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A Normocytic normochromic anemia is one of the most common types of anemia found in geriatric patients with chronic diseases or acute bleeding. Upper gastrointestinal bleeding (UGIB) may cause continuous blood loss resulting in decreased hemoglobin levels. This case report discusses a 72-year-old woman who presented to the Emergency Department of Cut Meutia Regional General Hospital with complaints of black stools for four days prior to admission accompanied by epigastric pain, nausea, weakness, and pallor. The patient had a history of long-term use of analgesic and anti-gout medications due to chronic joint pain, which was suspected to be a risk factor for UGIB. Physical examination revealed pale conjunctiva and tachycardia, while laboratory findings showed hemoglobin of 7.1 g/dL, hematocrit of 23.3%, MCV of 82 fL, MCH of 29 pg, and uric acid level of 11.56 mg/dL, leading to the diagnosis of normocytic normochromic anemia caused by UGIB accompanied by gout arthritis. The patient received intravenous fluid therapy, proton pump inhibitors, antifibrinolytic agents, gastroprotective therapy, packed red cell transfusion, and other supportive treatments. During hospitalization, clinical improvement was observed, including cessation of gastrointestinal bleeding, reduced epigastric pain, and increased hemoglobin level to 8.6 g/dL. This case highlights the importance of early diagnosis and comprehensive management in geriatric patients with anemia caused by UGIB and comorbid gout arthritis.

Providing passive ROM to the extremities can help improve blood circulation, improve respiratory function, and support the recovery of consciousness as assessed using the Aldrete Score. The purpose of this study was to determine the effect of providing early passive ROM mobilization of the extremities on changes in the Aldrete score in patients after general anesthesia. This study used a pre-experimental design with a one-group pretest-posttest approach. The study sample consisted of 57 respondents. The intervention provided was early passive ROM mobilization. The Aldrete score was measured before and after the intervention. Data analysis used the Wilcoxon signed rank test with a significance level of α = 0.05. The results showed that the average Aldrete score before the intervention was 5.89 and after the intervention increased to 9.26. The results of the statistical test showed a p value = 0.0001 (p <0.05), which means that there is a significant effect of providing early passive ROM mobilization of the extremities on increasing the Aldrete score after general anesthesia. From this study, it can be concluded that there is an effect of providing early passive ROM mobilization of the extremities on increasing the Aldrete score after general anesthesia.

Nursing services are a fundamental part of the hospital service system because nurses interact frequently with patients, particularly in inpatient rooms. The quality of nursing services significantly impacts patient satisfaction. This study aims to determine the relationship between the quality of nursing services and patient satisfaction in the inpatient rooms of UMMI Hospital Bogor. This study used a correlational analytical research design with a cross-sectional approach. The population in the study were 1,944 inpatients at UMMI Hospital Bogor. The sample calculation used the Slovin formula with a simple random sampling technique and obtained 332 respondents. The research instrument for the quality of nursing services was based on the five dimensions of SERVQUAL (tangible, reliability, responsiveness, assurance, and empathy) and a patient satisfaction questionnaire. Data analysis was performed univariately and bivariately using the Chi-Square Test statistic. The results showed that the majority of respondents rated the quality of nursing services as good, namely 214 people (64.5%), while respondents who rated the quality of nursing services as poor were 118 people (35.5%). Patient satisfaction results revealed that of the 332 respondents, the majority (230 people or 69.3%) expressed satisfaction, while 102 (30.7%) expressed dissatisfaction. The statistical test results showed a p-value of 0.000 (p < 0.05). The conclusion of this study is that there is a significant relationship between the quality of nursing services and patient satisfaction in inpatient wards. Therefore, continuous improvement in the quality of nursing services is necessary to enhance patient satisfaction and the quality of hospital services.

