PROBLEM STATEMENT

“ EFFECTIVENESS OF STRCTURED TEACHING PROGRAMMEON HYPERTENSION WITH

COVID-19 AMONG HYPERTENSIVE CLIENTS AT MEDICAL OP ,GGH KURNOOL”

OBJECTIVES

1. To assess the knowledge of clients regarding hypertension with covid- 19among

hypertensive clients by pre test
2. To evaluate the effectiveness of structured teaching programme on hypertension with
covoid -19 by post test
3. To find out the association between the effectiveness of structured teaching programme on
hypertension with covoid -19 among hypertensive clients with selected demographic
variables

OPERATIONAL DEFINITIONS
EFFECTIVENESS: In this study effectiveness refers to determining the extent to which a
structured teaching programme has achieved the desired effect as expressed by gain
knowledge scores.

STRUCTURED TEACHING PROGRAMME : Material prepared by investigator on hypertension

with covid 19 to impart knowledge among selected sample.

HYPERTENSIVE CLIENTS: it refers to people Diagnosed with high blood pressure and taking
treatement in Medical op at government general hospital kurnool

HYPERTENSION WITH COVID 19: in this study it refers to effects of covid 19 on

hypertensive clients

GGH: Government general hospital kurnool

NULLHYPOTHESIS

There will not be a statistically significant effect of structured teaching programme on

hypertension with covid-19 among hypertensive clients at medical op GGH Kurnool.
LIMITATIONS:

 Study is limited to clients who can speak and understand telugu

 Study is limited who are available and willing to participate in the study
 Study is limited to 30 samples

DELIMITATIONS

 The study is limited to 30 sample who participating in the study

 The study limited to medical op GGH kurnool
 CHAPTER -1

INTRODUCTION

“Attention to health is life s greatest hindrance”

-plato

A lamp can light the another lamp, the knowledge is also like a lamp when we share
the knowledge it changes the person’s life, improve health status and prevent complications
of disease
The world is currently suffering from the outbreak of a pandemic caused by the
severe acute respiratory syndrome coronavirus SARS-CoV-2 that causes the disease called
COVID-19, first reported in Wuhan, Hubei Province, China on 31 December 2019.

Hypertension or blood pressure is exceedingly frequent in the elderly and older people
appear to be at particular risk of being infected with SARS cov2 virus and of experiencing severe
forms and complications of covid19

Hypertension are known to have a two-fold higher risk of developing coronary artery
disease four times higher risk of congestive heart failure and seven times higher risk of
cerebrovascular disease compared to normotensive subjects. WHO (2016) reports that
hypertension causes 5 million premature death each year worldwide causing 13% of global
fatalities. Good health can be destroyed by various disorders. Among these hypertension is the most
common risk factor for death in industrialized countries.

Tooling of epidemiological studies shows that hypertension is present in 25% urban and
10% of rural subjects in India. Hypertension is one of the leading causes of death and disability
among the global adult population. The higher incidence of hypertension damages the physical and
economic health of the global community. In India, 196 million adult populations are affected with
hypertension.

Corona virus(cov) comprises of a large family of viruses(7 strains) that are common in human
beings these causes illness ranging from common cold to more severe disease

The clinical and epidemiological features of COVID-19 have been repeatedly published in the
last few weeks. Interestingly, specific comorbidities associated with increased risk of infection and
worse outcomes with development of increased severity of lung injury and mortality have been
reported. The most common comorbidities in one report were hypertension (30%), diabetes (19%),
and coronary heart disease (8%).

