The effect of cold application applied on median sternotomy before deep breathing and coughing exercise on the sternotomy pain

In this study, it was aimed to determine the effect of cold application applied on median sternotomy before deep breathing and coughing exercise on the sternotomy pain. The study was carried out quasi-experimentally with patients who underwent open heart surgery and median sternotomy and stayed in the service of cardiovascular surgery and intensive care unit of Adnan Menderes University Research and Application Hospital between 01.11.2015 and 15.04.2016. The study data were collected through patient description form, data collection form, numeric rating scale, pulse oximetry, blood pressure monitor and tape recorder. Having been carried out at 4 stages, on the first stage of this study which cold application was not applied, the patients were asked about their pain severity based on their sternotomy site and deep breathing and coughing exercise was done and then the pain severity was evaluated again. On the second stage which cold application was applied, the pain severity related to sternotomy site was questioned and then sternotomy incision was covered with single-layer sterilized dressing and cold gel package was kept on it for 15 minutes and after deep breathing and coughing exercise was done, the patients were asked again about their sternotomy pain severity. The third stage on which cold application was not applied is the same as the first stage on which cold application was not applied and the same processes were applied to the patient. The fourth stage on which cold application was applied is the same as the second stage on which cold application was applied and the same processes were applied to the patient. Each stage was performed at two hour intervals and vital signs were recorded before and after the deep breathing and coughing exercise at all stages. However, on the second and fourth stages which cold application was applied, the patients were asked about their feeling based on cold application in the fifth and fifteenth minutes during the cold application, and redness, bluish-purple spots were observed on the skin surface. After all stages were completed, the preferences of the patients related to cold application were asked and recorded. The data were analyzed via descriptive statistics, Mann Whitney U, Wilcoxon and Fried tests. Vital signs of the patients are similar both before and after deep breathing and coughing exercise. Any statistically significant difference was not found between the surgery type and before and after deep breathing and coughing exercise pain scores belonging to all stages. Any statistically significant difference was not found between the pain scores recorded before and after deep breathing and coughing exercise done on the first and third stages which cold application was not applied, and between the pain scores recorded before and after deep breathing and coughing exercise done on the second and fourth stages which cold application was applied. The pain score recorded after deep breathing and coughing exercise done on the second stage which cold application was applied was found to be statistically significant lower than the pain score recorded after deep breathing and coughing exercise done on the first stage which cold application was not applied. The pain score recorded after deep breathing and coughing exercise done on the fourth stage which cold application was applied was found to be statistically significant lower than the pain score recorded after deep breathing and coughing exercise done on the third stage which cold application was not applied. It was determined that 90% of the patients (18) felt relaxed during the cold application, 85% of them (17) preferred cold application before deep breathing and coughing exercise and they wanted to try it again, 95% of them (19) suggested the cold application to other patients. It was found that cold gel package application used in our study reduced the pain that developed based on deep breathing and coughing exercise which was done so as to prevent the respiratory complications following open-heart surgery. Key Words: Open-Heart Surgery, Sternotomy, Pain, Deep Breathing And Coughing Exercise, Cold Application