Stroke often causes hemiparesis, which impairs hand motor skills and independence in daily activities. Mirror therapy is a rehabilitation intervention that stimulates motor function through visual feedback, while patient motivation plays a crucial role in exercise adherence. This study aims to analyze the effect of mirror therapy and patient motivation on hand motor skills in patients with hemiparesis.The study used a quasi-experimental design with a pretest–posttest approach in 30 hemiparesis patients undergoing rehabilitation at the Ciherang Community Health Center. Mirror therapy intervention was administered for 20–30 minutes, three times per week for four weeks. Hand motor skills were measured using Manual Muscle Testing on a scale of 0–5, while patient motivation was assessed using a questionnaire.The results showed a significant increase in hand motor skills after mirror therapy (p < 0.05) and higher patient motivation was associated with greater motor score improvement (p < 0.05). Mirror therapy and patient motivation have been shown to have a positive effect on hand motor skills in hemiparesis patients, so this combined intervention can be considered as part of a stroke rehabilitation program.

Hypertension is a non-communicable disease often referred to as a silent killer because it generally does not present noticeable symptoms. Several risk factors contribute to the development of hypertension, including high body mass index (BMI) and low levels of physical activity. However, data regarding the association between BMI, physical activity, and hypertension at Pakuan Baru Public Health Center, Jambi City, remain limited. Therefore, this study aimed to determine the relationship between body mass index and physical activity with hypertension among adults at Pakuan Baru Public Health Center, Jambi City. This study employed a quantitative approach with a cross-sectional design. The research was conducted at Pakuan Baru Public Health Center, Jambi City, from November 19 to December 6, 2025. The study population consisted of all adult patients with hypertension at Pakuan Baru Public Health Center, totaling 2,797 individuals. A sample of 93 respondents was selected using an accidental sampling technique. Data were collected using observation sheets through measurements of height and weight to calculate BMI, as well as the Global Physical Activity Questionnaire (GPAQ). Data analysis was performed using univariate and bivariate analyses with the chi-square statistical test. The univariate analysis showed that 27 respondents (29.0%) were classified as severely obese, 42 respondents (45.2%) had a low level of physical activity, and 28 respondents (30.1%) were categorized as having stage 2 hypertension at Pakuan Baru Public Health Center, Jambi City. The bivariate analysis revealed a significant relationship between body mass index and physical activity with blood pressure among patients with hypertension (p = 0.000). It is expected that healthcare providers at Pakuan Baru Public Health Center will continue to provide education regarding the importance of controlling body mass index and engaging in regular physical activity, as these factors contribute to increased blood pressure among patients with hypertension.

Hypertension is one of the most common chronic diseases among the elderly and is often accompanied by insomnia. This condition can increase anxiety and reduce quality of life. Progressive Muscle Relaxation (PMR) is an effective non-pharmacological therapy to lower blood pressure and improve sleep quality. This paper describes nursing care for elderly patients with hypertension and insomnia through PMR application at RSUD Embung Fatimah Batam City in 2025. A case study approach was used through the nursing process, including assessment, nursing diagnosis, intervention, implementation, and evaluation. The main nursing diagnosis was sleep pattern disturbance related to physical discomfort and anxiety. Interventions included education and PMR exercises for six consecutive days. Results showed blood pressure decreased from 180/100 mmHg to 130/80 mmHg, sleep quality improved from difficulty sleeping to 6–7 hours per night, and anxiety levels reduced. Progressive muscle relaxation therapy proved effective as an independent nursing intervention to reduce blood pressure and improve sleep quality in elderly patients with hypertension and insomnia. Nurses should use this therapy as a routine non-pharmacological intervention in gerontological nursing practice.

Background: Anxiety can affect physiological functions in patients prior to surgery, including increased heart rate and respiration, changes in blood pressure and temperature, relaxation of smooth muscles in the bladder, cold and clammy skin, and dry mouth, which may reduce the patient’s energy level. Psychologically, anxiety can lead to increased postoperative pain, delayed wound healing, increased physical disability, and decreased quality of life. One effective non-pharmacological intervention to reduce anxiety is Benson relaxation therapy. Objective: This study aimed to determine the effect of benson relaxation therapy on reducing anxiety levels in pre operative. Methods: This study used a case study design involving one preoperative patient with anxiety symptoms in the Teratai Ward of Prof. Dr. Margono Soekarjo Hospital, Purwokerto. Benson relaxation therapy was administered for 3 days, twice daily, with a duration of 15 minutes per session. Anxiety levels were measured using the Zung Self-Rating Anxiety Scale (ZSAS) before and after the intervention. Results: The patient showed a decrease in anxiety score from 55 (moderate anxiety) to 40 (mild anxiety) after receiving Benson relaxation therapy. Subjectively, the patient reported feeling calmer, more accepting, and motivated. Objectively, there was a reduction in heart rate and physical signs of anxiety. Conclusion: Benson relaxation therapy is effective in reducing anxiety levels in preoperative patients. This intervention can be used as a non-pharmacological alternative to support psychological recovery of pre-operative patients.