(acc to american heart association 1 april 2020)

 Systemic arterial hypertension (referred to as hypertension herein) is a major risk factor of
mortality worldwide, and its importance is further emphasized in the context of the novel severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to as COVID-19. Patients
with severe COVID-19 infections commonly are older and have a history of hypertension. Almost
75% of patients who have died in the pandemic in Italy had hypertension

Acc to europieian society of cardiology mar 2020

High blood pressure is called “the silent killer” because it often causes no symptoms for many
years, even decades, until it finally damages certain critical organs. Uncontrolled hypertension can
cause strokes, cardiac complications, renal damage which can lead to brain or neurological damage.
And also they are prone to covid 19 The best prevention for these complications of hypertension is
control of the blood pressure. Effective management in hypertension requires a multisectorial
approach. It is necessary to create public awareness of this danger and this study is intended to find
out the knowledge and improve the knowledge among hypertensive patients.

Special attention is definitely required in patients with COVID-19 with associated

comorbidities including hypertension, diabetes and established Cardiovascular diseases.

NEED FOR THE STUDY

 “It is health that is real wealth and pieces of gold and silver “

_ Mahatma Gandhi
Hypertension as a prognostic indicator for severity and mortality in COVID-19

COVID-19 is already a pandemic. Emerging data suggest an increased association and a

heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the
outcome in hypertensive patients with COVID-19 .

Zung et al( 2020 ) From the pooled data of all ten available Chinese studies (n = 2209) that
have reported the characteristics of comorbidities in patients with COVID-19, hypertension was
present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease
(CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality
in COVID-19 patients with known hypertension.

A study which appears in JAMA international medicine followed 201 people with covid 19 of
these individuales 84% developed ARDS among them 27.4% had hypertension in comparision 13.7%
of those who did not develop ARDS had hypertension. Hypertension as a significant comorbidity with
COVID-19

( journal of American hypertension society apr2020)

The association of hypertension and diabetes in patients with COVID-19 is not unexpected,
given the rising prevalence of both of these chronic diseases, globally. Interestingly, in the pooled
data from the ten Chinese studies (n = 2209) that have reported the characteristics of comorbidities
in patients with COVID-19; associations of hypertension, diabetes and presence of established
cardiovascular disease (CVD) are larger, varying from 15 to 30% (average 21%), 5–20% (average 11%)
and 2–40% (average 7%) respectively . Established CVD was also present in nearly 43% in Italian
study of 355 patients with COVID-19

( Acc to journalof infection control apr 2020)

Hypertension , diabetes and other co-morbidities in COVID-19, world-wide data.

 authors smokers HTN% DM% CVD COPD% CLD CKD REF

COVID-19 in China

Liu et al. 61 6.6 19.7 8.2 1.6 8.2 NR NR 3

Guan et al. 1099 12.6 15.0 7.4 3.8 1.1 0.7 NR 4

Huang et al. 41 7.3 14.6 19.5 15.0 2.4 NR 2.4 5

Chen et al. 99 NR NR 12.1 40.0 1.0 NR NR 6

Wang et al. 138 NR 31.2 10.1 19.6 2.9 2.9 2.9 7

Zhou et al. 191 6.0 30 19 8.0# 3.0 1.0 NR 8

Zhang et al. 140 NR 30 12.1 8.6 1.4 1.4 NR 9

Yang et al. 52 4.0 NR 17.0 23.0 8.0 NR NR 10

Wu et al. 201 NR 19.4 10.9 4.0 2.5 1.0 3.5 11

Guo et al. 187 9.6 32.6 15.0 11.2# 2.1 3.2 NR 14

Overall, China,

N = 2209 10.7% 20.7% 10.5% 7.4% 2.0% 1.2% 3.2%

COVID-19 in Italy

Onder et al. 355 NR NR 35.5 42.5 NR NR NR 12

COVID-19 in Singapore

Young et al. 18 NR NR NR NR NR NR NR 13

Zhou et al (2020 ) While consistent association of hypertension in patients with COVID-19

