Patients With Post Stroke Dysphagia Health And Social Care Essay

Patients With bureau nip Dysphagia Health And Social rush EssayThis chapter deals with discussion, summary and conclusions drawn. It clarifies the limitations of the matter, the implications and recommendations given for different areas in care for practice, Education, presidentship and look.DISCUSSIONThe present athletic field was designed to assess the authorisation of Selected treat Interventions among patients with daub apoplexy Dysphagia at KMCH, Coimbatore-14. The researcher carried out the say among 30 patients and adopted pre-experimental research design with individual(a) assemblage pre judge maculation audition design. The researcher apply non probability purposive sampling proficiency to select the 30 subjects. The researcher conducted this show to assess the effectiveness of shaker Exercise and Hyoid aerodynamic lift Maneuver on Swallowing and nutriment doing among patients with jeopardize dig Dysphagia.DEMOGRAPHIC DESCRIPTION OF SUBJECTSThe demogr aphic variables included in the study were age, Sex, Education and Habits.The beggarly Age of the subjects was 60. Half of the subjects were in the Age assort 50-70 years. Almost equal numbers of subjects were in the 30-50 and above 70 years Age hosts and it was near 23 and 27 share respectively.Regarding the Sex, or so equal numbers of subjects were in the male and female Sex group and it showed 53 and 47 part respectively.On the keister of their Educational Status, 67 percent of the subjects were studied up to secondary Education. About 33.33 percent of the subjects stainless any one of the graduate degree course.In accordance with their personal Habits, 53.33 percent had no bad Habits like Smoking and Alcoholism. Ten percent of subjects had the habit of Tobacco use. Seven percent of subjects were consuming Alcohol. Thirty percent of the subjects had the habit of both Tobacco and Alcohol consumption.CLINICAL DESCRIPTION OF SUBJECTSThe clinical variables include Type of blastoff and Co-morbid Illness.In consistent with the Type of cut, 10 percent of the subjects had solidus due to the problem in anterior circulation, 40 percent of the subjects had Stroke due to problem in middle circulation and 50 percent of the subjects had Stroke due to problem in the sideerior circulation. With book of facts to the Co-morbid Illness, 13.33 percent of the subjects had No Co-morbid Illness. About 10 and 40 percent of the subjects had the complaints of Diabetes Mellitus and high blood pressure respectively. rest 36.67 percent of the subjects had both Hypertension and Diabetes Mellitus.The major feelings of the study were discussed accord to the objectivesThe first objective was to assess the Swallowing and provide instruction execution of patients with conduct Stroke Dysphagia.In the pre rivulet assessment of the Swallowing cognitive process using GUSS Score indicates 23.33% of the subjects had crackers Dysphagia, 40% of the subjects had Moderate Dys phagia and 36.67% of the subjects had backbreaking Dysphagia. The station-test assessment of Swallowing procedure explains that 16.67% of the subjects were improven to the No Dysphagia stage with good Swallowing and sustenance transaction. About 26.67% of the subjects had Mild Dysphagia and 23.33% of the subjects had Moderate Dysphagia. remain 33.33% of the subjects had severe Dysphagia with several(a) improvements in the Swallowing execution.The pre test and identify test ply Performance Score using FOIS describes equal number of subjects in the metro Dependent (36.67%) and supply verbal pulmonary tuberculosis category (63.33%). Despite the dissolver revealed an equal number of subjects in the pre and post test assessment, the subjects had an improvement in the nutriment Performance during the post test assessment from no oral examination intake level to tube supplement with consistent oral intake level in the Tube Dependent category. Likewise, subjects showed an improvement from the intake of undivided consistency to the total intake with no restriction in the Total Oral Intake category.The present study was supported by Trapl et al., who conducted study in 2002 and described that out of 30 patients, 30 to 50% had serious Dysphagia and showed meaning(a)ly higher lay on the line of aspiration with liquids compared with semisolid textures (p=0.001). in that locationfore they affirm the subsequent sequence of GUSS.The second objective was to de experimental conditionine the effectiveness of Selected treat Interventions on Swallowing and nutriment Performance in patients with beam Stroke Dysphagia.With bring up to the Swallowing Performance ground on the GUSS Score, the mean