Jurnal Kegawatdaruratan Medis Indonesia

Ventilator Weaning Difficulties in ICU: A Study on VAP Patients with Post-Tracheostomy, Thoracic Trauma, and Thoracic Spinal Cord Injury

Virgiana Piesesha — 2025-02-27

Ventilator weaning failure is an inability to adapt to reduced mechanical ventilator assistance, which can slow down and prolong the weaning process. Ventilator weaning failure is characterized by increased respiratory rate, use of respiratory muscles, gasping breath, out-of-synchronization efforts to assist breathing and ventilator support, shallow breathing, agitation, and abnormal blood gas arteries. Ventilator weaning failure is an inability to spontaneous breathing trial (SBT), re-intubation, and assisted ventilation after extubation or death within 48 hours after extubation. Weaning process failure factors are divided into non-ventilator and ventilator factors. Ventilator factors include poor patient conditions, long-term use of ventilators, and abnormal blood gas analysis (BGA). Meanwhile, the ventilator factor is related to the condition of the patient's lungs that have suffered severe damage or barotrauma and excessive tidal volume pressure. This study analyzes ventilator weaning failure in patients with Ventilator-Associated Pneumonia (VAP), Post Thoracic Trauma, and Post Spinal Cord Injury in Thoracic 10-12 at the intensive care unit. This research method is based on case reports by compiling comprehensive nursing care. The results of the analysis of ventilator weaning failure in this patient are related to the worsening of the patient's condition, complex thoracic trauma, prolonged use of mechanical ventilators causing ventilator-associated pneumonia (VAP), and respiratory acidosis.

Managing Postoperative Pain: The Role of Guided Imagery Therapy in Supravaginal Hysterectomy Patients with Uterine Myoma

Hani Febriyanti — 2025-02-27

Myoma uteri are benign tumors that grow both inside and outside the uterus that are not malignant but can cause pain to those who have them. Management of uterine myoma is by surgery. Surgery is closely related to an incision in the skin, which can cause a feeling of pain in the patient. One of the non-pharmacology techniques that can be used to reduce the pain scale is guided imagery. Guided imagery is useful for increasing the relaxing effect, increasing comfort, and relieving the pain that is felt. This work aims to determine the analysis of guided imagery therapy to reduce postoperative pain of SVH (Supravaginal Hysterectomy) laparotomy. Implementation is carried out on patients. The method used in this study was a case study on a client with postoperative SVH laparotomy for indications of myoma uteri. Guided imagery therapy is carried out for 15-20 minutes, with pain assessment carried out before and after guided imagery is carried out. Pain scale measurement using a numeric rating scale (NRS). After being given guided imagery therapy the patient's pain scale which was initially 8 was reduced to 3. Image memory resulting from guided imagery can lead to the perception that the image is happening, which then affects pain receptors and can reduce the intensity of pain felt. Guided imagery relaxation therapy can reduce pain and anxiety and divert attention so that patients feel relaxed and happy.

The Optimizing Intraoperative Nursing Care: Hypothermia Management in Exploratory Laparotomy for Adhesiolysis and Jejunal Diverticulectomy

Muhammad Alfarizi — 2025-02-27

Exploratory laparotomy surgery is a procedure that is often found in patients with adhesive obstruction ileus. In the intraoperative phase, exploratory laparotomy takes a long time and exposure to cold environments and anesthetic drugs often causes hypothermia which has an impact on serious complications. The purpose of this study was to analyze intraoperative hypothermia management interventions in patients undergoing exploratory laparotomy surgery with adhesiolysis and jejunal diverticulectomy. The study design used a case study with a nursing care approach. The research sample was Mr. S with a diagnosis of adhesive obstruction ileus taken using the convenience sampling technique. Data collection was carried out by observation during surgery and documentation studies with a perioperative nursing care format. Hypothermia management was carried out by providing warm irrigation interventions of the gastrointestinal organs with 0.9% NaCl fluid at a temperature of 38^0C and laparotomy gauze when starting exploration for 4 hours according to the duration of surgery. The results of the study showed significant clinical improvements in body temperature, skin, blood pressure, pulse and gastrointestinal motility. The irrigation method with warm NaCl 0.9% during exploratory laparotomy is very effective in overcoming intraoperative hypothermia and facilitating the adhesiolysis process in the gastrointestinal organs.

