mucous inside the lungs, which in healthy people is normally removed by systemic responses

and reactions. In the diseased lung, however, this clearance mechanism will be ineffective most

of the life time. Cough and expectoration of mucous are the best known symptoms in patients

with pulmonary disease. The ‘Gold Standard Method’ of airway clearance can be attained

through postural drainage with gravity assisted drainage to manage such cases. The

consequences of not properly removing the mucous are increased lung infection, sufferings and

consequent scarring of the lung tissue. If unchecked, the latter leads ultimately to failure of the

lungs and to the patient’s death.1

The pneumonia are the infectious diseases affecting the Lower Respiratory tract

(LRT)which includes trachea, bronchi, bronchioles, alveolar ducts and alveolar sacs. Most of the

acute and chronic diseases affecting these parts of the lungs induce lots of mucus to be secreted,

which gets impacted within the lungs and unable to be expectorated, will lead to structural and

physiological damage of the lungs. Among the pneumonia’s, the most common and important

superlative diseases are tuberculosis, bronchiectasis, chronic bronchitis, lung abscess, and cystic

fibrosis and others.1

People with infectious pneumonia often have a productive cough, fever accompanied

by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths,

confusion, and an increased respiratory rate. In the elderly, confusion may be the most prominent

symptom. The typical symptoms in children under five are fever, cough, and fast or difficult

breathing. Fever, however, is not very specific, as it occurs in many other common illnesses, and

may be absent in those with severe disease or malnutrition. Additionally, a cough is frequently

absent in children less than 2 months old. More severe symptoms may include: central cyanosis,

decreased thirst, convulsions, persistent vomiting, or a decreased level of consciousness.2

Some causes of pneumonia are associated with classic, but non-specific, clinical

characteristics. Pneumonia caused by Legionella may occur with abdominal pain, diarrhea, or

confusion, while pneumonia caused by Streptococcus pneumonia is associated with rusty colored

sputum, and pneumonia caused by Klebsiella may have bloody sputum often described as

"currant jelly."3

Typically, oral antibiotics, rest, simple analgesics, and fluids are sufficient for complete

resolution. However, those with other medical conditions, the elderly, or those with significant

trouble breathing may require more advanced care. If the symptoms worsen, the pneumonia does

not improve with home treatment, or complications occur, hospitalization may be

required. Worldwide, approximately 7–13% of cases in children result in hospitalization while in

the developed world between 22–42% of adults with community acquired pneumonia is

admitted. The CURB-65 score is useful for determining the need for admission in adults. If the

score is 0 or 1 people can typically be managed at home, if it is 2 a short hospital stay or close

follow up is needed, if it is 3–5 hospitalization is recommended. In children those

with respiratory distress or oxygen saturation's of less than 90% should be hospitalized. The

utility of chest postural drainage in pneumonia has not yet been determined.  Over the

counter cough medicine has not been found to be effective.4

Because pneumonia affects the lungs, people with pneumonia often have difficulty

breathing, sometimes to the point where mechanical assistance is required. Non-invasive

breathing assistance may be helpful, such as with a bi-level positive airway pressure machine. In

other cases, placement of an endotracheal (breathing tube) may be necessary, and

a ventilator may be used to help the person breathe.5

Pneumonia can also cause respiratory failure by triggering acute respiratory distress

syndrome (ARDS), which results from a combination of infection and inflammatory response.

The lungs quickly fill with fluid and become very stiff. This stiffness, combined with severe

difficulties extracting oxygen due to the alveolar fluid, creates a need for mechanical ventilation.6

