RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A study to assess the effectiveness of structured teaching programme on

knowledge regarding extracorporeal shock wave lithotripsy management of clients

with renal calculi among final year GNM nursing students in selected school of

nursing at chitradurga.”

Mr.SHIVAKUMAR H R
1ST YEAR M.Sc NURSING
MEDICAL SURGICAL NURSING

VIVEKANANDA COLLEGE OF NURSING

BASPAPPA MULTY SPECIALITY HOSPITAL CAMPUS

TURUVANUR ROAD, CHITRADURGA-577501

1
GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

SYNOPSIS FOR
REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED TO:

RAJIV GANDHI UNIVERSITY OF HEALTH SERVICES

IN PARTIAL FULFILLMENT OF

M.Sc (N) IN MEDICAL SURGICAL NURSING

SUBMITTED BY:

Mr. SHIVAKUMAR H R

1ST YEAR M.Sc NURSING

UNDER THE GUIDANCE OF:

Mr.

HOD

MEDICAL SURGICAL NURSING

VIVEKANANDA COLLEGE OF NURSING

BASPAPPA MULTY SPECIALITY HOSPITAL CAMPUS

TURUVANUR ROAD, CHITRADURGA-577501

2
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MR. SHIVAKUMAR H R
NAME OF THE 1ST YEAR M.Sc NURSING
1 CANDIDATE AND VIVEKANANDA COLLEGE OF NURSING,
ADDRESS BASAPPA HOSPITAL, TURUVANUR
ROAD CHITRADURGA-577501
VIVEKANANDA COLLEGE OF NURSING,
NAME OF THE
2 BASAPPA HOsSPITAL, TURVANUR
INSTITUTION
ROAD CHITRADURGA-577501
COURSE OF THE M.Sc NURSING
3 STUDY AND THE MEDICAL SURGICAL NURSING
SUBJECT
DATE OF ADMISSION
4
TO THE COURSE
A study to assess the effectiveness of

structured teaching programme on knowledge

regarding extracorporeal shock wave

lithotripsy management of clients with renal

5 TITLE OF THE TOPIC
calculi among final year GNM nursing

students in selected school of nursing at

chitradurga

3
6. BREIF RESUME OF THE INTENDED WORK:

6.1 INTRODUCTION

The urinary system consists of kidney, ureters, bladder and urethra. The
kidneys are two bean shaped organs located below the ribs, the middle of the back.
They remove extra water and waste from blood and converting into the urine. 1..

About 75% of the total body mass is constituted by water. Maintenance of

water level in the body is important as it controls many life sustaining facts like
temperature regulation, circulation of body fluids, elimination of waste products etc.
Kidney plays a vital role in the maintenance of water level. The human kidney filters
about 1200 – 2000 liters of blood a day. During filtration, as the blood passes through
the kidney and nephrons, the kidney filters blood to form urine that contains toxic and
chemical substances, most of which are dissolved. In some circumstances like
pathological conditions, they get sedimented and accumulated. Over a period of time
the sediments combines and consolidate to form a rigid stone like mass that may
obstruct the urinary tubules. These stones are formed in the kidneys, which may then
be shifted to the ureters and even to the bladder. The stones found in the kidneys are
known as kidney stones and the resulting condition is called NEPHROLITHIASIS.
Urolithiasis and nephrolithiasis refer to stones (renal calculi) in the urinary tract and
kidney respectively. Stones are formed in the urinary tract when urinary
concentration of substances such sa calcium oxalate calcium phosphate and uric acid
incrises.2

urgent relief is to be given to these patients. In the initial phase, the condition
can be controlled by dietary restrictions and increased fluid intake. But if it is ignored
or not diagnosed, it leads to increased stone size which severs the symptoms and needs
pharmacological treatments and and surgical removal of stone is needed.

Now a days advanced treatments are developed to treat renal calculi like
Extracorporeal shock wave lithotripsy, uretaroscopy, ect. .most of medical health
practitioners and health workers dose not have much informations about new advanced
treatment for renal calculi . they need to know all the informations of these new
advanced treatments . it helps in their daily working practices .

4
. The treatment of renal calculi has undergone a remarkable evolution in the
last 15 years .At one time open uretero-lithotomy and blind stone basket manipulation
were the mainstay of surgical management ,they have now been superseded by an
array of superior maodalites . Among them ureteroscopy(URS) and Extracorporeal
shock wave lithotripsy(ESWL) are the two most favoured method for the treatment of
renal calculi.

Lithotripsy is a medical procedure involving the physical destruction of

hardened masses like kidney stones, bezoars or gallstones. The term is derived from
the Greek words meaning "breaking (or pulverizing) stones" (litho- tripso]. Surgery
was the only method to remove stones too large to pass until lithotripsy was developed
and replaced it as the most frequent treatment beginning the 1980s. In ESWL, external
shockwaves are focused at the stone to pulverize it3.

