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Introduction:

Urolithiasis is formation of calculi at any
part of the urinary system. Between 1% and 15% of people globally are affected
by kidney stones at some point in their life (Morgan, and Pearle, 2016). In 2013, 49
million cases occurred (Naghavi,
et al., 2014), resulting in about
15,000 deaths (Vos  et al.,2015). Urolithiasis is the
more painful urological diseases among Egyptian older adults, it is responsible
45% of urological hospital admissions per year and approximately about 800,000 older
patients were diagnosed and hospitalized with renal calculi (El-Sharqawy
and Ewis, 2002). The objective of nephrolithiasis calculi management
among the patients is to achieve high rate of calculi clearance with less
complications to the patients.

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            Before
the appearance of extracorporeal shockwave lithotripsy (ESWL) in 1980, the only
treatment available for calculi that could not pass through the urinary tract
was open surgery. Since then, ESWL has become the first line of treatment and preferred
technique by urologists for renal and ureteral stone. Works best with stones in
the upper ureter between 0.4mm and 2 cm in diameter (Hayes et al., 2015).
About 80
to 85% of simple renal calculi can be effectively treated with ESWL (Miller &Lingeman, 2007).  It is an effective procedure for managing
85-90% of upper urinary tract stones.  Compared with open and endoscopic procedures,
ESWL is outpatient procedure, easy to apply, minimally invasive, exposes
patients to fewer anesthesia, and less complications rates (Haecker &
Wess, 2010; Chandhoke, 2007).  Nevertheless, occasional side effects such as
hematoma, petechial bleedings, interactions with cardiac rhythm etc. are
reported.

Extracorporeal shock-wave lithotripsy is a
method by which stones in the urinary tract are broken down. The shock-waves
produced by the machine are carefully focused on to the area with the use of
ultrasound or x-ray imagine. The waves travel through tissues without causing
permanent damage and break up the stone into sand like gravel or small pieces.
This material will then pass out in your urine over a period of time. It is the
most widely performed procedure for stone treatment, treating all size and locations
of stones. It works best with kidney stones
of less than 2.5 cm in size, proximal ureter stones and distal ureter stones
ranged from 0.4 to2 cm (AL-Hakary et al., 2016;
Urology, O. and Mohd et al., 2006). 

ESWL is a noninvasive surgical procedure. Hospital anxiety and surgery fear
are common among the most of patients, especially for the patient who hasn’t previous
experience, but some people become so anxious, these normal fears turn into Claustrophobia from procedure (Aman,
20013).  Anxiety
has been associated with several pathophysiological responses such as
hypertension and dysrhythmias,
elevated temperature, sweating, nausea. It may cause vasoconstriction,
which makes it difficult for the hospital staff to obtain blood, so the
high anxiety can increase postoperative complications.(John,
(2009).

It is often helpful for The patients
suffer from anxiety about surgery to express their fears to health care
workers. This can be especially beneficial for patients who are having a
high-risk procedure. The nurse and other health team must play an active role
in reassuring and managing anxiety by advising the patient to trust on himself
and his surgeon and give him full information about the nature of procedure,
preoperative preparation, anesthesia methods, and ideal behaviors during postoperative
management (Aman, 20013 6; Pritchard, 2009). The
family should be included in psychological preoperative care to maximize
feeling of patient security. Patients and families who are prepared
psychologically tend to do well in the patient’s postoperative course (Townsend & Beauchamp et al., 2015.)

Preoperative patient teaching can reduce
potential problems through provision of anticipatory knowledge on necessary
preparations and the procedures. It directly impacts patient safety and became
part of the standard care emphasized by the Joint Commission (The Joint
Commission. Ambulatory Health Care: 2011). Preoperative teaching must meet
the patient’s need for information related to the surgical procedure, which may
help in alleviating most of his or her fears, and improve surgical outcome (Lubin et al., 2013).

Patients must be
educated about management of postoperative pain. They should be advised to ask
the analgesic before the pain become severe. They are taught about rating their
pain on pain scale, this help the health team in evaluating degree of their
pain, they also taught about none pharmacological methods for pain control (wicker , 2010).

There are a very few researches about
the effect of education on patient knowledge, anxiety level, claustrophobia and
postoperative pain,  so the current study
examine The Effect of Pre-Procedure teaching for patients undergoing  First Session of Shock Wave Lithotripsy
on  Anxiety levels, Pain Perception, and
claustrophobia.

Significance
of the study

 In the current time,
the extracorporeal shock waves lithotripsy (ESWL) is considered the first line
therapy for upper urinary tract calculi (Lingeman et al., 2009).
Little researches were conducted about its advantages, necessary preparations,
precautions before, during and after procedure and the instructional plan to
prevent further urinary calculi (Mohamed et al., 2015).  SWL procedure can cause significant anxiety
which may affect pain perception and influencing the success of the SWL
treatment by decreasing patient compliance (Ngee-Ming, 2014).
Little clinical data are available about pre-procedure teaching and its effect
on   pre-procedure anxiety that may
affect the pain perception and patient compliance. The aim of this study was to
evaluate the effect of Pre-procedure teaching for patients undergoing first
session of shock wave lithotripsy on patients’ anxiety level, claustrophobia,
pain perception, and patient compliance. 

Aim of the study

The
aim of the present study is to evaluate the effect of Pre-procedure teaching
for patients undergoing first session of shock wave lithotripsy on patients’ anxiety
level, pain perception, and claustrophobia.

 

Hypotheses

Patients
who take pre-procedure teaching module will report high level of knowledge as
compared to
control group. 
Patients
who take pre-procedure teaching module will report a decrease in anxiety score at   first
session of shock wave lithotripsy as compared to control group.
Patients
who take   pre-procedure teaching module
will experience a decrease in pain score during sessions of shock wave
lithotripsy and post sessions as compared to control group.
Score
and levels of claustrophobia will be lower for patients who take the pre-procedure
teaching module regarding shock wave lithotripsy as compared to control group
at first session.

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