Pneumonia places a considerable strain on the health budget and are generally more

serious than upper respiratory infections. Since 1993 there has been a slight reduction in the total

number of deaths from Pneumonia. However in 2002 they were still the leading cause of deaths

among all infectious diseases, and they accounted for 3.9 million deaths worldwide and 6.9% of

all deaths that year.7

As, in case of bronchiectasis, chronic bronchitis, pulmonary tuberculosis, the condition

and changes are irreversible, the treatment whatever we give is symptomatic and temporary and

if at all any patients needs permanent relief he has to sacrifice a part of his lung, which is

damaged, by surgical intervention. This reduces lung volumes, capacity, and reduces the oxygen

saturation of blood and increases the complications like hemoptysis, emphysema and others. This

not only disturbs the patient’s life style but also it reduces the productivity of the patient in terms

of employment and income generation.5

Instead of that, if a patient is subjected to postural drainage to drain the mucus / sputum

out of lungs / bronchial tree, it reduces the frequent attacks of infections, decreases the breathing

difficulty, increases the air flow, improves the lung volumes, reduces the cost of drug therapy

and even it can postpone the need for surgical intervention.4

Various studies on postural drainage have shown the above fact that it clears the lungs, so

that good air entry will occur, reaching the alveolar level where the oxygen exchange occurs. In

most of the studies, postural drainage is combined with various other methods of chest postural

drainage. In some other studies, it is combined with other modalities of treatment like heat

therapy, positive expiratory pressure therapy, and there are many other studies where postural

drainage compared with other modalities of therapies to clear the airways.4

There are studies to reveal that if postural drainage is practiced regularly then it helps in

clearing the airway in term of amount of expectoration of sputum in cases of pneumonia,

bronchiectasis, chronic bronchitis, lung abscess, pulmonary tuberculosis patients, who are having

mild to moderate symptoms.

6.1 NEED FOR THE STUDY

“Great ability develops and reveals itself increasingly with every new assignment.”

Postural drainage is as mentioned before, a collaborative approach which is intended to

improve the physiologic status of a person who is suffering with any pulmonary complications.

Postural drainage is a combination of postural drainage, medical and nursing care. As if now,

there is very little uniformity in postural drainage training or duties, with a considerable variation

between and sometimes within the countries.

The lower respiratory tract diseases are the conditions, where the lung undergoes

reversible to irreversible damage because of recurrent pulmonary infections. The repair of lung

parenchyma occurs with cavitations, fibrosis of bronchi. The lung parenchyma is further

damaged with loss of drainage mechanism of the various mucoidal fluids which are formed

within the alveoli and bronchi. As repeated infections occur, the naturally occurring cilia, and the

regular drainage assisting mechanism is lost. This un-drained mucus accumulation gets

secondarily infected, very commonly, which makes the life of such patient’s miserable.8

As, in case of pneumonia, bronchiectasis, chronic bronchitis, pulmonary tuberculosis, the

condition and changes are irreversible, the treatment whatever we give is symptomatic and

temporary and if at all any patients needs permanent relief he has to sacrifice a part of his lung,

which is damaged, by surgical intervention. This reduces lung volumes, capacity, and reduces

the oxygen saturation of blood and increases the complications like hemoptysis, emphysema and

others. This not only disturbs the patient’s life style but also it reduces the productivity of the

patient in terms of employment and income generation.9

Indian Information

The Prevalence of Chronic Lower Respiratory diseases is estimated to be 32 million

including 15 million undiagnosed, which comes to Prevalence Rate approximately 1 in 8 or

11.76%. Undiagnosed prevalence rate of pneumonia’s is approximately 1 in 18 or 5.51%.10

According to CDC- centre for communicable diseases, Deaths from Chronic lower

respiratory diseases are 124,181 annual deaths (5.2% of total deaths) (CDC/1999). 5th top cause

of death in 1999 is "Chronic Lower Respiratory Disease" in India (CDC).10

Extrapolation of Prevalence of Chronic Respiratory diseases in India is 125,302,421 and

undiagnosed prevalence is 58,735,509 among the 1,065,070,607 population studied.

Worldwide Information

During 1993 and 1994, the Hospital Infection Society conducted its Second National

Prevalence Survey of infections in patients in British hospitals. The prevalence rates for hospital-

acquired (HA) and community-acquired (CA), Pneumonia (Pneumonia) were 2.4% and 6.1%,

respectively; this shows an increase over that reported in the First National Prevalence Study.

