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Background: Non-communicable diseases (NCDs) are diseases caused by changes in human organs or degenerative diseases (age factor). Rheumatoid arthritis is a chronic autoimmune disease that occurs when the body's immune system mistakenly attacks joint tissues. According to WHO 2025, rheumatoid arthritis sufferers reach 355 million people worldwide. Method: This scientific paper uses a descriptive narrative method, namely by providing an overview of family nursing care to patients through a nursing process approach. The general objective of this paper is to understand and apply family nursing care to patients with Musculoskeletal System Disorders: Rheumatoid Arthritis. Results: Nursing diagnoses that appear in patients with Musculoskeletal System Disorders: Rheumatoid Arthritis include chronic pain and knowledge deficit. Conclusion: After nursing implementation for 2 days, the chronic pain diagnosis was partially resolved and the knowledge deficit was resolved, so the author performed routine discharge planning by doing warm compresses using ginger.

Diabetes Mellitus Type II is a chronic metabolic disease characterized by elevated blood glucose levels due to insulin resistance and impaired insulin secretion. Globally, the number of people with diabetes in 2024 is estimated to reach 800 million, with more than 95% being Type II Diabetes Mellitus. At RSUD Prof. M. Yamin, SH Pariaman in 2025, there were 189 recorded cases of Type II Diabetes Mellitus without complications. The purpose of this scientific paper is to provide nursing care to a patient with Type II Diabetes Mellitus in the Internal Medicine Ward of RSUD Prof. M. Yamin, SH Pariaman. The method used is a case study with a nursing process approach, including observation, interviews, physical examination, and data collection from medical records. This study was conducted in the internal ward for 5 days, from February 6, 2026 to February 10, 2026, with the subject Mrs. N. The assessment results identified nine nursing problems: unstable blood glucose levels, acute pain, impaired skin/tissue integrity, ineffective peripheral perfusion, impaired physical mobility, sleep pattern disturbance, fatigue, risk of infection, and risk of nutritional deficit. The evaluation after 5 days of nursing care showed that five diagnoses were resolved, namely unstable blood glucose levels, ineffective peripheral perfusion, fatigue, risk of infection, and risk of nutritional deficit. Meanwhile, the other four diagnoses were not fully resolved but showed improvement. It is expected that the patient and family will maintain adherence to a healthy lifestyle, therapy, diet, and regular follow-up in order to prevent complications.

