Chest physiotherapy considered basic nursing interventions for patients undergoing cardiothoracic surgery to improve breathing efficiency, oxygenation and pulmonary functions. Aim of the study: to evaluate the pulmonary function status after implementing chest physiotherapy for extubated cardiothoracic surgery patients. Design: Quasi experimental research design (study and control) was used in this study. Setting: cardiothoracic intensive care unit and cardiothoracic department at cardiothoracic hospital that belongs to Minia University Hospitals, Egypt. Two tools: 1. Socio demographic and medical Assessment sheet. 2. Oxygenation level assessment sheet. Results: mean age of study and control groups were (38.4±5.4) & (37.2±4.8) year respectively. (40%) from the study group suffered myocardial infarction and did coronary angioplasty, (43.3%) of the control suffered coronary artery stenosis (33.3%) among them did coronary angioplasty. Regarding breathing sound, and pulmonary function test there is statistical significant difference between both groups presented by p value <0.05, also there were significant difference between both groups related to all items of the arterial blood gases test presented by P value with (.031*, .004**, .020*, .013* & .003**). Conclusion: This study concluded that chest physiotherapy had a positive effect on patient's pulmonary function status which reflected on the patients outcomes post cardiothoracic surgery. Recommendations: All cardiac surgery patients should receive an explanation about chest physiotherapy before their operations.

Background: End stage of kidney disease (ESKD) the last stage of renal failure and can develop from untreated chronic kidney disease. The study aimed to evaluate the effect of nursing guidelines for Buttonhole cannulation technique of arteriovenous on reducing its complications among hemodialysis patients. Research design: This research employed a quasi-experimental methodology. Setting: The study was conducted in Minia University at Nephrology and Urology Hospital at Hemodialysis Units. Subjects of the study: A purposive sample composed of sixty patients going for hemodialysis, study participants was classified equally for both study and control groups (thirteen for each one).Tools of data collection In order to conduct the current study, four data gathering methods were employed, including; A Structured interviewing questionnaire sheet, Pain assessment scale, Observational Checklist for Manifestation of infection and hematoma and assessment sheet for Laboratory investigation of kidney function. Results: the findings of the study indicated that 13.3% among the study group & 36.7% of the control group were had hematoma at 1st week of HD after the application of study guidelines, while 3.3% & 86.7% among both groups were had hematoma at the fourth week of HD after the application of study guidelines respectively. Conclusion: Buttonhole study guidelines was had positive impact on hemodialysis complications (pain, infection, hematoma, vital signs) for study group in first and fourth week in hemodialysis sessions in-comparison with control group. Recommendations: Increase awareness through nursing staff of hemodialysis patients and caregivers regard self-care related to vascular access and encourage patient participation in health education programs about evidencebased practice regard hemodialysis care at home.

BACKGROUND: Surgical drains, as useful as they are, have been noted not to be without complications. Small bowel herniation through a previous drain site is a rare complication of abdominal drain insertion. OBJECTIVE: To report a case of strangulated hernia through a drain site. METHODS: A 46-year-old civil servant was referred to our hospital from a general hospital with a two-week history of progressive abdominal pain and bulge in the right lower quadrant. She was evaluated clinically as with an ultrasonography. Results of tests indicated a laparatomy. RESULTS: She had a previous abdominal drain insertion when she had an emergency exploratory laparatomy for perforated typhoid enteritis in the same hospital 20 years prior to presentation. Exploratory laparatomy done revealed gangrenous loops of small bowel that herniated through a previous drain site with interstitial spread. Resection and end-to-end anastomosis was effected and internal end was closed with non absorbable suture (Nylon 1

Background:Total knee Replacement (TKR) are rapidly becoming one of the most common elective inpatient surgeries is really cartilage replacement with an artificial surface. The knee itself is not replaced. An artificial substitute for the cartilage is inserted onto the end of each of the bones. At present, cold therapy has been widely used in all kinds of surgery. After TKA, patients are prone to knee swelling and pain, even leading to the loss of knee function in severe cases. Postoperative cold therapy can reduce pain sensation and enhance the effectiveness of early rehabilitation training (Benner, et al., 2019). Aim of this study: is to evaluate effect of performance cold compresses on reducing post-operative pain among patients with total knee replacement. Subjects and method: Design: A quasiexperimental research design was used to achieve the aim of this study. Setting: The study was conducted in orthopedic department at Luxor International Hospital. Sample: A convenience sample of 60 adult patients post-knee replacement surgery. Tools of data collection: First tool Scio demographic and medical data Part (A): assess patients' socio-demographic data Part (B): assess patients' medical data Part(C): patient observational checklist: Part (D): knee range of motion (ROM) checklist; Numerical Rating Scale (NRS) second tool. Result shows a highly statistical significant reduction regarding level of pain between the two groups at 2 nd , 3 rd and 1 week postoperative. The total knee replacement surgery can change the lifestyle of a person living with osteoarthritis or another knee condition that causes continuous pain. The total knee replacement is a more invasive surgery where the bone is cut away and the entire joint is replaced with a prosthesis. Recovery is difficult, and usually takes six to eight weeks of intense physical therapy. The patient still needs physical therapy, but should be able to walk without assistive devices. Recommendations: The total knee replacement is effective at reducing pain in the knee. However, it is useful for different populations. There is more information about the total knee replacement because it is more common, and generally attracts a larger population.

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