The prevalence rate of HA infections for ventilated patients were 18.6%. The prevalence was

greater in males, odds ratio (OR, 95% CI) for HA-Pneumonia (1.4, 1.1-1.6) and CA-Pneumonia

(1.2, 1.1-1.3) than in females.11

According to the World Health Organization (WHO), nearly 2 billion people—one

third of the world's population—have been exposed to the pneumonia. Annually, 8 million

people become ill with pneumonia, and 2 million people die from the disease worldwide. 10

The five countries that rank first to fifth in terms of total numbers of cases in 2007 are

India (2.0 million), China (1.3 million), Indonesia (0.53 million), Nigeria (0.46 million) and

South Africa (0.46 million). The average prevalence of all forms of pneumonia in India is

estimated to be 5.05 per thousand.11

The practice of postural drainage is very important to the pneumonia clients it relieves the

secretion and reduces the patients to go for further complications. Postural drainage provides

91% chest manipulation, 100% in mobilization, and 100% breathing exercise. Even though, the

recognition for need for postural drainage in ICU growing worldwide, the kind of referral system

is being practiced in Indian ICUs did not consider this in account. Since, the need for the postural

drainage is at its peak level, it is necessary for the staff nurses and other supportive staffs to

practice postural drainage in order to provide better quality of life.

A study was conducted on the need for postural drainage verses the positive expiratory

pressure and the study revealed that postural drainage was more effective and also it is

recommended that postural drainage was is very essential to practice for effective removal of the

secretions and avoid any complication.

The postural drainage helps in to improve the mobilization of bronchial secretions and

the matching of ventilation and perfusion. Postural drainage’s Regular practice helps in the

clients to change body position, expectorated sputum production greater than 25-30ml/day

(adult)which blocks the normal breathing pattern, reduction in cystic fibrosis, helps in

alleviation in potential or presence of atelectasis and clearance in mucus plugging.

Considering the facts that how the inappropriate method of practice and absence of

postural drainage can cause complication to the clients so it is better to perform postural drainage

to avoid any complications and benefits the patients. Investigator was motivated to do this study

after she observes many obstacles and problems of performing the postural drainage and patients

undergoing lots of complications. Investigator experience tells that proper education of postural

drainage will benefits the clients.

6.2 REVIEW OF LITERATURE

According to Polit and Hungler (1999) Review of Literature is a critical summary of

research on a topic of interest generally prepared to put a research problem in context to identify

gaps and weakness in prior studies so as to justify a new investigation.21

The review of literature is traditionally considered as a systematic critical review of the

most important published scholarly literature on a particular topic.

For the present study the review of literature is organized under the following headings.

1. Literature related to prevalence of pneumonia

2. Literature related to management of pneumonia

3. Literature relate to effectiveness of postural drainage on expectoration of mucus from

airway’s

4. Literature related to practice of postural drainage

1. Literature related to prevalence of pneumonia

Esther Chipps , (2008), conducted a study o obtain quantitative information from published

data on the association between environmental tobacco smoke (ETS) exposure and the

prevalence of serious Pneumonia in infancy and early childhood. The results of community and

hospital studies are broadly consistent and show that the child of a parent who smokes is at

approximately twice the risk of having a serious respiratory tract infection in early life that

requires hospitalization.12

D.C. Currie, (2009), this study was designed to collect data on the prevalence of respiratory

syncytial virus infection in Italy in infants hospitalized for Pneumonia. Thirty-two centers

throughout Italy participated in the study. Over a 6-month period (November 1, 1999 to April 30,

2000), they evaluated all children < 2 years of age hospitalized for Pneumonia. The collected

data show that, in Italy, RSV is an important cause of Pneumonia in infants. Gestational age,

birth order, birth weight, and exposure to tobacco smoke affected the prevalence and severity of

RSV-related lower respiratory tract disease.13

 Schulgen, (2009), conducted a study to assess the Prevalence and Risk Factors for

Nosocomial Pneumonia in German Hospitals. The study included 14,966 patients in 72

representatively selected hospitals with departments of general medicine, surgery, obstetrics,

gynecology, and intensive care units (ICU).  The result showed that The overall prevalence of

hospital-acquired pneumonia was 0.72% with the highest rate in hospitals with more than 600

beds (1.08%) and among the patients on intensive care units (9.00%). Ventilator-associated

