Introduction: is outpatient procedure, easy to apply, minimally invasive,

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Last updated: October 15, 2019

Introduction:Urolithiasis is formation of calculi at anypart of the urinary system. Between 1% and 15% of people globally are affectedby kidney stones at some point in their life (Morgan, and Pearle, 2016). In 2013, 49million cases occurred (Naghavi,et al., 2014), resulting in about15,000 deaths (Vos  et al.,2015). Urolithiasis is themore painful urological diseases among Egyptian older adults, it is responsible45% of urological hospital admissions per year and approximately about 800,000 olderpatients were diagnosed and hospitalized with renal calculi (El-Sharqawyand Ewis, 2002).

The objective of nephrolithiasis calculi managementamong the patients is to achieve high rate of calculi clearance with lesscomplications to the patients.             Beforethe appearance of extracorporeal shockwave lithotripsy (ESWL) in 1980, the onlytreatment available for calculi that could not pass through the urinary tractwas open surgery. Since then, ESWL has become the first line of treatment and preferredtechnique by urologists for renal and ureteral stone. Works best with stones inthe upper ureter between 0.4mm and 2 cm in diameter (Hayes et al., 2015).

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About 80to 85% of simple renal calculi can be effectively treated with ESWL (Miller &Lingeman, 2007).  It is an effective procedure for managing85-90% of upper urinary tract stones.  Compared with open and endoscopic procedures,ESWL is outpatient procedure, easy to apply, minimally invasive, exposespatients to fewer anesthesia, and less complications rates (Haecker &Wess, 2010; Chandhoke, 2007).  Nevertheless, occasional side effects such ashematoma, petechial bleedings, interactions with cardiac rhythm etc. arereported.Extracorporeal shock-wave lithotripsy is amethod by which stones in the urinary tract are broken down.

The shock-wavesproduced by the machine are carefully focused on to the area with the use ofultrasound or x-ray imagine. The waves travel through tissues without causingpermanent 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 themost widely performed procedure for stone treatment, treating all size and locationsof stones. It works best with kidney stonesof less than 2.

5 cm in size, proximal ureter stones and distal ureter stonesranged 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 fearare common among the most of patients, especially for the patient who hasn’t previousexperience, but some people become so anxious, these normal fears turn into Claustrophobia from procedure (Aman,20013).  Anxietyhas been associated with several pathophysiological responses such ashypertension and dysrhythmias,elevated temperature, sweating, nausea.

It may cause vasoconstriction,which makes it difficult for the hospital staff to obtain blood, so thehigh anxiety can increase postoperative complications.(John,(2009). It is often helpful for The patientssuffer from anxiety about surgery to express their fears to health careworkers. This can be especially beneficial for patients who are having ahigh-risk procedure. The nurse and other health team must play an active rolein reassuring and managing anxiety by advising the patient to trust on himselfand his surgeon and give him full information about the nature of procedure,preoperative preparation, anesthesia methods, and ideal behaviors during postoperativemanagement (Aman, 20013 6; Pritchard, 2009). Thefamily should be included in psychological preoperative care to maximizefeeling of patient security.

Patients and families who are preparedpsychologically tend to do well in the patient’s postoperative course (Townsend & Beauchamp et al., 2015.)Preoperative patient teaching can reducepotential problems through provision of anticipatory knowledge on necessarypreparations and the procedures. It directly impacts patient safety and becamepart of the standard care emphasized by the Joint Commission (The JointCommission. Ambulatory Health Care: 2011). Preoperative teaching must meetthe patient’s need for information related to the surgical procedure, which mayhelp in alleviating most of his or her fears, and improve surgical outcome (Lubin et al., 2013).Patients must beeducated about management of postoperative pain.

They should be advised to askthe analgesic before the pain become severe. They are taught about rating theirpain on pain scale, this help the health team in evaluating degree of theirpain, they also taught about none pharmacological methods for pain control (wicker , 2010). There are a very few researches aboutthe effect of education on patient knowledge, anxiety level, claustrophobia andpostoperative pain,  so the current studyexamine The Effect of Pre-Procedure teaching for patients undergoing  First Session of Shock Wave Lithotripsyon  Anxiety levels, Pain Perception, andclaustrophobia.Significanceof the study In the current time,the extracorporeal shock waves lithotripsy (ESWL) is considered the first linetherapy 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 toprevent further urinary calculi (Mohamed et al., 2015).  SWL procedure can cause significant anxietywhich may affect pain perception and influencing the success of the SWLtreatment by decreasing patient compliance (Ngee-Ming, 2014).Little clinical data are available about pre-procedure teaching and its effecton   pre-procedure anxiety that mayaffect the pain perception and patient compliance. The aim of this study was toevaluate the effect of Pre-procedure teaching for patients undergoing firstsession of shock wave lithotripsy on patients’ anxiety level, claustrophobia,pain perception, and patient compliance. Aim of the studyTheaim of the present study is to evaluate the effect of Pre-procedure teachingfor patients undergoing first session of shock wave lithotripsy on patients’ anxietylevel, pain perception, and claustrophobia.

 HypothesesPatientswho take pre-procedure teaching module will report high level of knowledge ascompared tocontrol group. Patientswho take pre-procedure teaching module will report a decrease in anxiety score at   firstsession of shock wave lithotripsy as compared to control group.Patientswho take   pre-procedure teaching modulewill experience a decrease in pain score during sessions of shock wavelithotripsy and post sessions as compared to control group.Scoreand levels of claustrophobia will be lower for patients who take the pre-procedureteaching module regarding shock wave lithotripsy as compared to control groupat first session.

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