Meningitis is a serious infectious disease that can be prevented through vaccination; however, the vaccination process often causes anxiety in patients, especially during the pre-procedure phase. Uncontrolled anxiety can affect patient readiness and comfort. Therapeutic communication by nurses is one intervention that has the potential to reduce this level of anxiety. This study aims to determine the relationship between nurses’ therapeutic communication and the anxiety levels of patients prior to meningitis vaccination at Pambalah Batung Amuntai Regional General Hospital. This study used a quantitative analytic design with a cross-sectional approach. The sample consisted of 107 respondents selected using a convenience sampling technique. Data on therapeutic communication were collected using an observation sheet, while anxiety levels were measured using the DASS questionnaire (anxiety subscale). Data analysis was conducted using univariate and bivariate methods with the Chi-Square test at a significance level of 0.05. The results showed that most therapeutic communication was in the good category, and patient anxiety levels were predominantly in the normal category. Statistical test results indicated a significant relationship between nurses’ therapeutic communication and patient anxiety levels (p = 0.000 < 0.05). The better the therapeutic communication provided, the lower the patient’s anxiety level. In conclusion, nurses’ therapeutic communication plays an important role in reducing patient anxiety prior to meningitis vaccination and needs to be optimized in nursing practice.

Type 2 diabetes mellitus is a chronic condition marked by elevated blood glucose levels resulting from insulin resistance and decreased insulin secretion. Effective glycemic control is crucial to prevent complications, and HbA1c is commonly utilized as an indicator of long-term blood glucose levels. This study aimed to examine the relationship between HbA1c levels and blood glucose levels among patients with type 2 diabetes mellitus at Tilamuta Community Health Center, Boalemo Regency, Gorontalo Province. This study employed an analytical cross-sectional design using a total sampling method, involving 557 patients. Data were collected from laboratory records and analyzed through descriptive statistics, the Shapiro-Wilk test for normality, Spearman correlation, and chi-square test. The findings indicated that the average HbA1c level was 7.39%, while the mean blood glucose level was 205.85 mg/dL. A significant and very strong positive correlation was found between HbA1c and blood glucose levels (p=0.000; r=0.862). Furthermore, medication adherence showed a significant association with HbA1c status (p=0.000). These results underscore the role of HbA1c as a dependable marker for assessing glycemic control and highlight the importance of medication adherence in optimizing the management of type 2 diaType 2 diabetes mellitus is a chronic condition marked by elevated blood glucose levels resulting from insulin resistance and decreased insulin secretion. Effective glycemic control is crucial to prevent complications, and HbA1c is commonly utilized as an indicator of long-term blood glucose levels. This study aimed to examine the relationship between HbA1c levels and blood glucose levels among patients with type 2 diabetes mellitus at Tilamuta Community Health Center, Boalemo Regency, Gorontalo Province. This study employed an analytical cross-sectional design using a total sampling method, involving 557 patients. Data were collected from laboratory records and analyzed through descriptive statistics, the Shapiro-Wilk test for normality, Spearman correlation, and chi-square test. The findings indicated that the average HbA1c level was 7.39%, while the mean blood glucose level was 205.85 mg/dL. A significant and very strong positive correlation was found between HbA1c and blood glucose levels (p=0.000; r=0.862). Furthermore, medication adherence showed a significant association with HbA1c status (p=0.000). These results underscore the role of HbA1c as a dependable marker for assessing glycemic control and highlight the importance of medication adherence in optimizing the management of type 2 diabetes mellitus.betes mellitus.  

