Abstract: A decrease in pulmonary function is well known after open heart surgery. Roentgenological signs of atelectasis are common, reduced lung volumes and oxygenation in the post-operative period. Post-operative treatment includes early mobilization, change of position, breathing exercises and coughing techniques. Various mechanical devices have been used in order to improve post-operative pulmonary function, for example incentive spirometry, continuous positive airway pressure and intermittent positive pressure breathing and blow bottle device. The blow bottle is another technique to produce expiratory resistance and the initial rationale for the technique was to expand the lungs.
Design A quasi –experimental design.
Setting, The study was conducted in postoperative intensive care unit of Assiut university hospitals. Subject,a convenience sample of 50 adult open heart patients of both sexes.
Group1 (conservative therapy), and group2 (blow bottle)] 25 patients for each.
Tools, Two tools were developed in this study, tool one (Patient's socio demographic characteristics and health status tool among open heart patients),tool two (Observation checklist for post-operative pulmonary complications among open heart surgical patients).
Result of this study revealed that a statistical significant difference was found between the two groups regarding to atalectasis p (0.044). As regard pulmonary secretion it was noticed that percent 72% of patients in group 1(incentive spirometer), while 60% of patients having pulmonary secretion in group 2(blow bottle).
Conclusion of this study illustrated that a positive effects of PEP (blow bottle)than conservative therapy on occurrence of pulmonary complications among open heart patients postoperatively. Patients who performed deep breathing exercises with a blow bottle device postoperatively showed a significantly smaller amount of secretions and atelectasis, improved oxygenation and had less reduction in FVC and FEV1 on the fourth postoperative day compared to conservative therapy .
Recommendations, Explain to the nurse the deference between deep breathing exercise alone and deep breathing exercise with anther maneuver such as blow bottle device, and the effectiveness on respiratory system for preventing respiratory complications.

Tracheostomy is performed in Patients with multiple trauma can be liberated from mechanical ventilation rapidly and be transferred out of the ICU in a shorter time (1.). One of the greatest contributions the nurse can make to decreasing costs, length of stay, and mortality in patients with respiratory problems is to implement interventions that will prevent or minimize complication (2). Nursing guidelines is to outline the principles of management for patients with a new or existing tracheostomy for clinicians at the trauma ICU (3).

Aim:

this study was carried out to investigate Impact of nursing practice guidelines for early tracheostomy management in mechanically ventilated trauma patient.

Design:

a quasi-experimental design.

Setting:

trauma ICU at Assiut University Hospitals. patients: A convenience sample of 60 patients in trauma ICU They were divided into two equals group 30 patients for each group–first group which tracheostomy was performed within the first 7 days of initiation of mechanical ventilation and the late tracheostomy group which tracheostomy was performed after 7 days of initiation of mechanical ventilation at any time.

Methods:

Both groups were evaluated daily during the three shifts using nursing guidelines. Assessment of tracheal secretions was done to detect any abnormalities in the amount, color and consistency was assessed every shift. Laboratory investigations (ABGs) were done daily from the 1st day of admission and until the 7th day of the study. Total leukocytes count and serum hemoglobin was done at the time of admission and repeated at the 4th, 7th and when needed. Culture of the respiratory secretions was done twice …

Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma us a result of liver failure. In the advanced stages it is called hepatic coma. It may ultimately lead to death. It is caused by accumulation in the blood stream of toxic substances that are normally removed by-the liver. Standards of nursing care provide the required knowledge and skills that can be used to orient new staff and guide nurses in clinical practice; moreover, standards form a basis for monitoring, evaluating and improving quality of care. Therefore, the aim was to identify the impact of implementing standardized nursing care on hepatic encephalopathy patient's outcome. Quasi-, experimental research design was used to conduct this research. This study was carried out in intensive care unit of gastroenterology and hepatology in internal medicine department at main Assuit University Hospital. The sample of this study consisted of 60 patients, divided into study and control group equally. Tools used in this study comprised three main. Tool 7> patients groups assessment sheet. Tool II- Neurological examination including mental state assessment. Tool 111-Evaluation sheet of hepatic encephalopathy patients. The

results:

it revealed that majority of the study sample was older than 55 years with a mean age [55.9 +/- 7.8 and 60.2 +/- 5.1 respectively] for the study and control group with significant difference. Regarding length of hospital stay there was a significant difference between both study and control group with p-value [< 0.001]. There results revealed significant difference between both groups regard the level and grade of lower limb edema [p < 0.01]. On the other hand, the result showed skin ulceration with statistically significant difference ktween both groups [p< 0.01]. In addition the current study revealed significant increase in both groups as regard neurological assessment using GCS, while it showed significant decrease as regards west haven criteria [p < 0.05].