pre-test SwallowingS among subjects was 12.50 and the mean post-test Swallowing Score was 13.87 based on the GUSS tool. Paired t test was utilise to compute the mean dissimilarity. The t value for this mean difference amongst pre and post test Swallowing Score was 6.150. The t value obtained at .001 level of significance and at 29 degrees of freedom. Hence there is a important difference outlive between the mean pre and post test Swallowing Scores. It elevate implies that the Swallowing Score in the post test was higher than the pre test Swallowing Score. This improvement was due to the Selected cling to Interventions such(prenominal) as Swallowing Exercises and berth while Swallowing. So the Swallowing Exercises such as Shaker Exercise and Hyoid Lift Maneuver found to be effective in change the Swallowing Performance in Stroke patients. The closing result concluded that 22 subjects (73.3%) expressed improvement after(prenominal) the treatment. Remaining 8 subjects (26.7%) had no changes in their Swallowing Performance after the therapy.The median(prenominal)(a) of pre-test eating Score among subjects was 5 and the median of post-test feed Score was 6.5. Sign test was computed to knock out the difference between the pre an d post test median Scores of nourishment. The sign test Score showed the p value 0.000 which was significant at .001 level. It showed that, a significant difference present between the pre and post test cater Scores. It further implies that the Feeding Score in post test was higher than the pre test Feeding Score. This improvement in the Feeding Performance was due to the Selected treat Interventions. So the Swallowing Exercises were effective in improving the Feeding Performance in Stroke patients having Dysphagia. Median test was employ to compare the effect between the pre test and post test group instead of mean as because the FOIS was a 7 point likert scale. As the variables did non follow the normality and the highest Score was 7, parametric test was not applicable. Hence non parametric sign test was adopted which is equivalent to diametric t test to find out the effectiveness.The result of the present study was substantiated with a study conducted by Mepani et al., in 2 005 on augmentation of deglutitive thyrohyoid muscle cut by the Shaker Exercise. The study involved the effect of 6 weeks shaker exercise in 11 dysphagic patients sise patients were randomized to control group and 5 patients to the Shaker Exercise group. After the therapy the change in thyrohyoid length among Shaker Exercise group was significantly greater compared to the control group (p=0.034), this subsequently improve the swallowing function of the patients.Association of the Swallowing and Feeding Performance with selected demographic and Clinical variables among patients with Post Stroke DysphagiaThe Fisher exact test was employ to associate the selected Demographic and Clinical variables with the Swallowing and Feeding Performance of the patients with Post Stroke Dysphagia.The calculated p values for the association between the Swallowing Performance of Post Stroke patients with the selected Demographic and Clinical variables such as Sex, Habits, Type of Stroke and Co-mor bid Illness were not significant and hence there exist no association between them.The calculated p values for the association between the Feeding Performance of Post Stroke patients with selected Demographic and Clinical variables such as Sex, Habits, Type of Stroke and history of Co-morbid Illness were not significant and hence there is no association between them.SUMMARYThe objective lens of the present study was to assess the effectiveness of Selected Nursing Interventions on Swallowing and Feeding Performance among patients with Post Stroke Dysphagia, for which the following objectives were formulatedTo assess the Swallowing and Feeding Performance of patients with Post Stroke Dysphagia.To determine the effectiveness of Selected Nursing Interventions on Swallowing and Feeding Performance in patients with Post Stroke Dysphagia.To associate the Swallowing and Feeding Performance with selected Demographic and Clinical variables.The study was based on Ernesteine Wiedenbachs desti ny art of clinical nursing theory (1970). The research design apply for the study was pre experimental single group pre test-post test design. Study was conducted in KMCH. 30 samples were selected by non probability purposive sampling technique. The tool used for data collection consists of Demographic and Clinical variables, Gugging Swallowing Screen (GUSS) and Functional Oral Intake Scale (FOIS) to assess the Swallowing and Feeding Performance in Post Stroke Dysphagic patients. The data