across all these studies is unique, the concern which needs a serious attention is the increase in
mortality. Two Chinese studies have worked in this direction to-date. In 191 patients with COVID-
19,found hypertension to have an odds ratio (OR) of 3.05 (95% CI, 1.57 to 5.92; p < 0.006), diabetes
with OR of 2.85 (95% CI, 1.35 to 6.05; p < 0.001), whereas presence of coronary artery disease had
an OR of 21.40 (95% CI, 4.64 to 98.76; p < 0.0001) for in-hospital mortality.
 Xiobo yang (2020 ) in this stuy they identified The most distinctive comorbidities of 32 non-
survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019
(COVID-19) i cerebrovascular diseases (22%) and diabetes (22%). Another study2 included 1099
patients with confirmed COVID-19, of whom 173 had severe disease with comorbidities of
hypertension (23•7%), diabetes mellitus (16•2%), coronary heart diseases (5•8%), and
cerebrovascular disease (2•3%). In a third study,3 of 140 patients who were admitted to hospital
with COVID-19, 30% had hypertension and 12% had diabetes.

Three-fourths of Covid-19 patients in India are men. Data analysis of Covid-19 patients and
related deaths by the Ministry of Health and Family Welfare reveals that more men than women
have been infected in India. According to the data, 76% of Covid-19 patients are males and the
profile of deaths is similar, with males accounting for 73% of the fatalities (

( Hindustan times apr 1 2020)

A key finding is that 86% of Covid-19 victims had comorbidity conditions, including diabetes,
chronic kidney problems, hypertension or heart ailments, revealing that an underlying illness makes
a person more susceptible to infection by the coronavirus. At the same time, comorbidity increases
mortality among Covid-19 patients.

71% of covid 19 patients who died had hypertension and diabetis in Gujarat. By govt of gujarat

In Andhra Pradesh presently 2230cases identified in that50 deaths and 754 active among them 20
deaths reports had history of hypertension co morbidity and age factor according to the state health
department

From the pooled data in Kurnool reported positives 611 out of 298 active and deaths are 14
21% followed by comorbid hypertension and age, although emerging data hints to increase in
mortality in covid 19 patiens with known hypertension

Nurses working in the hospital should give more emphasis on prevention and control of
hypertension. Even more a concrete call for every one including patients with hypertension and the
common public to make life style changes and in particular period of covi19 that will keep blood
pressure at a normal level such as preventive approach may be more effective in reducing cardio-
vascular morbidity and mortality than treating patients who have been diagnosed with
hypertension.

Thus the investigator observe there is a need for these patients to be instructed about the
disease condition and covid 19 and its management and preventive measures.
 PART-2

CONCEPTUAL FRAME WORK

Roy ‘s adaptation model is helpful to adapt the new situation. In this model pre
assessment of knowledge is the input ,and pre assessment conducted by using structured
Questionnaire. Through put is the structured teaching programme, cognater it improves the
knowledge of the clients . post test conducted after administering structured teaching program the
knowledge scores are given that is below average, average ,and above average that is out put
those who are getting below average and average feed back given through cognative process.
 CHAPTER-2

REVIEW OF LITERATURE
The review of literature is defined as a broad comprehensive, in depth systematic critical
review of literature scholarly publications.

The literature related to hypertension co morbid complications

The literature related structured teaching programme related to hypertension

The literature related to hypertension with covid 19

The literature related to hypertension co morbid complications:

Shikha sing(2017) Prevalence and Associated Risk Factors of Hypertension: A Cross-Sectional Study
in Urban Varanasi A community based cross-sectional study with multistage sampling design was
conducted among urban population of Varanasi. A modified WHO STEPS interview schedule on 640
study subjects aged 25–64 years was used. Conclusion. Around one-third of the subjects were
hypertensive and half of the study subjects were prehypertensive in this area. The awareness,
treatment, and control of high blood pressure were also very low.

Jafari ms et al’(2016) Effects of a Lifestyle Modification Program on Knowledge, Attitude and

Practice of Hypertensive Patients with Angioplasty This study was a randomized controlled clinical
trial conducted on 60 hypertensive patients with angioplasty in Shahid Chamran hospital of Isfahan,
Iran. The samples were randomly assigned to two equal groups Lifestyle modification program can
be effective in promoting the knowledge, attitude and practice of hypertensive patients with
angioplasty. Nurses can use this program in their care provision programs for these patients.