Lithotripsy is the use of highenergy shock waves to fragment and disintegrate

kidneystones. The shock wave, createdby using a highvoltage spark or an electromag
netic impulse, is focused on the stone. This shock wave shatters thestone and this allo
ws the fragments to pass through the urinary system. Since the shock wave is generate
d outside thebody, the procedure is termed extracorporeal shock wave lithotripsy, or E
SWL.Lithotripsy uses the technique of focused shock waves to fragment a stone in the
kidney or the ureter. The patient is placed in a tub of water or in contact with a water
filled cushion, and a shock wave is created which is focused on thestone. The wave sh
atters and fragments the stone. The resulting debris, called gravel, then passes through
theremainder of the ureter, through the bladder, and through the urethra during urinatio
4
n.

5
6.2. NEED FOR THE STUDY:

The prevalence and incidence of nephrolithiasis is reported to be increasing

across the world. In the United States, overall stone prevalence has doubled since the
1964–1972 time period, and appears to have stabilized since the early 1980s. Other
countries with documented increases in prevalence include Germany, Spain, and
Italy. Regional reports from Milan, Italy, also document an increased prevalence.. In
Japan, the incidence of nephrolithiasis has doubled over a 40-year time period, both in
men and women. These increases were most prominent in the last 10 to 20 years 5

A study conducted by 103rd Annual Scientific Meeting of the American

Urological Association (AUA) shows that the rising global temperatures could lead to
an increase in kidney stones. Dehydration has been linked to stone disease, particularly
in warmer climates, and global warming will exacerbate this effect. As a result, the
prevalence of stone disease may increase.6

The incidence of kidney stone in India is increasing rapidly. In some northern

states of India, every fifth person in the population is having renal stones and women
are more commonly affected with kidney stones than malesDuring the study period
January 2012 to December 2012, a total of 250 adult patients underwent surgical
treatment for renal calculi. Of these 160 patients were from North western Karnataka,
43 from the state of Goa and 47 were from South coastal Maharashtra. In India,
approximately 5-7 million people suffer from kidney stone disease and at least 1/1000
population needs hospitalization. In India the disease is prevalent in Maharashtra,
Gujarat, Punjab, Haryana, Karnataka and Rajasthan. 7

. Mankind has been affected by urinary stones since centuries and has been the
silent cause of renal failure. Surgery was usually required to remove the urinary stone
till lithotripsy was developed in the early 1980 in Germany by Dornier
Medizintechnik. Extracorporeal shock wave lithotripsy (ESWL) is the non invasive
treatment of kidney stones using an acoustic pulse. Within few years lithotripsy
became a standard treatment of calculosis8

For the vast majority of patients, ESWL is performed on an out-patient basis

with no need for hospital admission following the procedure. ESWL procedures

6
typically last approximately one hour. ESWL can be performed either under general
anesthesia or under intravenous sedation.9

A study was conducted in China on the management

of renal caliceal calculi with a newly designed ureteroscope: a rigid ureteroscope with
a deflectable tip to evaluate the indications for, and the effects of, the management
of renal caliceal calculi with deflectable tip rigid ureteroscopy. The procedure was
successfully performed in all patients with a mean operative time of 28 minutes (range
19-45 min). The mean size of renal caliceal stones was 1.3 cm (range 0.8-2.4 cm).
Seventeen patients had concurrent proximal ureteral calculi. The mean lithotripsy time
was 11 minutes (range 5-22 min), and the mean discharge time was 3 days after
operation. The overall stone-free rate at the 1-month follow-up was 83%. The study
concluded that ureteroscopic lithotripsy with the novel deflectable tip rigid
ureteroscope was a safe procedure and combined the advantages of rigid and flexible
ureteroscopy, especially for renal caliceal calculi of relatively small size.10

A study was conducted in West Germany on ESWL for kidney stones as an

alternative to surgery. Four years of experience with lithotripsy for renal and ureteral
calculi was summarized. Ninety-nine percent of treated patients had a satisfactory
clinical result; 90% of them were stone-free. No significant complications were
encountered. The study concluded that 85% of all patients with stones can be cured by
nonsurgical management.11

When researcher was working in hospital at chitradurga district, researcher

found many people are come to hospital with complaint related to kidney problems.
After they undergone some diagnostic procedure many cases are found to be renal
calculi. When researcher assessing the knowledge of nursing students posted in
wards they not having much information about lithotripsy management because of
they may not got much information about it.

But final year GNM students must need to know about lithotripsy management
for kidney stone. So planned to teach effectively for the students. It help full for them
in exams as well as in feature.

