الفهرس 
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Abstract
Esophageal varices are a potentially serious complication of cirrhosis. Between 25 and 40 percent of people with varices will experience an episode of severe bleeding (hemorrhage) resulting in significant illness or even death. Approximately 15 percent of people who bleed from varices will die, emphasizing the importance of preventing bleeding and treating the liver disease.
Bleeding varices require emergency medical treatment. If not treated quickly, a large amount of blood can be lost and there is a significant risk of dying. If one or more of these symptoms develop, the person needs to seek emergency care, Because of the serious consequences of bleeding and treatment can reduce this risk, experts recommend that all people with cirrhosis undergo testing to determine if varices are present.
Aim of the study:
This study amied to assess the effect of educational guidelines on patients’ outcomes post esophageal varices management. This was done through the following:
1. Assess patients’ needs post esophageal varices management.
2. Develope and implementing educational guidelines based on patients’ needs assessment.
3. Evaluate the effect of educational guidelines on patients’ outcomes.
Research Hypothesis:
The current study hypothesized that:The educational guidelines will affect positively on patients’ outcomes than who don’t receive it.
Research design:
A quasi-experimental design was followed to achieve the aim of this study.
Technical design:
The technical design includes research design, setting, subjects and tools of data collection
Setting:
The study was conducted at Kafer El Sheikh Liver and Heart Institute that affiliated to ministry of health/Egypt.
Sampling:
A purposive sample of 100 patients from both sex who admitted in the previous mentioned setting at the time of data collection were recruited in this study, subjects were selected according to certain inclusion criteria. The sample was divided equally and randomly into two groups, study group who will received the educational guidelines and routine care and control group who will received only the routine care.
Inclusion Criteria:
Adult patients, admitted to hospital with first time bleeding due to esophageal varices, never had been received educational program about the disease and it`s management and free from others chronic diseases.
Patients in the second day post esophageal varices management
Patients free from physical & mental handicapped
Patients able to communicate with others and hemodynamic stable
Exclusion criteria:
Patients with hepatocellular carcinoma or advanced liver cell failure and sever Portal hypertension
Patients have comorbid disease as (Renal impairment )
Tools of data collection:
Tool I: Patients assessment tool
It will be written in Arabic language and it will be consist of 2 parts which include:
Part 1: Patients’ demographic assessment tool: (Appendix I)
It was developed by the researcher to assess patients’ demographic characteristics, such as; age, gender, occupation, marital status, level of education. It was written in simple Arabic language.
Part 2: Patients clinical data assessment tool (Appendix II)
It was developed by the researcher based on related literature. It was concerned with patients’ history which included present, past and family health history and health habits of the patients under study.
Tool II: Patients’ outcomes assessment tool
:(Appendix II)
It will be written in Arabic language. This tool will include the following 3parts:
Part (1) Patient’s knowledge assessment questionnaire:
It was developed by the researcher and written in simple Arabic language ad based on review of literature. It was concerned with assessment of patients’ knowledge regarding esophageal varices and its management. It included 29 MCQ questions and every question may have one correct answer or many correct answers.
Part 2: Fatigue Impact scale:
This tool was adopted from Hassoun et al, (2002). It was translated into Arabic language and back translation was done. It consisted of (21) statements that was used to assess patients’ fatigue level using 5 Likert scale.
Part 3: Patient’s complications assessment tool:
It was used to assess complications that related to esophageal varices management. It was developed by the researcher based on review of the literature and written with English language. This tool included items as following: patients’ vital signs including pulse, respiratory rate, temperature, blood pressure and pain that measured by researcher. The patient’s lab findings as: hemoglobin, red blood cell, white blood cell, blood urea, albumin and INR… Also contain other markers as: dysphagia, melena, syncope, re-bleeding with intervention, readmission with its causes.
The results of the present study could be summarized as follows:
• The study sample age ranged between 50-59 years, with mean age and stander deviation (55.6 ± 4.11years) for study group and (55.1±4.37) for control group.
• As regard total level of patient knowledge 78% of study and 10 % of control group had satisfactory knowledge level during follow up implementation of educational guidelines.
• Patients fatigue level mean and stander deviation was (10.9±3) for study group and (29.9±11.2) for control group with significant difference between two groups for patients’ level of fatigue during follow up implementation of educational guidelines.
• As regard patients dysphagia and readmission 10% of study and 66 %, 40% respectively of control group suffering from dysphagia and readmission. There were significant differences between two groups for, patient vital signs, laboratory data and patient complication during follow up.
Conclusion educational guidelines had remarkable improvement in study group patient ’ knowledge, fatigue level, pain level and patient complication as dysphagia and patient readmission outside their follow up schedule toward esophageal varices management.