Turbinate hypertrophy is a condition characterized by abnormal enlargement of the nasal turbinate mucosa, which can lead to chronic nasal obstruction and decreased quality of life. This condition is associated with inflammatory processes in which eosinophils play a role as part of the immune response. This study aimed to determine the relationship between eosinophil levels and the degree of turbinate hypertrophy based on blood examination in hospitalized patients. This research used an observational analytic design with a cross-sectional approach involving 40 patients diagnosed with turbinate hypertrophy at Cut Meutia General Hospital, North Aceh. Data were obtained from medical records, including patient characteristics, eosinophil levels, and the degree of turbinate hypertrophy. The results showed that most patients were aged 17–25 years, predominantly female, and commonly had non-allergic underlying conditions. The majority of patients had normal eosinophil levels (80%), while most cases were classified as grade III turbinate hypertrophy (65%). Statistical analysis using Fisher’s Exact Test demonstrated no significant relationship between eosinophil levels and the degree of turbinate hypertrophy (p>0.05). These findings suggest that eosinophil levels may not be a reliable indicator in assessing the severity of turbinate hypertrophy, particularly in patients with non-allergic conditions. This study highlights the need to consider other contributing factors in the evaluation and management of turbinate hypertrophy to improve diagnostic accuracy and treatment outcomes.

Congestive heart failure (CHF) is a cardiovascular disease that frequently causes shortness of breath (dyspnea) and negatively impacts patients’ quality of life. The management of dyspnea involves not only pharmacological approaches but also nonpharmacological interventions, one of which is handheld fan therapy, which works by stimulating sensory receptors in the facial area. This study aims to describe the effect of handheld fan therapy on reducing shortness of breath in patients with CHF. This study employed a descriptive design using a case report method on a single 63-year-old female patient diagnosed with CHF. The intervention was conducted over four days, involving the use of a handheld fan for 10 minutes, held at a distance of 15–30 cm from the face and directed toward the nose and mouth. Measurements were taken before and after the intervention using respiratory rate and oxygen saturation as parameters. The results showed a gradual decrease in respiratory rate from 24 breaths/minute to 18 breaths/minute, as well as an increase in oxygen saturation from 91% to 96% during the intervention period. These findings indicate an improvement in breathing patterns and increased respiratory efficiency in the patient. Handheld fan therapy is effective as a nonpharmacological intervention for reducing shortness of breath and improving oxygenation in patients with CHF. This intervention is safe, easy to use, and can be implemented as a complementary therapy in nursing practice.

Hypertension is a major public health concern with a high prevalence and a significant risk of complications if left uncontrolled. Effective management requires not only pharmacological treatment but also non-pharmacological approaches and active family involvement. One potential non-pharmacological therapy is the use of celery (Apium graveolens), which is believed to lower blood pressure. This study aimed to evaluate the effectiveness of family education combined with celery decoction administration in reducing blood pressure among patients with hypertension. A descriptive case study design was employed using a family nursing care approach over three home visits, each lasting 30–45 minutes. The intervention included health education on hypertension and a demonstration of how to prepare and administer celery decoction, which was consumed twice daily. Data were collected through interviews, observation, and blood pressure measurements. The results showed a reduction in blood pressure from 159/90 mmHg to 130/80 mmHg, along with a decrease in symptoms such as headaches and dizziness. In addition, there was an improvement in family knowledge, caregiving skills, and the ability to modify the home environment. In conclusion, family-based education combined with the administration of celery decoction appears to be effective in reducing blood pressure and enhancing the family’s role in managing hypertension.

Services in the health sector are a form of public service that must be implemented properly by the government. In the context of health services, the importance of effective and efficient implementation cannot be ignored because this has a direct impact on people's quality of life. In order for health services to achieve their goals, various requirements must be met, including the availability of adequate facilities and infrastructure, a harmonious relationship between patients and service providers, easy accessibility, and high quality. The aim of this research is to determine the description of the service quality of administrative staff. at the Kelapa Gading Community Health Center. The method used is descriptive with a quantitative approach which produces univariate results. This research was conducted at the Kelapa Gading Community Health Center with a total of 150 respondents. The variables in this research are Service Procedures, Completion Time, Service Costs, Service Products, Facilities and Infrastructure, Accreditation of Service Officers. The population in this study were all 1.216 outpatients with a sample of 150 respondents.