7
6.3. REVIEW OF LITERATURE

A). Review Of Literature Related To Magnitude Of Renal Calculi Problem

B). Review Of Literature Related To Extracorporeal Shock Wave Lithotripsy

A). Review Of Literature Related To Magnitude Of Renal Calculi Problem

A study was conducted by Tschöpe W, Ritz E, Haslbeck M, Mehnert H,

Wesch H.about Prevalence and incidence of renal stone disease in a German
population. According their study 261 male and 242 female patients (age 15-65 years)
were questioned about renal colics with passage of renal stones. The patients were
questioned while undergoing a medical examination. The prevalence of renal
stones varied between 1.1% (males 15-29 years) and 20.6% (males 50-65 years) with
an average of 6.9%. The incidence of passage of a calculus was 0.62% percent of the
population per year. These figures in a German population sample are in agreement
with more recent data from other industrialized countries and point to
the magnitude of renal stone disease as a public health problem.12

A study was conducted by. Trinchieri A, Montanari E.about Prevalence of

renal uric acid stones in the adult Urolithiasis according to them The aim of this study
was to estimate uric acid renal stone prevalence rates of adults in different countries of
the world . Alternative searches were made to collect further information on specific
topics. The prevalence rate of uric acid stones was computed by the general renal stone
prevalence rate and the frequency of uric acid stones in each country. After the initial
search, 2180 papers were extracted. Out of them, 79 papers were selected after the
reading of the titles and of the abstracts. For ten countries, papers relating to both the
renal stone prevalence in the general population and the frequency of uric stones were
available. Additional search produced 13 papers that completed information on 11
more countries in 5 continents. Estimated prevalence rate of uric acid stones was
>0.75% in Thailand, Pakistan, Saudi Arabia, Iran, South Africa (white population),
United States and Australia; ranged 0.50-0.75% in Turkey, Israel, Italy, India
(Southern), Spain, Taiwan, Germany, Brazil; and <0.50% in Tunisia, China, Korea,
Japan, Caribe, South Africa (blacks), India (Northern). Climate and diet are major
determinants of uric acid stone formation. A hot and dry climate increases fluid losses
8
reducing urinary volume and urinary pH. A diet rich in meat protein causes low
urinary pH and increased uric acid excretion. On the other hand, uric acid stone
formation is frequently associated with obesity, metabolic syndrome and diabetes type
2 that are linked to dietary energy excess mainly from carbohydrate and saturated fat
and also present with low urine pH values. An epidemic of uric acid stone formation
could be if current nutritional trends will be maintained both in developed countries
and in developing countries and the areas of greater climatic risk for the formation of
uric acid stones will enlarge as result of the global warming.13

A study was conducted by Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A,

Talati J, Lotan Y.about Epidemiology of stone disease across the world ,according to
them Nephrolithiasis is a highly prevalent disease worldwide with rates ranging from
7 to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Due to high rates of
new and recurrent stones, management of stones is expensive and the disease has a
high level of acute and chronic morbidity. The goal of this study is to review
the epidemiology of stone disease in order to improve patient care. A review of the
literature was conducted through a search on Pubmed, Medline, and Google Scholar.
This review was presented and peer-reviewed at the 3rd International Consultation on
Stone Disease during the 2014 Society Internationale d'Urologie Congress in Glasgow.
It represents an update of the 2008 consensus document based on expert opinion of the
most relevant studies. There has been a rising incidence in stone disease throughout
the world with a narrowing of the gender gap. Increased stone prevalence has been
attributed to population growth and increases in obesity and diabetes. General dietary
recommendations of increased fluid, decreased salt, and moderate intake of protein
have not changed. However, specific recommended values have either changed or are
more frequently reported. Geography and environment influenced the likelihood of
stone disease and more information is needed regarding stone disease in a large
portion of the world including Asia and Africa. Randomized controlled studies are
lacking but are necessary to improve recommendations regarding diet and fluid intake.
Understanding the impact of associated conditions that are rapidly increasing will
improve the prevention of stone disease.14

9
 Ahmad F, Nada MO, Farid AB, Haleem MA, Razack SM. Epidemiology of
urolithiasis in soudi Arabia . This retrospective study was conducted to determine the
prevalence of urinary calculi in the indigenous population of Saudi Arabia and
compare it with expatriates of different nationalities working in Saudi Arabia with
emphasis on the anatomic location of the calculi and the role of ultrasound in the
detection and management. The study included 5371 patients (both sexes, mean age
36.6 years) examined by us from September 2004 to February 2008. The patients
hailed from 30 countries, which included Bangladesh (42.3%), Pakistan (18.3%),
Yemen (17.5%), India (6.5%), Sudan (3.4%), Saudi Arabia (2.8%), Egypt (2.3%) and
Eritrea (1.7%). All patients were referred for abdominal/renal ultrasonography.
Urinary calculi were detected in 1029 patients. The distribution of calculi was as
follows: Renal 73.3%, pelviureteric junction 2.3%, proximal, middle and distal thirds
of the ureter 13%, vesicouretic junction 9.8%, vesical 1.1% and urethral 0.5%. The
prevalence of urinary calculi according to ethnic origin in descending order of
frequency was Egyptians (29.5%), Pakistani (24.9%), Indian (23.3%), Yemeni
(20.5%), Sudanese (17.6%), Bangladeshi (16.2%), Eritrean (15.4%) and Saudi
Arabian (7.4%). Urinary calculi were found in 19.1% of the studied population.
Approximately three-quarters of the calculi were located within the kidney. The
nationalities with the highest prevalences were Egyptian, Pakistani and Indian.15