Conclusion:

-Based on the findings of the present study, it can k concluded that the standardized nursing care were better than the routine care of the hospital for hepatic encephalopathy

Critically ill patients are at a higher risk for pressure ulcers than patients in general care unites. Several factors increase the risk: severity of illness; increased length of stay; poor tissue perfusion due to hemodynamic instability, use of vasoactive medications, anemia; sensory impairment, skin maceration due to moisture; immobility; and poor nutritional status.  

Aim:

the aim of this study is to assess the risk factors of pressure ulcers among traumatized patients.

Design:

descriptive research design was used to conduct this research.

Setting:

this study was carried out at Trauma ICU at Assiut University Hospitals.

Subjects:

sampleof this studyincluded 60 adult patients.

Tools:

  two tools were used for data collection in this study.

Results:

The main results revealed that most of study sample aged between 41- 60 years old, and there was a significant difference between the age groups. Results also indicated a significant difference between the studied samples in relation to the different risk factors. There was a significance difference in the studied patients in relation to the temperature. As regard the Braden scale assessment, it was found a significance difference between the studied patients in relation to the sub items of the scale.

Conclusion:

  proper assessment of the patients for pressure ulcer risk factors is very important for prevention.

Abstract Aim of the studyTo investigate the prevalence of modifiable and non modifiable risk factors associated with acute stroke Retrospective research design was used. This study was carried out at Emergency department at Assiut University Hospitals .The sample of this study was consisted of 60 patients, admitted to Emergency department with acute stroke. Tool used in this study consisted of an assessment sheet developed by the researcher for identifying the risk factors commonly associated with types of acute stroke. This tool comprised two main parts, part I: - Assessment of socio-demographic and clinical data. part II: - assessment of acute stroke risk factors. The main results: revealed significant difference between both groups regard type of acute stroke (p < 0.03). The result of the current study revealed that majority of the study sample was old age with no significant difference. Also majority of the study sample were females in both ischemic and hemorrhagic acute stroke. The current study revealed that hypertension is the first and major cause of acute ischemic or hemorrhagic stroke. Risk factors associated with acute stroke show no significant difference between both group with (46.66%) for hypertension, (10.0%) for DM, (15.0%) for obesity and IHDs. conclusion: age and hypertension are the most significant risk factors for incidence of stroke the study sample. Recommendations: - Based on the study it is recommended to develop educational programs for raising public awareness of stroke risk factors and warning signs and identifying those at risk of stroke

Abstract
Use of music has the potential to positively affect patient perception during intraoperative of surgical treatment. Intraoperative awareness is the most frustrating complication in patient undergoing surgery under general anesthesia. Study Design was Quasi-experimental research design. Three tools were used to conduct this study namily: "Preoperative assessment tool", "intraoperative assessment tool" and "postoperative assessment tool". Method: In a prospective, randomized double blind study, patients were randomized into two equal groups; In C group (n = 25) patients acted as the control and did not listening to music, while in music group (n = 25) patients listening to music. In both groups, auditory evoked potentials index electrodes connected before induction of anesthesia at operative room to detect depth of anesthesia and occurrence of intraoperative awareness. An interview with the patients and their parents to evaluate occurrence of awareness by using a semi-structured in-depth questionnaire. The main results: The results of the current study revealed that there was statistically significant decrease in occurrence of awareness in music group versus the control group (P value =0.000***). Conclusion: The application of music was highly effective in reducing intraoperative awareness.