Bhadoria et al., 2014)The prevalence of hypertension and associatedcardiovascular risk factors

were assessed in central India. The prevalence of hypertension was 17%, with 21.4% of the urban
residents and 14.8% of the rural residents.These were significantly higher mean values for weight,
height body mass index, hip circumference, waist circumference, waisthip ratio, systolic blood
pressure, fasting blood sugar and serum cholesterol levels in the urban residents than the rural
residents.Regression analysis found, increasing age, physical inactivity central obesity, tobacco
chewing and smoking were independent predictors of hypertension in rural residents.

(Yao et al., 2015) a cohort stydy conducted on lifestyle and risk factors of hypertension, among 20-
45 years old hypertensive young adults. The results showed that during a median follow-up of 4.7
years, among 1009 patients participated, 182 patients developed hypertension. The study concluded
that increased body mass index was associated with an increased risk of hypertension occurrence
Toirov Erkin, Davlatov Salim, & Nobuyuki Hamajima, 2014) A study was conducted To assess the
hypertension related knowledge, practice and drugadherence among 209 primary hypertensive
patients in Uzbekistan. The study concluded that, the patients had sufficient knowledge about
hypertension, but they had inadequate knowledge about specific issues such as treatment for
symptomsof hypertension. Both drug adherence and BP control rate were

The literature related structured teaching programme related to hypertension

John selah(2017) conducted effectiveness of planned teaching program regarding

hypertension life style modifications among hypertensive clients at manglore, An evaluative
approach with quasi experimental non-equivalent pre-test post-test design was adopted for the
study. Through non-probability purposive sampling technique 60 samples were selected. This data
indicates that the individual teaching was comprehensive, simple, easy to understand, practicable
and effective in increasing the knowledge and practice of hypertensive patients. By improving the
knowledge and practice of hypertensive patients on lifestyle modification the risk for complications
can be prevented.

Dhakal m(2017) A hospital based cross sectional study to evaluate awareness of lifestyle
interventions among hypertensive patients in Sikkim (North-Eastern State of India) Patients
knowledge on lifestyle interventions for the management of blood pressure is important. The rural
population and uneducated people have inadequate knowledge on lifestyle modifications of
hypertension. Structured teaching programs are needed to improve awareness about the lifestyle
changes.

Pushpa ramaiah( 2016) conducted a quasi experimental study to evaluate the effectivenss of
structured teaching program on knowledge levels of hypertensive clients regarding hypertension
lifestyle modifications among hypertensive clients 50 samples selected using purposive sampling
technique structured teaching programe Hence it was concluded that structured questionnaire was
effective as a method to improve knowledge among hypertensive patients.

Manideepkumar singh(2016) a quasi experimental study on effectiveness of structured teaching

programe regarding hypertension lifestyle modifications among hypertensive clients 60 samples
selected using purposive sampling technique structured teaching programe Hence it was concluded
that structured questionnaire was effective as a method to improve knowledge among hypertensive
patients

m. girija(2015) conducted a study on A pre experimental research design was used to

assess the effectiveness of structured teaching programme on knowledge, attitude and practice
among hypertensive patients at Melmaruvathur Adhiparasakthi Institute of Medical Sciences and
Research Institute. The study sample consisted of 100 newly diagnosed both male and female
hypertensive patients belonging to the age group of 40-70 years attending the hypertensive clinic
during the period of study. Convenient sampling technique was adopted. The results of the present
study under,Thus the structured teaching programme was effective in improving the knowledge,
attitude and practice among hypertensive patients.

Sabin peral 2015 Randomized Evaluation of the Effectiveness of a Structured Educational

Program for Patients With Essential Hypertension A total of 256 patients in 13 centers were enrolled
and randomly assigned to 2 groups The results of this multicenter randomized controlled study
provide significant evidence for benefit by participation in a structured educational program. Positive
effects seem to be mediated by better adherence and life style changes due to higher levels of
information and patient empowerment. Therefore, educational strategies should be considered as
standard of care for hypertensive patients.