A study was conducted by Aslin Shamema A, Thanigai Arul K, Senthil

Kumar R, Narayana Kalkura S.about Physicochemical analysis of urinary stones from
Dharmapuri district.according to them Nephrolithiasis is a common disease caused by
the multifactorial components such as geographical location, bacterial infection, low
urine volume, and low intake of water. This disease induces severe metabolic
abnormalities in the human body. As the prevalence of this disease was high in
Dharmapuri district located in Tamil Nadu, urinary stones removed from the patients
pertaining to this district were collected and to identify the toxic elements present in
the stones. The presence of functional groups and phases of the stones were analyzed
using X-ray diffraction (XRD), Fourier transform Raman spectroscopy and Fourier
transform infrared spectroscopy (FT-IR). The majority of stones were found to be
calcium oxalate monohydrate (COM) and mixed stones having minor existence of
struvite and uric acid. Hexagonal shaped COM crystals, needle shaped uric acid
crystals and layered arrangement of struvite crystals in the core region were revealed
by Scanning Electron Microscopy (SEM). Thermo Gravimetric Analysis (TGA) was
10
used to determine the thermal stability and the hardness of the stone which was
measured using Vickers hardness (HV). The presence of toxic elements in stones such
as zirconium and mercury was identified using Energy Dispersive X-ray
Spectroscopy.16

A study cundected by Abhishek, Kumar J, Mandhani A, Srivastava A, Kapoor

R, Ansari MS.about Pediatric urolithiasis: experience from a tertiary referral
center.according to their study Pediatric urolithiasis can cause significant morbidity
and damage to the kidney, or even renal failure. We review our experience of the
management of urolithiasis in pediatric patients at a tertiary referral center.they
reviewed medical records of all children with urolithiasis who were diagnosed and
managed at our center from August 2003 to October 2011. Management was planned
according to stone burden and location. We noted and statistically analysed data about
age, sex, stone burden, clinical features, management, metabolic abnormalities and
recurrence. There were 325 children with 378 stone sites. Age range was 3-17 (mean
8) years. The male to female ratio was 3:1. Most common presentation was abdominal
pain in 257 children (79%), and the most common stone site was kidney in 215 (57%).
Twenty-four (7%) children (stone burden ≤3 mm) were managed conservatively, while
the rest received some form of intervention. Metabolic workup could be done in 154
(47%) children. A metabolic abnormality was seen in 67 (43%) children,
normocalcemic hypercalciuria being the most common. Recurrence of urolithiasis was
seen in 78 (24%) children after a mean follow-up of 3.2 (1-6) years, and was more
common in those who had a metabolic abnormality or in whom small residual
fragments were left in situ.17

11
B). Review Of Literature Related To Extracorporeal Shock Wave Lithotripsy

Robert A. Riehle, William R. Fair, E. Darracott Vaughan, Extracorporeal

Shock-Wave Lithotripsy for Upper Urinary Tract Calculi, Four hundred sixty-seven
patients with symptomatic upper urinary tract calculi underwent extracorporeal shock-
wave lithotripsy (ESWL) at The New York Hospital-Cornell Medical Center during
the first year. Ninety-five percent of stones were completely treated with one ESWL
session. An analysis of 300 treatments revealed that the overall stone-free rate
(success) three months after treatment was 75% The stone-free rate for patients with
renal pelvic calculi less than or equal to 20 mm in diameter was 91%. Individual
patient stone-free rates depended on stone size (burden), position, composition, and
quality of disintegration. Two percent of treatments failed to disintegrate the targeted
stone. Complications were minimal..18

Simunovic D, Sudarevic B, Galic J, Extracorporeal Shockwave Lithotripsy in

Elderly: Impact of Age and Comorbidity on Stone-Free Rate and Complications, A
longitudinal study was conducted to assess the impact of increasing age on success
rate of shockwave lithotripsy in nephrolithiasis patients. The aim of the study was to
investigate and compare the success rate and complication rate of lithotripsy in so
called patients above 60 years. Co morbidities were found in 55% of patients, with
almost every third patient having two or more ones present. Complications were noted
in 6% of patients, with no significant difference when comparing complication rates
between the groups. An overall SFR of 67.98% was found. SFR and low rate of
complications can be achieved with proper patient selection for SWL, regardless of
patients' age and co morbidities.19