Evaluating the Ineffectiveness of Chest Physiotherapy in Airway Clearance for Pneumonia Patients in the Hospital

Fandi Ahmad Kurniawan Setia Budi — 2025-02-27

Pneumonia is a respiratory disorder that commonly affects children. It is often characterized by weakened vesicular breath sounds, along with fine and coarse crackles, which can lead to ineffective airway clearance. Chest physiotherapy is one of the treatments administered to pneumonia patients with impaired oxygenation. This study aims to describe the application of chest physiotherapy in managing ineffective airway clearance in pneumonia patients in the Aster Room of RSD dr. Soebandi Jember. This research employs a case study approach conducted over three days. Data collection methods included interviews, measurements, and observations. The evaluation results showed that the patient experienced a reduction in secretion production, as evidenced by decreased rhonchi sounds and reduced cough intensity. Chest physiotherapy has been proven effective in clearing sputum from the airways and reducing cough intensity in pneumonia patients.

Application of Back Massage Therapy to Prevent Pressure Sores in Patients with Decreased Consciousness: A Case Study

Yeni Zanuba Arifa — 2025-02-27

Patients with neurological disorders, especially those with reduced consciousness, will experience a decrease in their ability to mobilize. Patients who experience decreased ability to mobilize for a long time are at risk of developing pressure sores. The presence of pressure in the protruding bone area causes pressure sores that block blood flow and cause injury to necrosis of the skin tissue. Interventions that nurses can do to improve blood flow to reduce the occurrence of pressure sores, namely by doing back massage. Back massage helps improve circulation in areas where the bones are protruding so that it can prevent pressure sores. This study aimed to explain the effectiveness of the Back Massage Therapy intervention in preventing pressure sores in patients with a decreased level of consciousness. The research method used is a case study with a research time of 3 days with data sources obtained from medical records, assessments, and direct observation of patients. Based on the results of the evaluation before and after the back massage, it showed that there was a change in the condition of the skin before and after the procedure, namely there were no signs of redness, abrasions, bluish or necrosis in the back area and bony prominences. Back Massage can reduce the risk of pressure sores in patients with decreased consciousness.

Enhancing Students' Earthquake and Tsunami Preparedness Through Comic Media Health Education: A Quasi-Experimental Study

Putri Puji Rahayu — 2025-02-27

Background: Indonesia is located in the Ring of Fire area at the meeting point between the Eurasian Plate, the Indonesia-Australian Plate, and the Pacific Plate. This meeting was the source of the megathrust earthquake in the East Java region. This makes Indonesia vulnerable to earthquakes and tsunamis along the southern coast of Java. As a vulnerable group to facing potential earthquakes and tsunamis, the level of preparedness of children in Indonesia needs to be increased. Aim: To determine the effect of comic media health education on the Earthquake and Tsunami Preparedness level of students at SDN Sumberejo 09 Ambulu Jember. Method: The sample of this study was students in SDN Sumberejo 09 Ambulu Jember. The research design used a quasi-experiment using the non-equivalent control group design and probability sampling with the proportionate stratified random sampling approach. Data collection used a characteristic questionnaire and an earthquake and tsunami preparedness questionnaire by LIPI-UNESCO 2006. Result: The result of the study shows differences in the level of preparedness before and after the intervention in the intervention group with a p-value of 0.000 (<0.05). At the same time, there was no difference in preparedness between the data before and after in the control group, with a p-value of 0.101 (>0.005). Conclusion: Comic media has been proven to increase elementary school students’ preparedness.

From Floods to Trauma: Examining the Link Between Individual Traits and PTSD in Kalibaru, Banyuwangi

Yeni Maulina — 2025-02-27

The flood disaster has an impact on the community, namely damaged buildings, loss of life, and psychological impacts such as fear, anxiety, sadness, and despair. The purpose of this study was to determine the relationship between individual characteristics and Post Traumatic Stress Disorder (PTSD) in victims of flash floods in Krajan and Tegal Pakis Hamlets, Kalibaru District, Banyuwangi. This study was conducted using a cross-sectional research design with respondents, namely victims of flash floods in Krajan and Tegal Pakis Hamlets, Kalibaru District, Banyuwangi, with a sample of 181 using a purposive sampling technique. This study showed that most respondents were in the adult age category, with a percentage of 47.5% of the total respondents. Most respondents were female, with a percentage of 62.4%; most had a high school education, and most were homemakers. The most marital status was married, and most respondents experienced trauma due to losses experienced due to the disaster. Based on the analysis conducted using Spearman, a relationship was found between individual characteristics and the level of PTSD in respondents on the variables of age and gender. However, other variables such as education, occupation, marital status, and injuries experienced did not have a significant relationship with PTSD in respondents.