Introduction: Carpal Tunnel Syndrome (CTS) is the most common neuropathy caused by compression and tension of the median nerve in the carpal tunnel of the wrist. The most common symptoms of CTS include pain and paresthesia (tingling) with or without numbness in the me dian nerve area of ​​the wrist. Method: The method used was a case study on a 72-year-old male patient diagnosed with bilateral CTS who experienced pain (NRS 7/10), tingling, numbness, and limitations in hand movement and functional activity. Physiotherapy interventions provided included Ultrasound therapy (US), Transcutaneous Electrical Nerve Stimulation (TENS), nerve mobilization, and structured exercise therapy in the form of stretching and median nerve gliding. Evaluation was carried out using the Numeric Rating Scale (NRS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ) for functional activity. Result: The results showed a significant reduction in pain, with motion pain decreasing from a scale of 7 to 3 and pressure pain from 5 to 1 after three therapy sessions. Furthermore, there was an increase in functional activity, as indicated by a decrease in BCTQ scores, namely the Symptom Severity Scale (SSS) from 4 to 2 and the Functional Status Scale (FSS) from 4 to 2. This indicates a gradual improvement from the moderate-severe category to approaching mild. Conclusion: A multimodal physiotherapy approach is effective in reducing pain, reducing paresthesias, and improving hand function in CTS patients. Combining various therapeutic modalities has been shown to be more optimal than single therapies because it can address various pathological aspects simultaneously. Therefore, comprehensive, evidence-based physiotherapy interventions are highly recommended in the conservative management of CTS.

Background: Knee osteoarthritis is a degenerative joint disease that often occurs in the geriatric population and causes pain, limited movement, and decreased function. In advanced conditions, management is carried out with Total Knee Replacement (TKR). However, post-surgery patients still experience functional limitations so that physiotherapy intervention is needed. Objective: To determine the effectiveness of static bicycle and quadriceps strengthening exercises on pain, range of motion, muscle strength, functional mobility, and quality of life in post-TKR patients. Methods: This study used a case study design in one patient with post-TKR dextra et causa bilateral knee osteoarthritis. The intervention was given for 3 weeks with a frequency of 2 times per week. Evaluation was carried out using the Numeric Rating Scale (NRS), goniometer, Manual Muscle Testing (MMT), Timed Up and Go Test (TUG), and the Knee Osteoarthritis Outcome Score (KOOS). Results: Results showed a decrease in motion pain from NRS 6 to 4 and stationary pain from 3 to 2. Knee range of motion increased from 75° to 90° of flexion and from -5° to 0° of extension. Muscle strength increased from MMT 3 to 4 in the quadriceps muscle. Functional mobility also improved, with TUG time decreasing from 22 seconds to 18 seconds. However, the KOOS score remained relatively unchanged at 38.84. Conclusion: Static bicycle and quadriceps strengthening exercises were effective in reducing pain, increasing ROM, muscle strength, and functional mobility in post-TKR patients. However, the improvement in quality of life as measured by the KOOS was not significant, requiring a longer rehabilitation period.

Frozen  shoulder or adhesive capsulitis is a chronic condition that causes pain and limited movement in the shoulder joint. Intervention in the early phase (freezing stage) is crucial to prevent more severe functional disabilities, especially in the elderly population. This case study was conducted on a 60-year-old female patient with complaints of pain and stiffness in the right shoulder for one month. Clinical assessment was conducted using the Numeric Rating Scale (NRS) for pain, Manual Muscle Testing (MMT) for muscle strength, goniometry for joint range of motion, and the Shoulder Pain and Disability Index (SPADI) for functional ability. The therapy program was administered in three intervention sessions. After undergoing three therapy sessions, there was a significant reduction in pain intensity, where movement pain decreased from a score of 7 to 5 and pressure pain from 5 to 2. Muscle strength improved from a value of 3 to 4 on the MMT scale. Additionally, the total SPADI score decreased from 66.1% to 50%, indicating an improvement in the patient's functional capacity in daily activities. The multimodal physiotherapy approach has proven effective in reducing pain, increasing muscle strength, and improving shoulder function in elderly patients with early-stage frozen  shoulder. The combination of electro-physical modalities and manual therapy provides more comprehensive clinical outcomes compared to single interventions.