James E. Lingeman, John R. Woods, Phillip D. Toth, Blood Pressure Changes

Following Extracorporeal Shock Wave Lithotripsy and Other Forms of Treatment for
Nephrolithiasis, Hypertension has been reported as a possible sequela of
extracorporeal shock wave lithotripsy (ESWL). To evaluate this issue as well as the
risk of hypertension following other current non-ESWL treatment options for
urolithiasis (percutaneous nephrostolithotomy [PCNL], combined PCNL and ESWL,
ureteroscopy, and spontaneous stone passage), detailed blood pressure measurements
were made in 961 patients at least 1 year after treatment. All follow-up blood pressures
12
were measured with random-zero blood pressure devices. This study includes 731
patients who received ESWL only (with an unmodified lithotriptor), 171 patients
treated with ureteroscopy or spontaneous stone passage (control subjects), 25 patients
who received PCNL only, and 34 patients treated with both ESWL and PCNL. In
patients who received ESWL only, the annualized incidence of hypertension (2.4%)
did not differ significantly from that in control patients (4.0%). However, there was a
significant rise in diastolic blood pressure after treatment with ESWL (0.78 mm Hg),
but not in the control group (—0.88 mm Hg). The long-term significance of this
change in diastolic blood pressure following ESWL is unknown and requires further
study..20

Istanbulluoglu MO, Hoscan MB, Tekin MI, Cicek T, Ozturk B, Ozkardes H,

Shock wave lithotripsy for distal ureteric stones: supin or prone, In a retrospective
study to assess the effectiveness of shock wave lithotripsy, it was found that Shock
Wave Lithotripsy (SWL) has become the preferred first-line approach to most patients
with symptomatic urolithiasis. A total of 342 patients participated in which they were
divided into two groups. The study was accepted as successful if the patient was stone
free or had only clinically insignificant fragments (≤3 mm) for 3 months or more after
the last SWL session. The success rate was found to be 85%.21

In 2008 .Dr.FRANCIS LEE studied on update on the management of ureteric

stones Study shows that efficacy of ESWL on the treatment of ureteric stones is
related to stone size and stone location.Stone clearance rates range from 74% for
stones <10mm to 43% for those >10mm.clearance rates for stone located at proximal
mid and distal ureter are 82%,73% and 74% respectively.Serious complications are
rare Ureteroscopy is particularly indicated in cases wen ESWL is technically difficult
or contraindicated such as radiolucentones,stonedensity>750HU,obese,anticoagulation
and pregnancy.22

Lam JS, Greene TD, Gupta M compared the safety and efficacy of
ureteroscopy with intracorporeal holmium:YAG laser lithotripsy and ESWL .A total of
67 patients underwent 81 primary procedures,including in situ ESWL with a Doli 50
lithotriptor or ureteroscopy combined with holmium:YAG laser lithotripsy for
proximal ureteral calculi.The authors demonstrated that ureteroscopy combined with
holmium:YAG laser lithotripsy is an acceptable treatment modality for all proximal
13
ureteral calculi and extended results are achieved for calculi 1cm or larger.Although
the stone free rate was better for smaller stones with ureteroscopic laser lithotripsy
efficiency quotients were similar.Therefore,ESWL should remain first line therapy for
proximal ureteral calculi less than 1cm.because of less morbidity,and a lesser
anaesthesia and analgesic requirement.23

Streem SB conducted study about Contemporary clinical practice

of shock wave lithotripsy: a reevaluation of contraindications. According to him The
exclusion of patients with conditions previously believed to
contraindicate shock wave lithotripsy has almost always been empiric rather than
based on experimental or clinical studies showing adverse effects in those settings.
The contemporary literature suggests that shock wave lithotripsy in patients with
proximate calcified aneurysms, implanted cardiac pacemakers and defibrillators, and
bleeding diatheses can be accomplished safely and effectively with
careful treatment and monitoring before, during and after shock wave lithotripsy.
Likewise, patients with morbid obesity, children, and those with mid and distal
ureteral calculi can also be treated successfully, even with first generation lithotriptors,
with minor modifications that allow for appropria te positioning of the patient and
stone .24

Rassweiler JJ1, Renner C, Chaussy C, Thüroff S.are conducted study about

Treatment of renal stones by extracorporeal shockwave lithotripsy: an update. And

they given the literature like this .Analysis of the literature include more than
14,000 patients. We have compared these data with long-term results of two major
stone centers in Germany. The results have been compared concerning the
anatomical kidney situation, stone size, stone localization and observation time.

According to the importance of residual fragments following

extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between
clinically insignificant residual fragments and clinically significant residual fragments
(CIRF). 24 months following ESWL stone passage occurs as a continuous process,
and if there are no clinical symptoms, any endoscopic procedure should be considered
as overtreatment. According to these results, stone-free rates of patients increase in
longer follow-up periods. Newer ESWL technology has increased the percentage of
CIRF. We consider ESWL in most patients with renal calculi as first-line treatment,
except in patients with renal calculi bigger than 30 mm in diameter.25
14
 A study was conducted in Methodist hospital of Indian, US on extracorporeal
shock wave lithotripsy. A total of 982 patients underwent treatments with lithotripsy
for upper urinary tract calculi. A very old single treatment was performed in 90
percent of the patients. Morbidity was extremely low and hospital stay was short
(3.0 days). Adjunctive procedures were required in 13 percent of the patients. The 72
percent were free of stones at the 3-month follow up, while 23 percent contained small
(less than 5 mm.), asymptomatic fragments. Only 1 percent of the patients required
surgical removal of the calculi. Lithotripsy is the preferred form of management for
symptomatic upper ureteral and renal calculi less than 2 cm. in diameter.26

