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Background: Breast cancer related lymphedema represents a major complication of breast cancer treatment, impacting the quality of life of breast cancer survivors. Patients with lymphedema need to conduct lifelong self care activities to control the progression of swelling, manage lymphedema-associated symptom burden, and minimize long term negative outcomes. Aim: This study aimed to assess knowledge and self care practices of women with breast cancer related lymphedema. Study design: A descriptive study design was utilized to conduct this study. Setting: This study was conducted in the outpatient breast clinic at Oncology Center and Nuclear Medicine, affiliated to Ain Shams University Hospitals. Subjects: A purposive sample of 50 women newly diagnosed with breast cancer related lymphedema, post mastectomy, and treated with radiotherapy. Data collection tools: A structured interview questionnaire for women with breast cancer related lymphedema, and self care practices questionnaire. Results: The mean age of the studied women was 47.71±7.16, and about one fifth of them had satisfactory level of total knowledge regarding breast cancer related lymphedema, also; the minority of them had adequate level of total lymphedema self care practices. Moreover there is statistically significant difference between the self care practices of the studied women and their educational level. Conclusion: The majority of the studied women had unsatisfactory knowledge regarding breast cancer related lymphedema, and almost of them had inadequate lymphedema self care practices. Recommendations: Educational programs about lymphedema and risk reduction methods after the breast surgery are strongly needed. Also, continuous in service educational programs should be held for all the health care team working in breast cancer units. In addition, further researches are recommended to assess barriers to self care among patients with breast cancer related lymphedema.

Background: Subcutaneous enoxaparin administration often causes problems such as pain; bruise and hematoma at the injection sites. In terms of these problems, cold application has been found to have various therapeutic benefits as relieve pain by produce localized anesthetic effect and controls bleeding by causing vasoconstriction. Aim of the study: To investigate the effect of cold application on local problems among patients receiving subcutaneous enoxaparin. Design: Self controlled trial design was utilized. Setting: The study was carried out in general surgery department, orthopedic surgery department, and chest Intensive Care Unit at Beni-seuf University Hospital. Study subjects: A purposive sample of 60 patients was included in the study. Data collection tools: Data were obtained through Patient assessment tool, Bruising Category Scale, Visual Analogue Scale for pain and Hematoma Formation Scale. Results: All studied patients had pain and more than half developed bruise at injection site when they received enoxaparin without cold application but more than three quarter of studied patients had pain and less than one quarter developed bruise when they received injection with cold application. Meanwhile, the majority of the studied patient did not develop hematoma whether cold applied at injection site or not. Conclusion: The pre-injection cold application at enoxaparin injection site was effective in reducing the occurrence of pain and bruising. Moreover, there was statistically significant relation between the patients’ pain intensity, the size of bruising and their demographic characteristics; age and gender. Recommendations: Cold application should be included in standard protocol for the administration of SC enoxaparin and providing on-going and regular in-service educational programs about it for nurses.

Background: Intensive Care Unit Acquired Muscle Weakness (ICU-AW) is one of the most important complications occurs in the ICU. ICU-AW is a multifactorial syndrome characterized by generalized muscle weakness. Critical care nurses (CCNs) have an important role in the prevention of ICU-AW through increase mobility and applying of range of motion. Design: A descriptive exploratory design was utilized to achieve aim of this study. Aim: This study aimed to assess factors contributing to acquired muscle weakness among critical ill patients. Setting: the study was carried out in intensive care units of Beni–Suef University Hospital. Subjects: A Purposive sample of seventy five patients admitted in the previous mentioned setting. Tools of data collection were consisted of Patient assessment tool, muscle strength scale and indicators to incidence of ICU-AW and factors contributing to ICU-AW assessment tool. Results: revealed that more than half of the studied patients had ICU-AW. The majority of studied patients who had muscle weakness were older than the Non ICU-AW patients. Application of positioning and range of motion exercises were not done in the ICU-AW patients. Administration of corticosteroid and incidence of malnutrition was higher in the ICU-AW patients than the Non ICU-AW patients. There were no statistically significant relation between incidence of ICU-AW and gender, admission medical diagnosis, administration of parenteral nutrition and application of positioning and walking exercises. Conclusion: More than half of studied patients developed ICU-AW. The contributing factors of ICU-AW are patient age, WBCs level, not applying range of motion and chair sitting exercise to ICU patients, administration of corticosteroid and malnutrition. Recommendations: Further researches are recommended to study extensively the effect of nutritional status on incidence of ICU-AW. Also, examine the incidence of ICU-AW in sedated and unconscious patients.