Pneumonia rates were highest in patients on ICUs (13.27).14 

Nino Khetsuriani, (2008), conducted a study to assess Prevalence of viral respiratory tract

infections in children with asthma. The aim of the study was to determine the prevalence of

respiratory tract infection in children with asthma. Respiratory specimens from children aged 2

to 17 years with asthma exacerbations (case patients, n = 65) and with well-controlled asthma

(control subjects, n = 77), frequency matched by age and season of enrollment, were tested for

rhinoviruses, enteroviruses, respiratory syncytial virus, etc. this study revealed that Symptomatic

rhinovirus infections are an important contributor to asthma exacerbations in children.15

M.C Kelsey, (2008), the Hospital Infection Society conducted its Second National

Prevalence Survey of infections in patients in British hospitals. The prevalence rates for hospital-

acquired (HA) and community-acquired (CA), Pneumonia were 2.4% and 6.1%, respectively;

this shows an increase over that reported in the First National Prevalence Study.16

Carme Puig, (2008), conducted a study to evaluate Incidence and risk factors of lower

respiratory tract illnesses during infancy in a Mediterranean birth cohort. The objective of the

study is to investigate the incidence rate, viral respiratory agents and determinants of lower

respiratory tract illnesses (pneumonia) in infants younger than 1 year.  A total of 487 infants

were recruited at birth for the Asthma Multicenter Infant Cohort Study in Barcelona (Spain).

Cases of Pneumonia were ascertained through an active register including a home visit and viral

test in nasal lavage specimens during the first year of life.  This study showed that Viral

Pneumonia is frequent in infants younger than 1 year of age and there is an inter-relationship

between maternal asthma, siblings, breast feeding and socioeconomic status.17

2. Literature related to management of pneumonia

Lara Surinach, (2010), conducted a study on the management of Pneumonia in patients

aged 15–65 yrs by general practitioners (GPs) in France. To obtain real-time data recording,

practitioners were required to submit an anonymous copy of their drug prescriptions. They were

then interviewed over the telephone. This study demonstrates the Pneumonia encountered by

general practitioners is usually mild. However, antibiotic prescription was more systematic than

in previous studies and the prescription of nonspecific symptomatic treatments was twice as

frequent.18

Laurent Kaiser, (2008) conducted a study to assess the Impact of Oseltamivir Treatment on

Influenza-Related Lower Respiratory Tract Complications and Hospitalizations. The aim of this

study was to assess the effect of oseltamivir treatment  on the incidence of LRTCs leading to

antibiotic treatment and hospitalizations following influenza illness. They analyzed prospectively

collected data on LRTCs and antibiotic use from 3564 subjects (age range, 13-97 years)  with

influenza like illness enrolled in 10 placebo-controlled, double-blind trials of oseltamivir

treatment. This study showed that Oseltamivir treatment of influenza illness  reduces LRTCs,

antibiotic use, and hospitalization in both healthy and "at-risk" adults.19

Matthias Briel, (2008), Procalcitonin-Guided Antibiotic Use vs. a Standard Approach for

Acute Respiratory Tract Infections in Primary Care. Fifty-three primary care physicians

recruited 458 patients, each patient with an acute respiratory tract infection and, in the physician's

opinion, in need of antibiotics. Patients were centrally randomized to either a procalcitonin-

guided approach to antibiotic therapy or to a standard approach. This study revealed that as an

adjunct to guidelines, procalcitonin-guided therapy markedly reduces antibiotic use for acute

respiratory tract infections in primary care without compromising patient outcome.20 

Sarrell, (2009), conducted a study to assess the effectiveness of Nebulization of 3%

Hypertonic Saline Solution Treatment in Ambulatory Children with Viral Bronchiolitis

Decreases Symptoms. The objective of the study was to determine the utility of inhaled

hypertonic saline solution to treat ambulatory infants with viral bronchiolitis. Sixty-five

ambulatory infants (mean ± SD age, 12.5 ± 6 months) with viral bronchiolitis received

either of the following: inhalation of 0.5 mL (5 mg) terbutaline added to 2 mL of 0.9%

saline solution. This therapy was repeated three times every day for 5 days. They conclude

that in nonasthmatic, non severely ill ambulatory infants with viral bronchiolitis,

aerosolized 3% saline solution plus 5 mg terbutaline is effective in decreasing symptoms as

compared to 0.9% saline solution plus 5 mg terbutaline.21

Clara C, (2008) conducted a study to assess the effectiveness of Postural drainage in