Pankaj N, Maheshwari, Hemendra N. A retrospective study was conducted in

Mumbai, India on in-situ holmium laser lithotripsy for impacted urethral calculi. The
positive experience with the safety and efficacy of holmium laser lithotripsy for
ureteral calculi was applied to the management of urethral calculi, and the initial
results were analyzed. 42 patients presented with symptomatic urethral calculi were
selected for the study. Under anesthesia, an attempt was made to push the calculus
back in the bladder using lidocaine jelly. In 18 patients in whom this attempt failed, in-
situ intracorporeal holmium lasertripsy was performed under cystourethroscopic
guidance. All the patients were rendered stone free after a single endoscopic
procedure. There were no intraoperative or postoperative complications. At a mean 17
of the patients having lasertripsy were asymptomatic with no evidence of development
of urethral stricture. The results showed that intracorporeal intraurethral holmium
lasertripsy is a feasible, safe, and effective minimally invasive alternative for the
treatment of impacted male urethral calculi.27

15
6.4. STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of structured teaching programme on

knowledge regarding Extracorporeal shock wave lithotripsy management of clients
with renal calculi among final year GNM nursing students in selected school of
nursing at chitradurga.

6.5. OBJECTIVES OF THE STUDY

1) To assess the knowledge of final year GNM nursing students regarding

Extracorporeal shock wave lithotripsy management of clients with renal
calculi before and after structured teaching programme.
2) To evaluate the effectiveness of structured teaching programme by comparing
pre and post test knowledge score of final year GNM nursing students.
3) To identify the association between the post test knowledge of students and
their selected socio demographic variable.

6.6. HYPOTHESIS OF THE STUDY

H1: There will be significant differences between the pre and post test
knowledge of nursing students regarding extracorporeal shock wave lithotripsy
management

H2: there will be significant association between selected demographic veriables

and knowledge of nursing students

6.7. ASSUMPTIONS:

1. Final year GNM nursing students will be having some knowledge regarding
Extracorporeal shock wave lithotripsy management
2. Self administering question asses the knowledge of nursing students
regarding Extracorporeal shock wave lithotripsy

16
6.8. OPERATIONAL DEFINITIONS

1. Evaluate: Refers to significance of systematic determination of merit, worth,

significance of structured teaching programme on shock wave lithotripsy
management of clintes with renal caluculi against set of standards.
2. Effectiveness: Refers to the extent to which the structured teaching programmes
on has Extracorporeal shock wave lithotripsy management of clintes with renal
calculi achieved the desired effect in improving the knowledge of students as
assessed by structured questionnaire.
3. Structured Teaching Programme: Refers to systematically planned group
instructions by lecture cum discussion method designed to provide information
regarding extracorporeal shock wave lithotripsy management of clintes with renal
calculi.
4. Knowledge- It is the understanding of information about a subject that has been
obtained by experience or study. In the present study, knowledge refers to
understanding of information about extracorporeal shock wave lithotripsy
management of clintes with renal calculi. Which has been measured by structured
interview schedule.
5. Renal calculi - renal calculi refers to the medical condition in which there occurs
stone like masses in the kidney.
6. Extracorporeal Shock Wave Lithotripsy- Extracorporeal Shock Wave
Lithotripsy (ESWL) is the non-invasive treatment of kidney stones and biliary
calculi which include crushing of the stones using an acoustic pulse

6.9. CRITERIA FOR SAMPLE SELECTION:

 Inclusion criteria

Students who are

 Students studying in final year GNM in selected school of nursing at

chitradurga.
 Willing to participate in the study.
 Students those who are available during study.

 Exclusion Criteria
 Not willing to participate in the study.
 Not present at the time of data collection.
17
6.10. LIMITATION OF THE STUDY:
The study is limited to:
 The Study is Limited to the final year GNM Nursing students in selected
school of Nursing at Chitradurga.
 Sample size Limited to 40 Final Year GNM Nursing Students.
7. MATERIAL AND METHODS OF STUDY:
6.1. SOURCE OF DATA
Data will be collected from the final year GNM Nursing students of the
selected Nursing Schools of Chitradurga.
6.2. METHODS OF COLLECTION OF DATA
6.2.1. Research design :
The Research design is one group Pretest – Post test study design.
6.2.2. RESEARCH APROACH:
Experimental approach. /quantitative approach.
6.2.3. RESEARCH SETTING:
The study will be conducted in selected School of Nursing at Chitradurga.
6.2.4. POPULATION
 Target Population: All the Final Year GNM Students at Chitradurga
District.
 Accessible Population: Only Final Year GNM Nursing Students
available for study at selected School of Nursing at Chitradurga.
6.2.5. SAMPLE:
Students who fulfill the inclusion Criteria from the selected School of
Nursing at Chitradurga.
6.2.6. SAMPLE SIZE:
The Sample size consists of 40 Final year GNM Nursing Students from
the selected School of Nursing at Chitradurga.
6.2.7. SAMPLING TECHNIQUE:
Probability simple random sampling technique will be used.
6.2.8. COLLECTION OF DATA:
The data will be collected from the Questionnaires method in final year
GNM Nursing Students of selected School of Nursing at Chitradurga by
STP.

