| Post Haemodialysis respiratory complication can be decrease by respiratory muscle training and health education. These changes can be applied more effectively if the patients involve actively in the process. therefor a nurse led respiratory muscle training after haemodialysis in India could be used as an intensive approach to reduce the complication and improve the functional outcome.
STEP 1: Enrolment The patients fulfilling the inclusion criteria in the nephrology department of selected tertiary care
teaching hospital will be recruited for the present study. Informed written consent will be
obtained from the patients for conducting the study, and the patients will be informed about the
intervention.
STEP 2: Baseline Data collection The baseline data will be collected from the enrolled patients which will include the Socio
demographic Variables, Clinical information sheet, 6 minute walk test, breath holding test ,
pulmonary function test , (MIP+MEP). Firstly data will be collected from the control group after
completion of collection interventional group data will be collected to avoid contamination.
STEP 3: Non Randomization Allocation Participants will be assigned into intervention and control group equally .
STEP 4: Intervention The control group will be given standard haemodialysis care .
The interventional group will receive the nurse led respiratory muscle training along with the
standard treatment which includes the following exercises:
ï‚· Deep breathing exercise Deep breathing exercises, scientifically termed diaphragmatic breathing, involve
engaging the diaphragm, the primary muscle responsible for respiration, to facilitate
efficient inhalation and exhalation. I will ask my patients to perform this technique:
Find a comfortable, quiet place to sit or lie down. Sit in a chair with your feet flat on the
floor or lie down on your back with a pillow under your head and knees for support.
Place one hand on your chest and the other hand on your abdomen, just below your rib
cage, to monitor your breathing patterns.
Inhale slowly and deeply through your nose. As you inhale, focus on expanding your
abdomen rather than raising your chest. This allows the diaphragm to descend and create
more space for the lungs to fill with air. You should feel your abdomen rise and your
lower hand move outward while keeping your upper hand relatively still. Once you’ve
inhaled fully, pause for a moment to hold the breath. This pause allows for oxygen
absorption and provides a brief moment of relaxation.
Exhale slowly and completely through your mouth. As you exhale, gently contract your
abdominal muscles to facilitate the release of air from the lungs. You should feel your
abdomen fall and your lower hand move inward. Repeat this cycle of deep breathing for
several minutes, aiming for a smooth, rhythmic pattern of inhalation, brief pause, and
exhalation.
As you continue with the exercise, try to focus your attention solely on your breathing,
letting go of any distracting thoughts or external stimuli.
 Incentive Spirometary I will ask the patients to perform deep breathing Exercise. Patient will follow these steps – Positioning: Sit up straight or recline slightly in a comfortable position. Make sure your feet
are flat on the floor or supported, and your back is well-supported. Patients will Hold the
incentive spirometer upright, ensuring the tubing is free from kinks or obstructions. Adjust
the flow rate indicator to the appropriate level, - Place the mouthpiece securely in your mouth, forming a tight seal around it with your
lips. - Inhale slowly and deeply through the mouthpiece, focusing on expanding your lungs as
much as possible. - Aim to raise the floating marker or indicator to the prescribed level on the spirometer.
This provides visual feedback on your inhalation effort. Hold your breath for 2-3 seconds at the peak of your inhalation, maintaining lung
expansion. - Exhale slowly and steadily, either through the mouthpiece or normally.
The exercise routine involves performing exercises for 20 minute and twice a day (morning
and evening), with each session lasting 5 minutes and including 1 minute of rest between
exercises. Participants will be demonstrated the exercise at haemodialysis unit ask the patients to
redemonstrate the exercise Patients will be asked to do Exercise at home for 20 minute twice
a day . As patients will come to haemodialysis unit weekly I will resolve the doubt of the
patients for exercise and reinforce the patients for the exercise continuation. As part of my research investigating the efficacy of home-based exercise, participants will
kindly request my participants in maintaining a detailed exercise log. Which will help in
follow up of participants?
I will ask my participants to record the following parameters for each exercise session: 1. Date 2. Time of Day 3. Exercise Type 4. Duration 5. Rest Intervals 6. Any Variations or Modifications 7. Subjective Notes on Perceived Exertion or Comfort
STEP 5: Post-intervention data collection Respiratory muscle capacity and strength will be evaluated after 8 week of intervention.
Respiratory muscle capacity will be assess by PFT and 6 minute walk test and respiratory muscle
strength will be assess by the MIP+MEP and breath holding time.
STEP 6: Data analysis Thereafter, collected data will be coded and entered in master sheet for analysis. Data analysis
will be done with the help of SPSS 24. Descriptive and inferential statistics will be used for data
analysis .
Duration of study The study will be completed in a period of 1 year.
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