Adult with pneumonia. We aimed to compare the effectiveness of standard postural

drainage postural drainage (SPT) with a modified postural drainage regimen without

head-down tilt (MPT) in Adult with pneumonia. Twenty newly diagnosed Adult with

pneumonia (mean age, 25 yrs; range, 50yrs) were randomized to SPT or MPT. Parents

kept a detailed symptom and treatment diary for the following 12 months. Serial chest

radiographs, taken at diagnosis, 12 months, 2½ years, and 5 years after diagnosis, were

assessed using the Brasfield score. This study revealed that standard postural drainage

postural drainage (SPT) is more effective for reducing the symptoms of pneumonia.22

Chris L. Kjolhede, (2000), conducted a study to assess the effectiveness of vitamin A as

adjuvant treatment for Pneumonia. The objective of the study was to test the efficacy of a high

dose of vitamin A as adjuvant treatment for radio graphically confirmed cases of acute

Pneumonia (ALRI). Sequential sample of 263 patient’s vaged 3o to 40 years identified in the

emergency departments and admitted to the hospital in Guatemala City.  Vitamin A (200,000 IU)

or placebo in addition to standard treatment for ALRI which included antibiotics, oxygen,

bronchodilators, and intravenously administered solutions. This study showed that Vitamin A

administration is very effective in reducing the symptoms of pneumonia.23

3. Literature relate to effectiveness of postural drainage on expectoration of mucus from

airway’s

J E Patterson, (2008), conducted a study to assess the effectiveness of postural drainage.

The purpose of this study was to compare the efficacy of the test of incremental respiratory

endurance (TIRE) with active cycle of breathing techniques (ACBT) [incorporating postural

drainage (PD) and vibration] as methods of airway clearance in adults with bronchiectasis. : A

randomized crossover study in which a single session of ACBT (incorporating PD and vibration)

was compared to a single session of TIRE was carried out in 20 patients (14 female) with stable,

productive bronchiectasis. This study concluded that ACBT (incorporating PD and vibration) is a

more effective method of airway clearance in bronchiectasis than TIRE during single treatment

sessions.24

B.A. Webber, (2008), conducted a study to assess the Effects of postural drainage,

incorporating the forced expiration technique, on pulmonary function in cystic fibrosis. Detailed

pulmonary function tests were performed on 12 patients with cystic fibrosis (CF) before and after

3 days treatment with postural drainage incorporating the forced expiration technique. The

results following treatment showed a statistically significant improvement in FEV1 (P<0.001),

FVC (P<0.001), PEFR (P<0.001), PIFR (P<0.001), and VEmax50 (P<0.025). The study

demonstrates objective benefit from this form of postural drainage in cystic fibrosis patients with

copious bronchial secretions.25

C. Munro,(2011), conducted A non invasive, radionuclide imaging technique for

measuring the rate of mucus clearance in the trachea (RT), was used to study gravitational effects

on mucus clearance in 13 patients with cystic fibrosis (CF), average age 17 years; 7 normal,

nonsmoking adults, average age 26 years; and a normal subject who was recovering from an

acute upper respiratory tract infection (URTI). The results of the study indicate that the force of

gravity can be a major influence on tracheal mucus clearance in CF and URTI subjects. This

conclusion supports the use of postural drainage as an effective form of therapy in patients with

cystic fibrosis.26

J.A. Pryor, (2010), conducted a study postural drainage and percussion: Airway

clearance in people with cystic fibrosis. Seventy-five people with cystic fibrosis entered the

prospective, randomized controlled trial of these five different ACTs. The primary outcome

measure was forced expiratory volume in one second (FEV1). Secondary outcome measures

included exercise capacity and health related quality of life. Using intention to treat, data were

available on 65 subjects at the end of the study period. There were no statistically significant

differences among the regimens in the primary outcome measurement.27

4. Literature related to practice of postural drainage.

D.C Currie (2009) conducted a study on the practice of the postural drainage as a

treatment modalities for the clients with pneumonia. The study revealed that the patients felt

comfortable after repetitive sessions of the postural drainage. This helped in the clearance of

mucus and to minimize pulmonary secretion retention, to maximize oxygenation, and to re

expand atelectasis lung segments28.