Background: Non-Hodgkin's lymphoma patients undergoing chemotherapy have symptoms that continue to place a significant burden and preventing them from living normally. This requires non-hodgkin's lymphoma patients to engage in a range of self-management actions. The aim of this study was to assess the effect of self-management guidelines on chemotherapy associated symptoms among non-Hodgkin lymphoma patients. Design: A quasi experimental design. Setting: the study was conducted at the hematology unit in Ain Shams University Hospital. Subjects: A purposive sample of 76 adult patients. Data collection tools: Three tools were used in this study, structured interview questionnaire for the non-hodgkin's lymphoma patients undergoing chemotherapy, self-care practices questionnaire, and symptoms experience tools. Results: Regarding total level knowledge, 28.9% of the studied patients had satisfactory level of total knowledge pre implementation of self-management guidelines which improved to 65.8% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). While 26.3% of the studied patients had satisfactory level of total self-care practices pre implementation of self-management guidelines which improved to 57.9% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). There was a significant improvement on patients` symptoms experience post implementation of self management guidelines. Conclusion: The implementation of self-management guidelines for patients with non-Hodgkin's lymphoma undergoing chemotherapy has a statistically significant positive effect on their knowledge, self-care practice and associated symptoms which support the stated hypothesis. Recommendation: This study recommends the importance of developing tailored self-management programs for fatigue, nausea, vomiting and oral mucositis to understand and promote chemotherapy associated symptoms self-management in patients with non-hodgkin's lymphoma disease.

Background: Hospital acquired anemia (HAA) is one of the most common intensive care unit (ICU) acquired complications that associated with poor outcomes, increase morbidity and mortality for critically ill patients. Factors contribute to its development include profound loss of RBCs or insufficient RBCs production. Aim of the study: to assess factors contributing to HAA among critical ill patients. Design: A descriptive exploratory design was utilized. Setting: The study was carried in Beni –Suief university hospital inside the critical care units which include; general ICU, cardio care unit (CCU) and chest ICU. Study subjects: purposive sample of 75newly admitted adult critically ill patients to the above mentioned sitting was included in the study. Data collection tools: Data were obtained through patients assessment tool, factors contributing to HAA and indicators of HAA tool. Results: reveals that, nearly one third of studied patients their age were more than or equal fifty years. As regard to gender, the results revealed that, more than half of them were males, nearly one third of anemic patients had HAA in the 5th day from admission to hospital. As well more than three quarter of anemic patients were under feeding and more than one third of them had sepsis, in addition to mean amount of blood loss for anemic patients exceed amount of blood loss for non anemic patients. Conclusion: More than half of studied patients developed HAA during their ICU stay. Even, non-anemic patients were subjected to a decline in their Hb level. As well as, there were statistically significant relation between nutrition deficiency, sepsis, blood loss in ICU and drugs increase RBCs loss factors and occurrence of HAA. Also there were insignificant relation between demographic characteristic of studied patients, their diagnosis on admission to hospital, hemodilution, drugs affect RBCs production and occurrence of HAA. Recommendations: Designing in-service training and educational program for nurses about blood conversation strategies especially prevention of blood loss associated invasive procedure and phlebotomy practice.

Introduction: Cerebrovascular Background: Critical care nurses are expertly trained to care for critically ill patients; however, many critical care nurses feel inadequately prepared to provide end of life care to patients in the intensive care unit. The nurses attribute this to lack of support and training on end-of-life care. The study aim was to assess effect of self-learning package (SLP) on critical care nurses' performance regarding care for end of life patient. Methods, Design: To achieve this aim a quasi-experimental design was utilized. Subjects and setting: A convenient sample of 60 nurses was selected from surgical, medical and neurological ICU of Ain-Shams university hospitals. Study results: Regarding demographic characteristics. This study revealed that, 58.3% of the studied subjects were less than 30 years, 83.3% were female, 75.0% were diploma nurses, 46.7% of them had ten or more years of experience, and 81.7% had no training related to end of life care. Regarding knowledge and practice 15.0% & 23.3% respectively of the study subjects had satisfactory knowledge and practice related to care for end of life patient in pre phase, 80.0% & 81.7 % respectively in post implementation of self-learning package and 60.0% &45% had a satisfactory knowledge and practice in follow up phase. While regarding attitude, positive attitude was 5%, 80% and 55% respectively in pre, post and follow up phases Conclusion: The current study concluded that there was highly statistically significant increase of total score of nurses' knowledge, practice and total score of nurse’s attitude pre/post, pre/follow up and post/ follow up phases of SLP implementation. there was statistically significant positive effect for SLP on nurses' knowledge, practice and attitude. Recommendations; conduction of further researches in end of life care to enrich, improve, & update nurse's knowledge, practice and attitude. Periodic in-services education program regarding end of life care and self-learning package to be performed for patients are recommended.