Laparotomy is a major surgical procedure associated with a high risk of acute postoperative pain. According to Gan (2017), if pain is not properly managed, it can progress to chronic pain. (Toro et al., 2018) reported that severe pain on the first postoperative day is still commonly found in laparotomy patients, while (Small & Laycock, 2020) indicated that moderate to severe pain within the first 24 hours following major surgery remains a significant clinical issue. This study aims to evaluate the effectiveness of pharmacological pain management following laparotomy under general anesthesia, specifically to identify the types of opioid analgesics used, analyze their effectiveness in reducing pain intensity, identify side effects, and examine administration techniques and routes. This study employed a Systematic Literature Review (SLR) method following the PRISMA guidelines. Literature searches were conducted in the PubMed, ScienceDirect, and SpringerLink databases covering the years 2015–2026. The included studies comprised randomized controlled trials (RCTs), cohort studies, and retrospective studies addressing opioid pharmacological pain management in adult patients following laparotomy under general anesthesia. Study quality assessment was performed using the Joanna Briggs Institute (JBI) instrument. A total of 11 studies met the inclusion criteria. The results of the systematic literature review indicate that opioids are effective in reducing postoperative pain following laparotomy under general anesthesia. The most commonly used opioids are morphine, fentanyl, and oxycodone. Of all the opioids reviewed, oxycodone provided the best pain control, while intrathecal morphine was most effective in reducing the need for supplemental opioids during the early postoperative period. Other opioids, such as extended-release dinalbuphine sebacate and tegileridine, are also effective, but the number of studies is still limited. The most common side effects are nausea, vomiting, pruritus, sedation, and dizziness. Pharmacological pain management using opioids is effective in reducing the intensity of postoperative pain following laparotomy under general anesthesia. Morphine, fentanyl, and oxycodone are the most commonly used opioids. Oxycodone and intrathecal morphine have shown good results in improving pain control and reducing the need for supplemental opioids. The selection of opioid type, dosage, and administration technique must be tailored to the patient’s clinical condition to achieve optimal analgesia with minimal side effects.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an obligate intracellular bacterium that affects the skin, peripheral nerves, upper respiratory mucosa, and eyes. Type 2 diabetes mellitus (T2DM) is a comorbidity that can worsen the course of leprosy. The female patient, Mrs. D, aged 55 years came to the emergency room of Cut Meutia Hospital with the main complaint of red bumps accompanied by pain on the face, hands, chest, and back since 3 days ago and additional complaints such as fever, joint pain, and numbness and loss of feeling in the legs, weakness, frequent thirst, and frequent urination. Dermatologic status is obtained in the facial region in the form of erythema nodules with firm boundaries with numular size, multiple. Laboratory examination showed anemia and leukocytosis. The therapy given was MDT MB package, ferrous sulfate 1x325 mg and PRC transfusion 3 kolf. Complaints arose acutely after the patient resumed taking MDT (multidrug therapy) leprosy drugs which had previously been stopped for more than 3 months. Based on the time of onset of symptoms, history of leprosy treatment, and the manifestation of systemic inflammatory lesions with signs of neurotropism, it can be suspected that the patient is experiencing a type 2 leprosy reaction or Erythema Nodosum Leprosum (ENL).

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.

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.

Ventricular septal defect (VSD) is a congenital heart defect characterized by a gap in the interventricular septum, with a prevalence of 20–30% of all cases of congenital heart disease. Based on their location, VSD is divided into perimembrane, muscular, and subarterial. This case report discusses a patient who came to the emergency room of Cut Meutia Hospital with good consciousness (GCS E4M6V5) and complained of shortness of breath, cough, nausea, and chest pain spreading to the neck and hands. The anamnesis showed chronic symptoms in the form of coughing up phlegm for two weeks, accompanied by throbbing headaches, dizziness, flatulence, and sleep disturbances. Physical examination showed vital signs of TD 140/90 mmHg, HR 86 x/min, RR 23 x/min, SpO₂ 37%, and temperature 37°C.  Supporting examinations in the form of chest X-rays showed cardiomegaly of the pulmonary segment, while ECG showed rhythmic sinuses with LAD axis, T-inverted in AVL, V1, V2, RsR' in V2, positive Cornell criteria, anterolateral myocardial infarction, RBBB, and LVH. Echocardiography shows the presence of a bidirectional shunt with a dominant right-to-left shunt. This case confirms the importance of comprehensive diagnosis through clinical and supporting examinations to determine optimal management in patients with VSD, as well as prevent further complications.

Osteoarthritis is a progressive degenerative joint disease characterized by cartilage damage, chronic inflammation, and functional limitation. Current treatments mainly focus on symptom relief and mechanical correction, with limited ability to restore the biological environment of the joint. Recently, mesenchymal stem cell derived secretome has emerged as a promising cell free regenerative therapy with anti-inflammatory and tissue-repair potential. This study aimed to systematically review the role of mesenchymal stem cell secretome in osteoarthritis management, both as an intra-articular therapy and as an adjuvant following surgical intervention. A literature review was conducted on relevant preclinical and early clinical studies published over the past decade. The selected articles were analyzed to evaluate therapeutic mechanisms and clinical implications. The findings indicate that intra articular administration of secretome reduces inflammatory mediators, suppresses catabolic enzyme activity, and improves cartilage integrity in various osteoarthritis models. Early clinical evidence also suggests improvements in pain and joint function, especially in patients with mild to moderate disease. Furthermore, secretome shows potential as an adjuvant therapy after surgery by supporting biological recovery of joint tissues. Overall, mesenchymal stem cell secretome represents a promising component of a multimodal strategy for osteoarthritis management, although further clinical trials are required to confirm its efficacy and safety.