ND Ciesla, (2008) conducted a study on the effectiveness of frequent practice of postural

drainage on the clients with respiratory disorders client with pneumonia the study revealed that

postural drainage helped in the beneficial effects of postural drainage. It helped in the removal of

retained secretions and fraction of inspired oxygen concentration ratio was improved.29

METHODOLOGY

6.3(A) STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of STP and practice on postural drainage on expectoration of mucus from airway among patients with acute pneumonia in selected hospitals at Bangalore.”

6.4(B) OBJECTIVES OF THE STUDY

1. To assess the pre-test ability of expectoration of mucus from airways in patients suffering

with pneumonia.

2. To evaluate effectiveness of STP on postural drainage on expectoration of sputum from

airways in patients with pneumonia.

3. To assess the practice of postural drainage.

4. To find out association between postural drainage on expectoration of mucus from

airway among patients with pneumonia with selected socio demographic variables.

6.5(C )OPERATIONAL DEFINITION

Effectiveness:

It refers to the extent to which the teaching programme had brought about the result

intended and measured in terms of significant knowledge gained in posttest.

Postural drainage:

It is a type of postural drainage which is pertained to the position applied for the

systematic withdrawal of fluids and discharges from cavities. It utilizes the gravity of earth for

the drainage of fluids or discharges like mucus.

Expectoration of Mucus

The act of ejecting phleg or mucus from the throat or lungs, by coughing, hawking, and

spitting.

Pneumonia

It refers to an infection of the lungs that is caused by bacteria, viruses, fungi, or parasites.

It is characterized primarily by inflammation of the alveoli in the lungs or by alveoli that are

filled with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen).

6.6(D) RESEARCH HYPOTHESIS

H1: There is significant relationship between the postural drainage and expectoration of mucus from

airway.

H2: There is significant difference between expectoration of mucus from airway before and after

giving postural drainage in patients with pneumonia.

H3: There is a significant association between performances of postural drainage with selected

socio demographic variables.

6.7(E) LIMITATION

The study is limited to the age group 15 to 55 years.

The sample size was limited to 30 male and female persons.

The study is limited to 6 weeks only.

The study was conducted in selected hospital only.

6.8 ASSUMPTIONS

1. Regular postural drainage will improve air entry in to the lungs and air way clearance.

2. Sputum expectoration will improve following postural drainage.

3. PEFR will improve following postural drainage.

4. Adequate practice of postural drainage will improve the quality of life of the patients.

7. MATERIALS AND METHODS

This chapter gives a description of the research approach, research design, variables, the

setting of the study, population, sampling, research tool, and methods of data collection and plan

for data analysis.

7.1 Sources of data

Data will be collected from patient with pneumonia admitted in selected hospitals at

Bangalore.

7.2 Methods of data collection

I. Research design

Quasi experimental method

II. Research approach

Evaluative approach.

III. Research variables

a. Independent variables

In present study the independent variable is postural drainage

b. Dependent variables

In this study the dependent variable refers to sputum production, PEFR of the patient

c. Socio-Demographic variables

Characteristics of patients such as age, gender, educational status, experience,

type of pneumonia effected, marital status, religion, type of family, socioeconomic status and

income.

IV. Setting

Study is planned to conduct in selected hospitals at Bangalore..

V. Population

The patient with Pneumonia admitted in selected hospitals at Bangalore.

VI. Sample

The patient with Pneumonia admitted in selected hospitals at Bangalore.. For pilot study

sample size will be 3. For main study the sample size will be 30.

VII. Criteria for sample selection

a) Inclusion criteria

Patient with Pneumonia admitted in select hospitals at Bangalore.

Patient with Pneumonia who can communicate freely in Kannada or English.

Male and female Patients who are between 15 to 55 years age group.