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 6.2.9. SELECTION OF TOOL:
Part-A: Socio demographic Profile
Part-B: Collection of data is done by using semi structured questionnaires
on knowledge regarding Extracorporeal Shock wave Lithotripsy
Management of Clients with Renal Calculi
7. VARIABLES
 Independent Variable: STP on extracorporeal Shock wave Lithotripsy
Management of Clients with Renal Calculi.
 Dependent Variable: Knowledge of Final year GNM Nursing Students on
extracorporeal Shock wave Lithotripsy Management of Clients with Renal
Calculi
 Extraneous Variables: Socio Demographic Variables such as age, sex,
religion, type of family, family income, education of father, occupation of
father, source of Health information, area of residency, previous
Knowledge regarding Extracorporeal Shock wave Lithotripsy
Management of Clients with Renal Calculi.
8. PLAN FOR DATA ANALYSIS
 Descriptive statistics: The Descriptive Statistical analysis includes
Frequencies, Percentages, Means and Standard Deviation for the Final year
GNM Nursing students regarding Extracorporeal Shock wave Lithotripsy
Management of Clients with Renal Calculi.
 Inferential Statistics: Difference in Knowledge and attitude score will be
analyzed by using independent t-test and association between
demographical variables of final year GNM Nursing Students regarding
Extracorporial Shock wave Lithotripsy Management of Clients with Renal
Calculi will be analyzed using Person chi-square test/ Yates Corrected Chi-
square test.

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9. ETHICAL CONSIDERATION:
 DOES THE STUDY REQUIRE ANY INTERVENTIONS TOBE
CARRIED OUT ON PATIENTS OR OTHER HUMANS?
YES. The study requires educational Interventions to be conducted on Final
year GNM Nursing Students and consent has been obtained.
 HAS ETHICAL CLEARANCE BEING OBTAINED FROM YOUR
INSTITUTIONS?
YES. Ethical clearance has being obtained from research committee of
Vivekananda college of Nursing Chitradurga.
 HAS THE ETHICAL CLEARANCE TAKEN FROM THE HAED OF
THE SELECTED SCHOOL OF NURSING CHITRADURGA?
YES. Ethical consideration has been taken from the head of the selected
School of Nursing at Chitradurga.

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10. LIST OF REFERENCES :
1. Lewis H elkenper, Dirksen O Brein. Text book of Medical surgical
nursing.7th Edition. New Delhi: Mosby publication; 2007 page no: 233.
2. Brunner,Suddarths. A text book of medical surgical volume-2.2014
:Page no-1375
3. available in the URL https://en.wikipedia.org/wiki/Lithotripsy
4. available in the URL http://medical
dictionary.thefreedictionary.com/lithotripsy
5. available in the URL
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931286/
6. Available from URL http://www.sciencedaily.
com/releases/2008/05/080515072740.htm
7. Availablefrom =
URL.http://www.ijournalhs.org/article.asp?issn=2349-
5006;year=2014;volume=7;issue=2;spage=83;epage=87;aulast
8. Karyn Maier. Extracorporeal shock wave lithotripsy. emedicine urology
.2010 September 29; p. :327-330.
9. avilable in the URL http://urology.ufl.edu/patient-care/stone-
disease/procedures/extracorporeal-shock-wave-lithotripsy-eswl/
10. Yinghao S,Yang B, Gao X. The Management Of Renal Caliceal Calculi
With A Newly Designed Ureteroscope: a rigid ureteroscope with a
deflectable tip. J Endourol. [abstract] 2010 Jan [2011 Oct 28]; 24(1): 23-
6..
11. Extracorporeal Shock Wave Lithotripsy (ESWL) For Kidney Stones. An
Alternative to Surgery? [abstract]. [Cited 2011Nov 04]; 6(1):80-7.
Available from:
URL:http://www.springerlink.com/content/vg7618371r432668/
12. Tschöpe W, Ritz E, Haslbeck M, Mehnert H, Wesch H. Prevalence and
incidence of renal stone disease in a German population sample. Klin
Wochenschr. 1981 Apr15;59(8):411-412. PubMed
13. Trinchieri A, Montanari E. Prevalence of renal uric acid stones in the
adult. Urolithiasis. 2017 Mar 3; doi: 10.1007/s00240-017-0962-5

