Study Effectiveness Of Nebulization Improving Childrens Respiratory Status Nursing Essay

Study Effectiveness Of Nebulization Improving Childrens Respiratory Status Nursing Essay Data analysis is the systematic organization and synthesis of research data and testing of research hypothesis using those data. Interpretation is the process of making sense of the result and examining their implication (Polit, 2004). Analysis is the method of rendering qualitative data meaningful and providing intelligible information, so that the research problem can be studied and tested, including the relationship between the variables. The study was conducted among children with wheezing to compare the effectiveness of nebulization with oxygen and without oxygen in improving their respiratory status. The data was collected, assembled, analyzed and tested and the findings based on the analysis are presented in this chapter. 4.1 Demographic Variables of Children with Wheezing: The age of the children with wheezing ranged between one month to five years. Out of this, 8 (16%) children were between the age group of one month to one year, 17 (34%) were between 1-3 years and 25 (50%) were between the age group of 3-5 years. Majority of the children were males (62%) and female children were 38%. 34 (68%) children belonged to nuclear family whereas 16 (32%) children belonged to joint family. LPG was used as the cooking fuel in all (100%) the houses (Table 4.1). 4.2 Family History of Smoking Habits: In nebulization with oxygen group, 5(20%) children had the family history of smoking habit. For majority (4) of children, grandfather was the person who smokes and for one child father was the smoking person. In nebulization without oxygen group, fathers of 3(12%) children smoke in the family (Table 4.2). 4.3 Family History of Respiratory Diseases: 5 (20%) children in the nebulization with oxygen group had a family history of asthma, out of which one person is on regular treatment. In nebulization without oxygen group, 5(20%) children had a family history of asthma and 3(12%) had a family history of COPD, out of which one person is on regular treatment (Table4.3). 4.4 History of Respiratory Diseases in Children: With regard to previous history of respiratory diseases, majority (64%) of children had wheeze associated lower respiratory infection (WALRI) in nebulization with oxygen group whereas in nebulization without oxygen group, 15 (60%) children had WALRI, .6 (24%) children had hyper reactive airway disease (HRAD) and 3 (12%) children had asthma in nebulization with oxygen group , whereas in nebulization without oxygen group,7 (28%) children had asthma and 3 (12%) had HRAD (Table.4.4). About the onset of respiratory diseases, 14 (56%) children developed respiratory diseases before 1year of age and 5 (20%) children developed between the age group of 1-2 years in nebulization with oxygen group whereas in nebulization without oxygen group, 10 (40%) children developed before 1year of age and 7 (28%) children developed between 1-2 years of age (Table.4.4). Regarding the duration of the disease, 14 (56%) children had the duration of disease less than a year and 6 (24%) had the duration between1-2 years in nebulization with oxygen group whereas in nebulization without oxygen group, 11 (44%) children had duration of less than 1 year and 8 (32%) had the duration between 1-2 years (Table.4.4). With regard to the regularity of the treatment, 3(12%) children in the nebulization with oxygen group and 6 (24%) children in the nebulization without oxygen group were on regular treatment. All these children were using inhalers. Majority of the children (66.66%) were using a combination of salbutamol -fluticosone inhaler in both groups and the rest (33.33%) were using asthalin alone (Table.4.4). 4.5 Immunization History: All the children (100%) in both groups were completely immunized. 4.6 Pre assessment of Respiratory Parameters in Nebulization with Oxygen Group: The initial assessment of respiratory rate of children in nebulization with oxygen group showed that 6 (24%) children were in mild distress, 6 (24%) children were in moderate distress and 13 (52%) children were in severe distress. In the assessment of oxygen saturation, 20 (80%) children had mild desaturation (95-97% in room air) and 5 (20%) children had moderate desaturation (90-94%in room air).In the initial assessment of wheezing, 12 (48%) children were having wheezing on terminal expiration and 13 (52%) children were having wheezing on entire expiration.The assessment of retraction showed that 16 (64%) children were normal, 8(32%) children had intercostal retractions and 1 (4%) child had intercostal and substernal retractions..In the initial dyspnoea assessment, 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.5). 