The literature related to hypertension with covid 19

Ritesh gupta et al;(2020): Comorbidities in COVID-19: Outcomes in hypertensive cohort and

controversies with renin angiotensin system blockers We have systematically searched the medical
database up to March 27, 2020 and retrieved all the published articles in English language related to
our topic using MeSH key words. Special attention is definitely required in patients with COVID-19
with associated comorbidities including hypertension, diabetes and established CVD. Although the
role of RASB has a mechanistic equipoise, patients with COVID-19 should not stop these drugs at this
point of time, as recommended by various world organizations and without the advice of health care
provider.

Xiaobo Yang and colleagues2020 The most distinctive comorbidities of 32 non-survivors from a
group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study

Another study2 included 1099 patients with confirmed COVID-19, of whom 173 had severe disease
with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases
(5·8%), and cerebrovascular disease (2·3%).

In a third study,3 of 140 patients who were admitted to hospital with COVID-19, 30% had
hypertension and 12% had diabetes. Notably, the most frequent comorbidities reported in these
three studies of patients with COVID-19 are often treated with angiotensin-converting enzyme (ACE)
inhibitors; however, treatment was not assessed in either study. the increased expression of ACE2
would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension
treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.

lakshmi patel(2020 ) 71% of covid-19 patients who died had comorbidity Mirror analysed reports
from the state health department and who succumbed to Covid-19 in Gujarat between March 23,
when33% deaths with co morbidities.

Lfang et al; quantitative study 52 intensive care patients with novel corona virus noted on their
observations they conclude that 30% had risk with co morbidity of hypertension
Yash paul sharma(2020) assessed the prevelance of co morbidity in covid 19 infected patients ,He
conclude that hypertensive patients were more at risk the fatality rate of 7.6% those with
hypertension CAD.

Christopher richer et al;(2020) a new study level meta analysis of 2552 confirmed covid 19 patients
reported a poles odds ratio of 249 (95% worsen covid 19 in the presence of hypertension and
above 60 yrs.

Wang et al; (2020 ) Comorbidity and its impact on 1590 patients with Covid-19 in China: A
Nationwide AnalysisWe analysed the data from 1590 laboratory-confirmed hospitalised patients 575
hospitals in 31 province/autonomous regions/provincial municipalities across mainland China The
mean age was 48.9 years. 686 patients (42.7%) were females. Severe cases accounted for 16.0% of
the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported
having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%),

Lippi G, Wong J, Henry BM(.2020) Hypertension in patients with coronavirus disease 2019
(COVID-19): a pooled analysis The Scopus, Medline, and Web of Science databases were searched to
identify studies reporting the rate of hypertensive patients in the population diagnosed with severe
or nonsevere COVID-19 or in COVID-19 survivors and nonsurvivors. The obtained data were pooled
into a meta-analysis to calculate odds ratios (ORs) with 95% CIs.. his pooled analysis of the current
literature would suggest that hypertension may be associated with an up to 2.5-fold higher risk of
severe or fatal COVID-19, especially in older individuals
 EFFECTIVENESS OF STRCTURED TEACHING PROGRAMME

ON HYPERTENSIONWITH COVID-19 AMONG

HYPERTENSIVE CLIENT AT

MEDICAL OP GGH

KURNOOL AP

BY

B.ANURADHA

MSC.,NURSING

1 ST YEAR

PROJECT SUBMITTED TO DR NTR UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA. IN PARTIAL

FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF 1ST YEAR MASTER’S OF SCIENCE IN
NURSING

GOVERNMENT COLLEGE OF NURSING: KURNOOL

DR NTR UNIVERSITY OF HEALTH SCIENCES

VIJAYAWADA

2020