Enhancing Foot Sensitivity in Diabetes Mellitus Patients: The Impact of Diabetic Foot Exercises

Nuraini Achmad Uba — 2025-02-27

Physical activity is an essential way for people with Diabetes Mellitus, especially in dealing with increased sensitivity of the foot. Diabetic foot gymnastics is an exercise performed by DM patients to prevent injuries, help smooth blood circulation, and increase foot sensitivity. The study was designed as a one-group pre and post-test design. The study was conducted on 22-26 May 2018 at the Public Health Center of Peterongan. The sample consisted of 35 respondents using the Purposive Sampling technique. The Independent variable was Diabetic foot gymnastics; the dependent variable was foot sensitivity. The results of analysis used the Wilcoxon test at significance level α = 0.05 was found that ρ <α or 0,000 <0.05, which means that there was an influence of diabetic foot gymnastics with plastic ball to the level of foot sensitivity in DM patients, in which pre-test of half respondent (54.3%) sensitivity of the foot of the ring as many as 19 respondents, and after the post-test become higher as many as respondent (42.9%) had their sensitivity of the foot of the ring as many as 15 respondents. A sensory examination of the foot was required. Because of these results, the risk of complications in the foot could be prevented as early as possible. Normal foot sensation and abnormal foot sensation were sometimes not known by people with diabetes mellitus as one of the factors of diabetic foot gymnastics.

Boosting Blood Flow: How Warm Compress Helps Manage Blood Pressure in Type 2 Diabetes

Izdihar Javier Wardika — 2025-02-27

Patients with diabetes can affect cardiac output, such as blood pressure dysfunction. Changes in insulin resistance and hyperglycemia can lead to blood pressure dysfunction and increased cardiac output problems. Warm compresses affect macrovascular function and impact blood pressure in patients. This study analyzed the effectiveness of warm compresses in reducing blood pressure in type 2 DM patients with decreased cardiac output problems. The study used a case report method. Warm compresses were applied for three days, for 2 hours per day, using a warm water sack placed on the abdomen at 40-42°C. Blood pressure was measured before and after the intervention. Results showed that after 3 days, there was a reduction in blood pressure, with an average decrease of 16.667 mmHg in systolic and 6.667 mmHg in diastolic pressure. Warm compresses effectively reduce blood pressure in patients with cardiac output problems. Nurses can apply warm compress therapy as a simple intervention to improve blood pressure in patients with decreased cardiac output.

Breathe Better: The Role of Pursed Lips Breathing Therapy in Chronic Bronchitis Patients

Adinda Widia Pangestu — 2025-02-27

Chronic bronchitis is an inflammatory disease of the bronchial respiratory tract that lasts more than 3 months or several times in 2 years. Symptoms in patients with chronic bronchitis can affect breathing patterns, including dyspnea, respiratory frequency, depth of breathing, and oxygen saturation. Providing Pursed Lip Breathing therapy can create resistance to the air coming out of the lungs and open the airways to improve breathing patterns. This study aimed to analyze the effectiveness of Pursed Lip Breathing therapy on breathing patterns in patients with chronic bronchitis. This descriptive, experimental research was conducted on a Chronic Bronchitis patient. Patient in the Inpatient Room of a government hospital. The implementation of Pursed Lip Breathing therapy was carried out for 4 days, where each day, there was one session of 8-10 repetitions of abdominal breathing followed by Pursed Lip Breathing therapy for 8 minutes. Data analysis was explained descriptively daily to compare the improvement in breathing patterns between pre and post-therapy values. The study results showed significant improvement in breathing patterns, including the level of dyspnea, depth of breathing, orthopnea, use of accessory muscles for breathing, and vital signs, including RR, SPO2, and the patient's blood pressure. This study concluded that Pursed Lip Breathing therapy effectively improved breathing patterns in Chronic Bronchitis patients. The results of this study indicate that pursed lip breathing therapy is safe to apply to patients undergoing treatment. Nurses can apply pursed lip breathing therapy and implement siki for patients with breathing pattern disorders.