4.7 Pre assessment of Respiratory Parameters in Nebulization without Oxygen Group: The initial respiratory rate assessment of children in nebulization without oxygen group showed that 10 (40%) children were in mild distress, 8 (32%) children were in moderate distress and 7 (28%) children were in severe distress. In the assessment of oxygen saturation, 22 (88%) children had mild desaturation (95-97% in room air) and 3 (12%) children had moderate desaturation (90-94%in room air). In the initial assessment of wheezing, 17 (68%) children were having wheezing on terminal expiration and 8 (32%) children were having wheezing on entire expiration. Initial retraction assessment showed that 18 (72%) children had intercostal retractions and 7 (28%) children had intercostal and substernal retractions. In the assessment of dyspnoea, 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.6). 4.8 Implementation of Therapies among Children with Wheezing: 4.8.1 Administration of nebulization with oxygen: Nebulization with oxygen was provided to 25 children with wheezing who were prescribed for Combimist nebulization in the OPD. Nebulization was provided by the staff nurse for a period of 15-20 minutes. Children who were on treatment prior to the nebulization were not included in the study. Assessment was done before and after nebulization with oxygen. 4.8.2 Administration of nebulization without oxygen: Nebulization without oxygen was provided by the staff nurse to 25 children with wheezing who were prescribed with Combimist (Salbutamol+ Ipravent) nebulization in the OPD. Nebulization was provided for a period of 15-20 minutes. Children who were on treatment prior to the nebulization were not included in the study. Assessment was done before and after nebulization with oxygen. 4.9: Post assessment of Respiratory Parameters in Nebulization with Oxygen Group: 4.9.1 Post Assessment at 5 Minutes: In the post 5 minutes assessment of respiratory rate of children in nebulization with oxygen group,1 (4%) child reached normal ,7 (28%) children were in mild distress,5 (20%) children were in moderate distress and 12 (48%) were in severe distress. In the assessment of oxygen saturation, 4 (16%) children reached normal saturation, 17 (68%) children had mild desaturation (95-97% in room air) and 4 (16%) children had moderate desaturation (90-94%in room air). Wheeze assessment showed that 1 (4%) child became normal, 13 (52%) children were having wheezing on terminal expiration and 11 (44%) children were having wheezing on entire expiration. In the assessment of retraction, 16 (64%) children were normal, 8 (32%) children had intercostal retractions and 1 (4%) child had intercostal and substernal retractions.In the dyspnoea assessment, 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.5). 4.9.2 Post Assessment at 10 Minutes: In the post 10 minutes assessment of respiratory rate of children,1 (4%) child reached normal ,8 (32%) children were in mild distress,7 (28%) children were in moderate distress and 9 (36%) were in severe distress. Assessment of oxygen saturation revealed that 13 (52%) children were having normal saturation, 11 (44%) children had mild desaturation (95-97% in room air) and 1 (4%) child had moderate desaturation (90-94%in room air). In the assessment of wheezing, 10 (40%) children were relieved from wheezing, 11 (44%) children were having wheezing on terminal expiration and 4 (16%) children were having wheezing on entire expiration. Assessment of retractions showed that 21 (84%) children became normal, 4 (16%) children had intercostal retractions.In the dyspnoea assessment, 22 (88%) children were having no dyspnoea and 3 (12%) children were having mild dyspnoea (Table 4.5). 4.9.3 Post Assessment at 15 Minutes: Post 15 minutes assessment of respiratory rate showed that 5 (20%) child reached normal ,5 (20%) children were in mild distress,9 (36%) children were in moderate distress and 6 (24%) were in severe distress. In the assessment of oxygen saturation, 17 (68%) children reached normal saturation, 8 (32%) children had mild desaturation (95-97% in room air). In the assessment of wheezing, 12 (48%) children were relieved from wheezing, 12 (48%) children were having wheezing on terminal expiration and 1(4%) child was having wheezing on entire expiration. The assessment of retractions revealed that 23 (92%) children became normal, 2 (8%) children had intercostal retractions.Dyspnoea assessment showed that 23 (92%) children became normal and 2 (8%) children were having mild dyspnoea (Table 4.5). 4.9.4 Post Assessment at 30 Minutes: Post 30 assessment of respiratory rate showed that 11 (44%) child reached normal, 7 (28%) children were in mild distress, and 4 (16%) children were in moderate distress and 3 (12%) were in severe distress. In the assessment of oxygen saturation, 19 (76%) children reached normal saturation, 5 (20%) children had mild desaturation (95-97% in room air) and 1 (4%) child had moderate desaturation. In the assessment of wheezing, 14 (56%) children were relieved from wheezing, 11 (44%) children were having wheezing on terminal expiration. The assessment of retractions showed that 24 (96%) children became normal, 1 (4%) children had intercostal retractions. Dyspnoea assessment revealed that 23 (92%) children reached normal and 2 (8%) children were having mild dyspnoea (Table 4.5). 