Aortic dissection is a cardiovascular emergency characterized by a tear in the aortic intima layer and the formation of a false lumen, posing risks of fatal complications such as rupture and organ malperfusion. Stanford type B dissections may be managed conservatively; however, complicated cases require intervention. Thoracic Endovascular Aortic Repair (TEVAR) has emerged as the preferred modality, offering lower perioperative morbidity and mortality compared to open surgery. To report the first TEVAR procedure performed in Manado on a patient with Stanford type B aortic dissection, highlighting the technical approach, operative challenges, and clinical outcomes. A 62-year-old male with a history of hypertension and chronic chest pain was referred following a CT angiography that revealed a Stanford type B aortic dissection with an entry site in the proximal descending aorta. TEVAR was performed with stent-graft placement in zone 2 and a chimney graft to preserve perfusion of the left subclavian artery (LSA). Intraoperative aortography confirmed false lumen exclusion without endoleak. The patient showed significant clinical improvement and recovered without postoperative complications. The procedure was technically and clinically successful, with no major complications. Postoperative evaluation confirmed stable stent position and maintained LSA perfusion. This case demonstrates that TEVAR can be safely implemented in non-tertiary regional hospitals with thorough preparation. The first TEVAR procedure in Manado illustrates that this technique can be an effective solution for complicated type B aortic dissections. This experience marks a milestone in the development of endovascular services in resource-limited settings and may serve as a reference for similar institutions in Indonesia.

Inflammation is a physiological response to tissue injury, infection, or harmful stimuli, characterized by redness, swelling, heat, and pain. However, excessive or chronic inflammation may lead to tissue damage and degenerative diseases. Long-term use of non-steroidal anti-inflammatory drugs is associated with gastrointestinal and cardiovascular side effects, highlighting the need for safer natural alternatives. Taro leaves (Colocasia esculenta) are traditionally used to treat swelling and wounds and contain bioactive compounds such as flavonoids, alkaloids, tannins, saponins, and triterpenoids with potential anti-inflammatory effects. This study aimed to evaluate the anti-inflammatory activity of ethanol extract of taro leaves and determine the most effective dose. An experimental study was conducted using male white mice (Mus musculus) divided into five groups: negative control (Na-CMC), positive control (sodium diclofenac), and three treatment groups receiving extract doses of 25, 50, and 75 mg/kg BW. Inflammation was induced by 1% carrageenan injection. The extract significantly reduced inflammation, with the highest inhibition (84.13%) observed at 75 mg/kg BW, comparable to diclofenac.  

Low back pain (LBP) is one of the most common musculoskeletal complaints globally and is the main cause of decreased work productivity. One of the risk factors that has been widely studied in the literature is prolonged sitting duration. Prolonged sitting activities cause increased static pressure on the lumbar spine, fatigue of the supporting muscles, as well as a decrease in local blood flow that can trigger chronic pain. This study is a literature review with a meta-analytical approach that aims to analyze the relationship between long-term sitting and the incidence of LBP. The review process was carried out following PRISMA guidelines through searches on PubMed, Scopus, ScienceDirect, and Google Scholar databases for publication in 2020–2025. Of the 20 previous studies analyzed, most showed a positive association between sitting time and an increased risk of LBP, both in adults, adolescents, and children. Sitting for more than 6 hours per day increases the risk of LBP by 33%, especially in individuals with low physical activity. In addition, longer sitting durations with poor posture and minimal active rest were found in the group of office workers and professional drivers who had a high prevalence of LBP. Physical activity has been shown to play a protective role against the risk of LBP, while ergonomic interventions such as lumbar support can reduce pain complaints. Although most studies were observational, the consistency of results supports the importance of prevention through reduced sitting time, increased physical activity, and ergonomic work environment settings. These findings provide a scientific basis for multidimensional interventions to effectively reduce the incidence of LBP.  