were collected for a period of 6 weeks. descriptive and inferential statistics were used in statistical analysis, to assess the effectiveness of Selected Nursing Interventions among patients with Post Stroke Dysphagia. Fisher exact test was used to find out the association between the selected Demographic and Clinical variables with the Swallowing and Feeding Performance in patients with Post Stroke Dysphagia.Major findings of the studyOn the basis of Gugging Swallowing Screening (GUSS), the inves tigator observed the degrees of improvement in Swallowing difficulty after the therapy among patients with Post Stroke Dysphagia. About 16.67% of the subjects had No Dysphagia, 26.67% had Mild Dysphagia, 23.33% had Moderate Dysphagia, and 33.33% had Severe Dysphagia.In accordance with the Functional Oral Intake Scale (FOIS), 36.67% of the subjects were in Tube Dependent category and 63.33% were in Total Oral Intake category with sustained improvement in the Feeding Performance.The mean pre test score of the Swallowing Performance using Gugging Swallowing Screening (GUSS) tool was 12.50. The mean post test Score of the Swallowing Performance using GUSS evaluation tool was 13.87.There was a significant difference between the mean pre-test and post-test Swallowing Performance Score. The t value obtained was 6.150 which is significant at 0.001 level and at 29 degrees of freedom.The utmost result explained that, 22 subjects (73.3%) expressed Swallowing improvement after the treatment. R emaining octonary subjects (26.7%) had no changes in their Swallowing Performance after the therapy.Median test was used to compare the Feeding Performance Score of the pre and post test groups. The median pre test Feeding Performance of the patients with Post Stroke Dysphagia was 5 with a range of 1 to 6 and that of post median test was 6.5 with a range of 1 to 7.The non parametric sign test was used to find out the effectiveness of the therapy on Feeding Performance. The obtained p value was 0.000 at 0.01 level of significance. This revealed a significant improvement in the Feeding Performance of Post Stroke Dysphagic patients.The final result revealed that 24 respondents (80%) showed an improvement in their Feeding Performance after the therapy and was assessed by FOIS scoring. But remaining six respondents (20%) showed no changes in the Feeding Performance when assessed by FOIS.There was no significant association exist between the Swallowing and Feeding Performance of the Post Stroke Dysphagic patients with the selected Demographic and Clinical variables.CONCLUSIONThe study was tested and real the hypothesis that there is a significant difference in Swallowing and Feeding Performance before and after the implementation of Selected Nursing Interventions in Post Stroke patients with Dysphagia.The result concluded that the study group had better outlet than the others. There was a significant improvement in the Swallowing and Feeding Performance of the Post Stroke Dysphagic patients after the Exercise and Positioning therapy. The participants had reduced the take a chance of aspiration and aspiration related complications after the therapy. Hence, Selected Nursing Interventions such as Swallowing Exercises like Shaker exercise and Hyoid Lift Maneuver and stead during Swallowing can be recommended for the patients with Post Stroke Dysphagia.IMPLICATIONSThe present study has its ingest implications in nursing practice, nursing education, nursing administ ration and nursing research.Nursing practiceDysphagia is one of the major complications among Post Stroke patients. This study implies the effectiveness of Selected Nursing Interventions in the improvement of Swallowing and Feeding Performance among the Post Stroke Dysphagic patients.This study creates awareness among the nursing personnel about the importance of the various complications after the Stroke and its various evidence based management.The present study shows that the exercise intervention for the Post Stroke Dysphagic patients can prevent the try of aspiration and aspiration pneumonia.The result shows that, Selected Nursing Intervention for the Post Stroke patients can reduce the risk of malnourishment. bears can gain skill for providing Swallowing Exercises in the Post Stroke Dysphagic patients to improve their quality of life.Nursing EducationThe deem pedagogue can create awareness among the health care professionals about the complicated cause of Stroke and its var ious evidence based management.The nurse educator can arrange in-service Education programs to update their knowledge regarding the unseasoned techniques and modalities to manage the Post Stroke Dysphagia.The nurse educator can