4.10 Post assessment of Respiratory Parameters in Nebulization without Oxygen Group: 4.10.1 Post Assessment at 5 Minutes: Post assessment of respiratory rate showed that 11 (44%) children were in mild distress, 8 (32%) children were in moderate distress and 6 (24%) were in severe distress. In the assessment of oxygen saturation, 1 (4%) child reached normal, 21 (84%) children had mild desaturation (95-97% in room air) and 3 (12%) children had moderate desaturation (90-94%in room air).Assessment of wheezing showed that 2 (8%) children became normal, 15 (60%) children were having wheezing on terminal expiration and 8 (32%) children were having wheezing on entire expiration. In the assessment of retraction, 19 (76%) children had intercostal retractions and 6 (24%) children had intercostal and substernal retractions. Dyspnoea assessment showed that 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.6). 4.10.2 Post Assessment at 10 Minutes: Post 10 minutes assessment of respiratory rate revealed that 4 (16%) children reached normal rate, 10 (40%) children were in mild distress,7 (28%) children were in moderate distress and 4 (16%) were in severe distress. In the assessment of oxygen saturation, 7 (28%) children reached normal, 15 (60%) children had mild desaturation (95-97% in room air) and 3 (12%) children had moderate desaturation (90-94%in room air). Assessment of wheezing showed that 16 (64%) children became normal, 4 (16%) children were having wheezing on terminal expiration and 5 (20%) children were having wheezing on entire expiration. In the assessment of retraction, 22 (88%) children became normal and 3 (12%) children had intercostal retractions. Dyspnoea assessment revealed that, 3 (12%) children were having mild dyspnoea and 22 (88%) children became normal (Table 4.6). 4.10.3 Post Assessment at 15 Minutes: In the post assessment of respiratory rate,9 (36%) children reached to normal rate, 7 (28%) children were in mild distress, 5 (20%) children were in moderate distress and 4 (16%) were in severe distress. The post assessment of oxygen saturation showed that 10 (40%) children reached normal, 13 (52%) children had mild desaturation (95-97% in room air) and 2 (8%) children had moderate desaturation (90-94%in room air). Wheeze assessment at 15 minutes showed that 19 (76%) children became normal, 6 (24%) children were having wheezing on terminal expiration. In the assessment of retraction, 24 (96%) children became normal, 1 (4%) children had intercostal retractions. Evaluation of dyspnoea revealed that 2 (8%) children were having mild dyspnoea and 23 (92%) children were normal (Table 4.6). 4.10.4 Post Assessment at 30 Minutes: Post assessment of respiratory rate showed that 13 (52%) children reached normal rate, 7 (28%) children were in mild distress, 2 (8%) children were in moderate distress and 3 (12%) were in severe distress. In the assessment of oxygen saturation, 10 (40%) child reached normal, 13 (52%) children had mild desaturation (95-97% in room air) and 2 (8%) children had moderate desaturation (90-94%in room air). In the assessment of wheezing, 19 (76%) children became normal, 6 (24%) children were having wheezing on terminal expiration. Assessment of retraction revealed that 24 (96%) children had no retractions, 1 (4%) children had intercostal retractions.Dyspnoea assessment showed that1 (4%) child was having mild dyspnoea and 24 (96%) children became normal (Table 4.6). 4.11 Comparison of Mean Difference of Pre and Post Assessment of Respiratory Parameters in Nebulization with Oxygen Group and Nebulization without Oxygen Group: 4.11.1 Mean Difference of Respiratory Rate in Nebulization with Oxygen Group and Nebulization without Oxygen Group: In nebulization with oxygen group, the pre mean values of respiratory rate was 41.68 and post mean value at 5 minutes was 40.4.Post mean values at 10 minutes was 37.76, at 15 minutes was 35.6 and at 30 minutes was 32.8. The mean difference between pre and post respiratory rate at 30 minutes was 8.88. This shows a significant reduction in respiratory rate after nebulization with oxygen. The pre mean value of respiratory rate in nebulization without oxygen group was 36.64 .The post mean value of respiratory rate at 5 minute was 36, at 10 minutes was 34.32, at 15 minutes was 32.48 and at 30 minutes was 30.96. The mean difference between pre and post respiratory rate at 30 minutes was 5.68. This shows a reduction in respiratory rate after nebulization without oxygen. Therefore, it can be inferred that the mean difference was high in nebulization with oxygen group comparing to nebulization without oxygen group. This showed that nebulization with oxygen is effective in reducing tachypnea among children with wheezing (Table 4.7). 