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14. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan
Y.Epidemiology of stone disease across the world. World J Urol. 2017
Feb 17; doi:10.1007/s00345-017-2008-6.
15. Ahmad F, Nada MO, Farid AB, Haleem MA, Razack SM.
Epidemiology of urolithiasis Saudi Arabia in with emphasis on
ultrasound detection. Saudi J Kidney Dis Transpl. 2015 Mar;26(2):386-
91.
16. Aslin Shamema A, Thanigai Arul K, Senthil Kumar R, Narayana
Kalkura S.Physicochemical analysis of urinary stones from Dharmapuri
district. Spectrochim Acta A Mol Biomol Spectrosc. 2015 Jan
5;134:442-8.
17. Abhishek, Kumar J, Mandhani A, Srivastava A, Kapoor R, Ansari MS.
Pediatric urolithiasis: experience from a tertiary referral center. J Pediatr
Urol. 2013Dec;9(6 Pt A):825-30
18. Robert A. Riehle, William R. Fair, E. Darracott Vaughan.
Extracorporeal Shock-Wave Lithotripsy for Upper Urinary Tract
Calculi. The journal of american medical association. 2006;page:255-
256
19. Simunovic D, Sudarevic B, Galic J, Extracorporeal Shockwave
Lithotripsy in Elderly: Journal of Endourology, 2010 Nov;24(11):1831-7
20. James E. Lingeman, John R. Woods, Phillip D. . Blood Pressure
Changes Following Extracorporeal Shock Wave Lithotripsy and Other
Forms of Treatment for Nephrolithiasis. The journal of american
medical association 2000;263 (15):2043-20
21. Istanbulluoglu MO, Hoscan MB, Tekin MI, Cicek T, Ozturk B,
Ozkardes H. Shock wave lithotripsy for distal ureteric stones: supin or
prone. Urological research. 2010 Oct; 21168(4 Pt 1):1307-14.
22. Dr. Francis Lee. Updated on the management of uretenic stones.Urol
J.2 008. May; Vol 13 pageNo : 511-12
23. Lam JS, Greene TD, Gupta M. the safety and efficacy of ureteroscopy
with intracorporeal holmium:YAG laser lithotripsy and ESWL. .J
Urol. 2002 May;167(5):1972-6.
24. Streem SB. Contemporary clinical practice of shock wave lithotripsy:
are evaluation of contraindications. J Urol. 1997 Apr;157(4):1197-203

22
25. Rassweiler JJ, Renner C, Chaussy C, Thüroff S. Treatment of renal
stones by extracorporeal shockwave lithotripsy: an update. Eur Urol.
2001 Feb;39(2):187-99.
26. Available From: URL:http://www.ncbi.nlm.nih.gov/pubmed/3520015
Extracorporeal shock wave lithotripsy the Methodist hospital of Indiana
Experience. J Urol [abstract] 1986 Jun. [cited 2011 Nov 02];
135(6):1134
27. Pankaj N, Maheshwari, Hemendra N. In-Situ Holmium Laser
Lithotripsy for Impacted Urethral Calculi. Journal of Endourology
[abstract] 2005 Oct [cited 2011 Oct 20]; 19(8):1009-11.

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 ETHICAL COMMITTEE CLEARANCE

1. TITLE OF THE DISSERTATION: “A study to assess the effectiveness of

structured teaching programme on
knowledge regarding extracorporeal shock
wave lithotripsy management of clients
with renal caluculi among final year GNM
nursing students in selected school of
nursing at chitradurga.”
2. NAME OF THE CANDIDATE: Mr. SHIVAKUMAR H R
1ST Year M.Sc NURSING
Vivekananda college of Nursing
Chitradurga.
3. SUBJECT : MEDICAL SURGICAL NURSING
4. NAME OF THE GUIDE : Mr.
HOD of Medical Surgical Nursing
Vivekananda College Of Nursing
Basappa Multy Specialty Hospital Campus
Turuvanur Road, Chitradurga-577501
5. APPROVED/NOT APPROVED:
(If not approved, suggestion)
Prof.
Principal,
Vivekananda College Of Nursing
Basappa Multy Specialty Hospital Campus
Turuvanur Road, Chitradurga-577501

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13. SIGNATURE OF THE CANDIDATE

14. REMARKS OF THE GUIDE The topic selected for the study is relevant

NAME & DESIGNATION OF (IN

BLOCK LETTERS)

15. MR.
15.1. GUIDE

HOD OF MEDICAL SURGICAL NURSING DEPT

15.2. SIGNATURE
15.3. CO-GUIDE (IF ANY)

15.4. SIGNATURE
15.5. HEAD OF THE DEPARTMENT MR.

15.6. SIGNATURE HOD OF MEDICAL SURGICAL NURSING DEPT

16.1. REMARKS OF PRINCIPAL
16. The topic selected for the study is relevant
16.2. SIGNATURE

25