Acute pain is a complex phenomenon frequently experienced by post-surgical patients. If not properly managed, it can hinder the recovery process and increase the risk of chronic complications. This study aims to conduct an in-depth analysis of the concept of acute pain in surgical patients from a nursing perspective to improve the quality of care. The method used was a narrative literature review, analyzing various research articles and clinical protocols related to surgical pain management. The study findings indicate that acute post-surgical pain involves sensory and emotional dimensions influenced by the type of surgical procedure, individual pain threshold, and the effectiveness of pharmacological and non-pharmacological interventions. Furthermore, the role of nurses in conducting accurate pain assessments and patient education is a key factor in successful pain management. The implications of this study emphasize the importance of implementing integrated multimodality pain management protocols and improving nurses' competency in conducting intensive monitoring. Optimizing pain management is expected to accelerate patient mobilization, shorten hospital stays, and increase patient satisfaction with nursing services.

Sleep quality is a crucial component of health and overall well-being among older adults, as the aging process is commonly associated with various physiological, psychological, and environmental changes that may significantly disrupt normal sleep patterns. Declining bodily functions, increased health problems, and changes in daily routines often contribute to sleep disturbances in later life. This literature review aims to analyze the factors influencing sleep quality in the elderly by synthesizing findings from relevant national and international studies published in recent years. Various factors were identified, including physiological conditions such as chronic diseases, pain, and hormonal changes; psychological factors such as anxiety, depression, stress, and cognitive decline; lifestyle-related factors such as levels of physical activity, dietary habits, medication use, and caffeine consumption; and environmental aspects including noise exposure, lighting conditions, temperature, and overall bedroom comfort. The reviewed literature consistently indicates that poor sleep quality is strongly associated with impaired physical health, reduced cognitive function, increased fatigue, and decreased emotional well-being in older adults. This review highlights the importance of comprehensive, multidisciplinary interventions that address both intrinsic and extrinsic determinants of sleep to effectively improve overall sleep quality among elderly populations.

Carpal tunnel syndrome (CTS) is the most common chronic neuropathy of the upper limb, characterized by compression of the median nerve within the carpal tunnel. It typically results from repetitive hand movements or trauma and leads to pain, numbness, and weakness, making it a significant occupational health concern. Increased intracarpal pressure causes venous stasis, edema, and ischemic damage, which slow nerve conduction and are detectable through electrodiagnostic (EDX) studies. Recently, ultrasonographic measurement of the median nerve cross-sectional area (CSA) has been proposed as a noninvasive diagnostic option. This study aimed to evaluate the diagnostic accuracy of ultrasound-based CSA measurement compared with EDX findings in CTS patients. The research was conducted at Al-Imamain Al-Kadhimain Medical City in Baghdad from November 2024 to March 2025 and included 100 patients (200 hands). All individuals underwent both EDX and high-resolution ultrasonography using a 5–13 MHz linear probe, with CSA calculated by the direct tracing method. CTS was confirmed in 102 hands (51%). Affected hands demonstrated significantly prolonged distal motor and sensory latencies, reduced amplitudes, and lower conduction velocities (p < 0.001). Mean CSA was significantly larger in CTS hands (13.75 ± 3.95 mm²) than in non-CTS hands (10.15 ± 3.33 mm², p < 0.001). ROC analysis produced an AUC of 0.776 and an optimal cutoff of 11.5 mm² (72% sensitivity, 76% specificity). CSA also increased with CTS severity. Moderate accuracy was observed when differentiating mild from moderate CTS at a 12.5 mm² cutoff, and moderate from severe CTS. In conclusion, median nerve CSA measurement by ultrasound is a reliable, noninvasive, and rapid tool for diagnosing and grading CTS, complementing EDX assessment.  