apprise the students about the present study findings and its implication in patients with Post Stroke Dysphagia. This depart help to improve the knowledge of the students on Swallowing Exercises.The nurse educator can motivate the nursing personnel and students to use this Swallowing Exercises and positioning in the improvement of Swallowing and Feeding Performance and in the reduction of aspiration risk in Post Stroke Dysphagic patients.Nursing administrationNurse decision maker should aware of the problem experienced by the clients after the Stroke.Nurse administrator can provide continuing education or short term courses in the clinical area for preparing the nurses with competence in managing the after effects of Stroke especially Dysphagia.Nurse ad ministrator can plan and tog up seminars, workshops and conferences about Selected Nursing Interventions for the improvements of Swallowing and Feeding Performance among patients with Post Stroke Dysphagia.Nurse administrator can formulate protocol to incorporate the study findings in nursing intervention.Nursing researchThis study provides a basis for further studies.The findings of the study can be a foundation for conducting the study on large sample to strongly support the efficacy.The implications of the study can be used as a motivation for nurses to conduct research in India, where the health care system is advancing.This study helps to update the knowledge and tight-laced utilization of resources in the field of nursing practice.LIMITATIONS OF THE STUDYThe study was bound to small sample coat of 30 subjects.The study was limited to a single setting.The study was conducted using a single group.RECOMMENDATIONSA uniform study can be conducted with large number of subjects to generalize the research findings.A study can be conducted at different settings. identical study can be undertaken using different Swallowing and lingual exercises.This study can be conducted with experimental and quasi experimental design.A relative study can be conducted between different types of Swallowing Exercises in Post Stroke Dysphagic patients.A similar study can be through to assess the effectiveness of Swallowing Exercises among patients with Dysphagia who are receiving head and neck radiation for cancer. victimizeThe present study entitled Effectiveness of Selected Nursing Interventions on Swallowing and Feeding Performance among patients with Post Stroke Dysphagia at KMCH, Coimbatore-14. This study was undertaken during the year 2012-2013, in partial fulfillment of requirement for the degree of Master of Science in Nursing at KMCH College of Nursing, Coimbatore, which is affiliated to the Tamilnadu Dr. M.G.R. Medical University, Chennai.Objectives 1.To assess the S wallowing and Feeding Performance of patients with Post Stroke Dysphagia. 2. To determine the effectiveness of Selected Nursing Interventions on Swallowing and Feeding Performance in patients with Post Stroke Dysphagia. 3. To associate the Swallowing and Feeding Performance with selected Demographic and Clinical variables. Research Design Pre experimental design with single group pre test-post test design. Setting Neuro inpatient and outpatient department of Kovai Medical oculus and Hospital, Coimbatore. Samples All Post Stroke Dysphagic patients. Sample Size The sample size was 30. Sampling Technique Non probability purposive sampling. Conceptual framework Ernestine Widenbachs destiny Art of Clinical Nursing Theory (1970) was adopted. Intervention Selected Nursing Interventions such as Swallowing Exercises and Positioning during the swallowing were incorporated. The clients were instructed to do the Shaker Exercise and Hyoid Lift Manoeuvre 3 to 6 times a day for a period of 6 wee ks. The subjects were instructed to elevate or down the chin and inclination the head towards stronger side while Swallowing. Outcome Measures Swallowing and Feeding Performance was assessed by Gugging Swallowing Screen (GUSS) and Functional Oral Intake Scale (FOIS) respectively. Results The mean difference between pre and post test Swallowing Score was 6.150 and which was significant at 0.001 level. The p value obtained for Feeding Score was 0.000 at 0.001 level of significance. The result showed a significant improvement in the Swallowing and Feeding Performance. Conclusion This study proved that the implementation of Selected Nursing Interventions rather than the other conventional treatment will improve Swallowing and Feeding Performance among Post Stroke patients with Dysphagia. Hence the Swallowing Exercises and Positioning can be recommended in clinical practice to improve the Swallowing and Feeding Performance in Post Stroke Dysphagic patients.