4.11.2 Mean Difference of Oxygen Saturation in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Oxygen saturation above 98% in room air is considered as the normal saturation level. The pre mean value of oxygen saturation in nebulization with oxygen group was 95.24. The post mean value of oxygen saturation at 5 minute was 96, at 10 minutes was 97.24, at 15 minutes was 98.08 and at 30 minutes was 98.32. The mean difference between pre and post oxygen saturation at 30 minutes was 3.08. This shows an improvement in oxygen saturation after nebulization with oxygen. The pre mean value of oxygen saturation in nebulization without oxygen group was 95.72 .The post mean value of oxygen saturation at 5 minute was 95.88, at 10 minutes was 96.68 at, 15 minutes was 97.36 and at 30 minutes was 97.08. The mean difference between pre and post respiratory rate at 30 minutes was 1.36. Therefore, it can be inferred that the mean difference was high in nebulization with oxygen group comparing to nebulization without oxygen group. This showed that nebulization with oxygen is effective in improving the oxygen saturation among children with wheezing (Table 4.7). 4.11.3 Mean Difference of Wheeze Score in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Auscultation of normal vesicular breath sounds is considered as normal. The pre mean value of wheeze score in nebulization with oxygen group was 1.52. The post mean value of wheeze score at 5 minute was 1.4, at 10 minutes was 0.72, at 15 minutes was 0.56 and at 30 minutes was 0.44. The mean difference between pre and post wheeze score at 30 minutes was1.08. This showed an improvement in wheeze score after nebulization with oxygen. The pre mean value of wheeze score in nebulization without oxygen group was 1.32. The post mean value of wheeze score at 5 minute was 1.12, at 10 minutes was 0.56, at 15 minutes was 0.24 and at 30 minutes was 0.24. The mean difference between pre and post wheeze score at 30 minutes was 1.08. This showed that there was no mean difference in wheeze score in nebulization with oxygen group and nebulization without oxygen group. Hence, nebulization with oxygen and nebulization without oxygen has similar effect in reducing wheeze score among children with wheezing (Table 4.7). 4.11.4 Mean Difference of Retraction Score in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Observation of normal chest movements is considered as normal. In nebulization with oxygen group, the pre mean value of retraction score was 0.4. The post mean value of retraction score at 5 minute were 0.4, at 10 minutes was 0.16, at 15 minutes was 0.08 and at 30 minutes was 0.04. The mean difference between pre and post wheeze score at 30 minutes was 0.36. This showed an improvement retraction score in nebulization with oxygen group. The pre mean value of retraction score in nebulization without oxygen group was 0.28. The post mean value of retraction score at 5 minute was 024, at 10 minutes was 0.12, at 15 minutes was 0.04 and at 30 minutes was 0.04. The mean difference between pre and post retraction score at 30 minutes was 0.24. This showed that there was no mean difference in retraction score in nebulization with oxygen group and nebulization without oxygen group. Hence, nebulization with oxygen and nebulization without oxygen has similar effect in reducing retraction score among children with wheezing (Table 4.7). 4.11.5 Mean Difference of Dyspnoea Grade in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Grade 0 is regarded as absence of dyspnoea. In nebulization with oxygen group, the pre mean value of dyspnoea grade was 0.2. The post mean values of dyspnoea grade at 5 minute were 0.2, at 10 minutes was 0.12, at 15 minutes was 0.08 and at 30 minutes was 0.08. The mean difference between pre and post dyspnoea grade at 30 minutes was 0.12. This showed an improvement in dyspnoea grade in nebulization with oxygen group. The pre mean value of dyspnoea grade in nebulization without oxygen group was 0.2. The post mean values of dyspnoea grade at 5 minute was 0.2, at 10 minutes was 0.12 ,at 15 minutes was 0..08 and at 30 minutes was 0..04. The mean difference between pre and post dyspnoea grade at 30 minutes was 0.16. Hence the result highlighted that the mean difference was slightly higher in nebulization without oxygen comparing to nebulization with oxygen. This showed that nebulization with oxygen had similar effect in reducing dyspnoea grade among children with wheezing (Table 4.7). 4.12. Effectiveness of Nebulization with Oxygen in Improving the Respiratory Parameters among Children with Wheezing through Pairedt test Analysis: Paired t test was used to assess the differences in pre and post assessments of respiratory parameters among nebulization with oxygen group. (Table 4.8). 4.12.1 Comparison of Pre and Post 5 Minutes, 10 Minutes, 15 Minutes and 30 Minutes Assessment of Respiratory Rate in Nebulization with Oxygen Group: Hypothesis: There will be a significant difference in pre and post assessment of respiratory rate in nebulization with oxygen group. t = t5min = =2.67 t10min = =5 t15min = =7.89 t30min= =12.94 The calculated values of t at 5,10,15 and 30 minutes are 2.67, 5, 7.89 and 12.94 respectively which are greater than the tabulated value at p