Sectio caesarea is a common surgical procedure to deliver a baby when normal delivery is not possible or risky. Postoperatively, patients often experience acute pain that can interfere with the recovery process. The benson relaxation technique is a nonpharmacological method that has been shown to be effective in reducing pain through a relaxation and patient confidence approach. This study uses a case study approach on Mrs. T, a post-sectio caesarea patient at Harapan Bunda Hospital, Batam City. Nursing care is carried out comprehensively for three days, including assessment, diagnosis, intervention, implementation, and evaluation. The main intervention was the administration of benzone relaxation techniques for 10–15 minutes every day. After three days of applying the Benson relaxation technique, Mrs. T's pain intensity decreased from a scale of 6 (moderate pain) to a scale of 2 (mild pain). Patients show increased comfort, ability to be active, and decreased expressions of pain such as grimacing. These results support previous findings that benzon relaxation is effective as a nonpharmacological therapy in reducing postoperative pain. This technique can be a safe and easy-to-apply alternative in nursing practice, especially for post-sectio caesarean patients.

The implementation of Hospital Management Information Systems (HMIS) has become a strategic imperative to enhance operational efficiency amidst the ongoing global digital health transformation era. This study aims to analyze the determinants of successful HMIS implementation and its impact on service efficiency and patient outcome quality. Employing a narrative review approach with thematic synthesis of literature from PubMed, Scopus, and ScienceDirect databases between 2016-2026, the study evaluates the relationship between technology investment and organizational performance. The synthesis results indicate that while HMIS significantly reduces administrative burdens and medication errors, a "digital paradox" exists where technical efficiency may disrupt interpersonal interactions between healthcare providers and patients if systems are not user-centered. Key success factors include data interoperability (HL7/FHIR standards), human resource readiness, and governance policy support. This study concludes that a patient-centered efficiency model is the fundamental basis for ensuring technology investments yield sustainable added value within the healthcare delivery system.

Edentulism is a condition of total tooth loss that has a significant impact on the efficiency of mastics, phonetics, and facial aesthetics. This case report presents the rehabilitation of a 72-year-old female patient with a condition of total mandible edentulus using two standard-diameter implants that support the overdenture with a locator retention system. Treatment procedures include clinical evaluation, radiographic analysis, implant placement, prosthesis placement, as well as follow-up evaluation to assess function and comfort. The results of the treatment showed an increase in patient retention, stability, and comfort in daily activities. In addition, patients reported improved confidence and quality of life after the use of implant-based overdentures. These findings confirm that overdenture with mandibular implant support is a predictive, effective, and reliable rehabilitation method in treating total edentulism. The success of this case provides clinical evidence that implant-based approaches are able to overcome the limitations of conventional prostheses, as well as being a solution that supports the functional and psychosocial aspects of elderly patients. Thus, implant-based overdenture can be recommended as the primary therapeutic option in the rehabilitation of mandibular edentulism.

The quality of interaction between physicians and patients plays a crucial role in the healthcare system, as it directly affects patient satisfaction. Ineffective communication by physicians may reduce patient satisfaction and increase the risk of complaints and medical disputes. This study aims to analyze the relationship between doctor–patient communication patterns and patient satisfaction in outpatient services. This research employed a quantitative approach with an observational analytic design using a cross-sectional method. The study population included all outpatient patients, with a sample of 110 respondents selected through accidental sampling. The independent variable was doctor–patient communication, while the dependent variable was patient satisfaction. Data were collected using a questionnaire, and analysis was performed using the Chi-Square test with a 95% confidence level. The results showed that the majority of respondents rated doctor–patient communication as good (80.9%) and reported high levels of satisfaction (75.5%). The analysis revealed that among respondents who experienced good communication, 84.3% reported high satisfaction, whereas the proportion of high satisfaction decreased significantly in the groups with moderate and poor communication. In conclusion, there is a significant relationship between the quality of doctor–patient communication and patient satisfaction in outpatient services, where improvements in communication quality are consistently associated with increased patient satisfaction.