The patients who are diagnosed as pneumonia.

The patients who are expectorating more than 30 ml per day sputum.

b) Exclusion criteria

Patient who are not willing to participate in the study

The patient who are under the age of 15 years

Patients who suffer with hemoptysis

Patients who have sputum positive for Mycobacterium tuberculosis.

Patients who have associated pulmonary conditions like large Pneumothorax, large

pleural effusion, emphysema

Patients who had recent myocardial infarction, cardiac arrhythmias, severe hypertension,

and cardiac surgery.

VIII. Sampling Technique

Non probability convenience sampling technique.

IX. Tool for data collection

SECTION I

Socio -Demographic Data

Socio -Demographic data included age, gender, educational status, experience, type of

pneumonia effected, marital status, religion, type of family, socioeconomic status and income.

SECTION II

1. Change in sputum production:

Sputum production in an optimally hydrated patient with more than 25

ml/day when compared with base line sputum production after postural drainage therapy.

2. PEFR (Peak Expiratory flow rate):

The patient will be asked to sit and take a deep breath and advised to blow forcefully

through the mouth piece of peak flow meter at least for 3 times with an interval of 30 seconds.

The best of the three readings will be taken and measurement will be recorded.

SECTION-III

OBSERVATION CHECK LIST:

Various observation check lists have been developed as there is no availability of standard

check lists. These check lists are helpful to observe how correctly the procedure has being

practiced, how the patient is following the instructions. Through the observation check list, if the

patient can be able to perform the procedure as per the steps, then the values obtained from the

procedure can be accepted.

X. Methods of data collection

After obtaining permission from concerned authority an informed consent from samples,

the researcher will collect data from samples.

Phase 1

During the selection of samples, every alternative patient was allotted for one group pre

test-post test postural drainage on expectoration on mucus from airway. A total of 60 patients

were allotted for this postural drainage.

Investigator has to develop good rapport with patient and consent was obtained from each

patient. Investigator has to collect demographic data. Before administering the postural drainage

from each patient, the parameters such as vital signs, sputum expectoration, Peak expiratory flow

rate (PEFR) were measured.

Phase 2

The patient was given full explanation about postural drainage which will be provided to

them in the form of handout or pamphlet and the steps of the procedure how it will be done.

Each patient will be kept in the position for about 10-15 min and will be given rest for

10-15 minutes. If the patient can able to tolerate the position, then the procedure can be repeated

again.

Phase 3

After completion of the procedure, again the parameters were measured and recorded.

XI. Plan for data analysis

The data will be analyzed by means of descriptive and inferential statistics.

a) Descriptive statistics

Mean, median, mode, standard deviation, percentage distribution, will be used to assess the

demographic variables.

b) Inferential statistics

The obtained measures of parameters before administration of postural drainage will be

tabulated, and‘t’ test will be computed to test the effectiveness of postural drainage.

To compare the Sputum production, Peak Exploratory flow rate (PEFR), before and after

postural drainage paired‘t’ test will be used.

XII. Projected outcomes

After the study, the investigator will able to know the ability of patients expectoration of

mucus from airway’s with Pneumonia, based on the findings. Postural drainage will be

administered to the patients. It will help them to expectoration of mucus more easily.

7.3 Does the study requires any investigation or intervention to the patient or other human

being or animal?

No

7.4 Has ethical clearance been obtained from the concerned authority to conduct the study?

Yes

a) Permission will be obtained from the Director of selected Hospitals at Bangalore.

b) Informed consent will be obtained from the patient with Pneumonia admitted in selected

hospitals at Bangalore. to participate in the study with their own knowledge.

8. LIST OF REFERENCES

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30. , ND Ciesla, PT, is Clinical Instructor, Department of Physical Therapy, University of

Maryland School of Medicine, Baltimore, MD 21201-1595 (USA) (nciesla@erols.com).

She also was Director of Physical Therapy, R Adams Cowley Shock Trauma Center,

University of Maryland Medical Center,

9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of

11.1 Guide

11.2 Signature

11.3 Co-guide

11.4 Signature

11.5 Head of the department

11.6 Signature

12 Remarks of the Principal

12.2 Signature