Synergy model gives nurses a common language for a definition and relation between patients and nurse's needs, so patient with acute coronary syndrome need immediate nurses knowledge in coronary care unit. Aim: the aim of this study is to investigate the impact of Synergy model application on patients with Acute Coronary Syndrome outcomes. Design: a quasi-experimental research design is used in this study. Setting: This study was carried out in the coronary care unit at Sohage University Hospital. Subjects: Sixty critically ill adult patients who are admitted to the previously mentioned setting, and 12 (twelve) number of nurses in coronary care unit. Tool: Synergy model tool which include two parts, Part I: Patients’ characteristics, (Stability, Resiliency and Resource availability ) Part two: Nurse-Competence (Advocacy moral agency, Caring practice and Clinical judgment). Results: Findings of the current study revealed statistical significance deference in both patient's needs and nurse's knowledge according to Synergy model for level I, level 3, level 5 which determine quality of nurses and the behavior toward the patient. In this study there are highly statistical significance different according to patients needs and nurses knowledge With (P=0.000*), (0.004)*. Conclusion: The synergy model outlines that when patients’ characteristics and nurses competencies synergize, optimal patient outcomes are achieved. As the patient is primary focus, optimal outcomes are defined as what patients themselves acknowledged as important.

Physical restraint is often seen as a simple solution to maintain patient comfort and safety in the intensive care unit, physical restraint is always accompanied by risk of complication Preventing and protecting the patient from harm are central nursing responsibilities for individuals who are temporarily incapacitated. Aims of study assess the Nurses' Knowledge and Performance about Physical Restraints in Critical ill Patients.

(Design)

The descriptive research design.

(Setting)

This study was carried out in the Trauma Intensive Care Unit at Assiut University Hospitals.

(Sample)

The sample of this study was consisted of 60 nurses.

(Tools)

two main tools used in this study. Tool I: Physical Restraints knowledge questionnaire. Tool II Observational checklist Tool. Main results the current study demonstrated that the majority of the study sample (70%) was having a satisfactory level of knowledge in all items, and more than half of nurses (68.3%) had an unsatisfactory level of Performance in all items. There were statically significant differences between years' experience, qualification and nurses' knowledge, nurses’ performance of the trauma intensive care unit. Recommendation Provide training programs to update critical care nurses' knowledge and performance about new physical restraint. Booklets about physical restraint should be available in each department, ICU

Prevention of corneal complications for intensive care unit patients is effective way to avoid corneal damage. Polyethylene covering is transparent dressing creates moist chamber providing a barrier against tear-film evaporation and providing physical barrier to organisms Aim: this study was carried out to investigate the impact of polyethylene eye covers dressingon preventing corneal complications. Design: A quasi-experimental design. Setting: Trauma Intensive Care Unit at Assiut University Hospital. Subjects: A convenience sample of 120 eyes of 60 adults patients divided into study and control groups (30 patient for each). Tools: tool I Patient assessment sheet. Tool II: Richmond Agitation Sedation Scale. Tool III: Eye assessment tool. Tool IV:Eye care technique, eye lid closure and eye cover by using polyethylene eye cover. Methods: Researcher assessed each patient's eye and ability to maintain eyelid closure. Then, eye care technique was applied, eye lid closure and eye cover by using polyethylene cover to each patient’s eye for preventing corneal complications. Results: Finding of present study revealed that there was significant statistical difference between both study and control groups in 7th day in relation to corneal ulcer in right eye and left eye ( P = 0.001& 0.000) respectively .Conclusion: eye lid closure and eye cover by using polyethylene eye cover could be significantly effective in preventing corneal complications.

Background: The post anesthesia nurse assumes important for the care and clinical stabilization of the patient in the immediate postanesthetic phase one period until they are fit. Aim this study was carried out to investigate the effect of nursing care guidelines for postanesthetic (phase one) on patient outcome. Tools three tools were utilized to collect data pertinent to the study, which is Tool I Patients assessment sheet consists of three parts. Tool II Richmond Agitation Sedation Scale. Tool III faces pain scales. Methods a quasi-experimental design. The sample was (102) patients that divided into two groups (control 51 and study 51) collected over sixth months. Results As regarding to all time intervals hemodynamic parameters, respiratory status and immediately post anesthesia pain related operation there were statistically significant difference (p < 001) between control and study groups post anesthesia phase one, also As regard post-anesthesia complication reduce with statistically significant difference relation to airway obstruction, pain related operation and hypothermia (p < 0.009, p=0.029 and p=0.017) respectively between both groups. Conclusion apply nursing care guideline for post-anesthetic showed statistically significance difference of hemodynamic parameters, respiratory status outcomes, decrease pain level and complication.