The rapid development of the digital era has led to a major shift in the modern workplace, with over 1.5 billion people spending more than six hours daily in front of computer screens. This working condition poses significant occupational health risks, including Musculoskeletal Disorders (MSDs) such as Low Back Pain (LBP) and neck strain, with a global prevalence of 60-80%. Furthermore, prolonged screen exposure and high workload contribute to mental health issues like chronic stress and digital fatigue. This community service aimed to increase awareness among PT. XYZ employees regarding the importance of integrated ergonomics to achieve optimal productivity. The method used was an informative sharing session through a presentation and discussion. The material emphasized a three-pronged intervention approach: physical ergonomics (workstation adjustment), technology-based interventions (wearable devices, break reminder apps, and electromagnetic radiation prevention), and mental well-being integration (mindfulness and relaxation techniques). The results showed a significant increase in participant understanding of the health risks and the practical steps to implement integrated ergonomic solutions. It was found that combining technology-based reminders and mindfulness exercises can reduce health complaints by up to 40% better than physical interventions alone. The implication of this service is the recommendation for PT. XYZ to adopt an integrated ergonomic policy that addresses physical, technological, and mental aspects to create a healthier, safer, and more productive work environment for its employees.

Knee osteoarthritis is one of the most prevalent musculoskeletal disorders in the elderly, characterized by progressive degeneration of articular cartilage, chronic pain, joint stiffness, and reduced functional capacity. In Indonesia, the prevalence of knee osteoarthritis is notably high, affecting over 30% of individuals aged above 60 years. This condition leads to significant health burdens, impaired quality of life, and increased economic costs. Non-pharmacological management strategies such as hydrotherapy and quadriceps exercise are widely recommended to relieve pain and improve joint function. Hydrotherapy utilizes the physical properties of water including buoyancy, hydrostatic pressure, viscosity, and warmth to reduce joint loading, enhance circulation, and promote relaxation. Quadriceps exercise, on the other hand, focuses on strengthening the quadriceps muscle to stabilize the knee joint, thereby reducing pain and improving functionality. The combination of these two interventions is expected to provide greater benefits than a single modality. Research Design: This study employed a quasi-experimental design with a one-group pre-post test approach on 12 elderly respondents with knee osteoarthritis at OSF Magdalena Daemen BSB Convent. Pain was measured using the Visual Analogue Scale (VAS) before and after the intervention, which consisted of hydrotherapy and quadriceps exercise administered twice a week for four weeks. Results: The findings showed a decrease in the mean pain score from 4.42 to 3.08, with the Wilcoxon test yielding p = 0.001 (p < 0.05), indicating a significant difference in pain levels before and after the intervention. Conclusion: The combination of hydrotherapy and quadriceps exercise is effective in reducing pain in patients with knee osteoarthritis.

Malaria is a global health problem, especially in tropical countries like Indonesia. Papua, with 14,586 cases, and Jayapura City in 2023 had 29,938 cases. This is due to nocturnal activities, knowledge, and preventive measures, which contribute to the high incidence of malaria. The purpose of this study was to identify factors associated with malaria incidence at Bhayangkara Hospital Class II, Jayapura. This research was an analytical study with a cross-sectional design. Data collection was conducted using a questionnaire. A total of 82 respondents were recruited using a simple accidental sampling technique. The data obtained were statistically analyzed using the chi-square test. Based on the analysis results, it was found that of the 82 respondents, the characteristics of the respondents were mostly aged > 20 years (74 people (90.2%), male (48 people (58.5%) and unemployed (53 people (64.6%). There was a significant relationship between nighttime activities and malaria incidence at Bhayangkara Hospital Level II Jayapura. (p-value 0.015 <α (0.05). There was a significant relationship between knowledge and malaria incidence at Bhayangkara Hospital Level II Jayapura (p-value 0.000 <α (0.05). There was a significant relationship between malaria prevention measures and malaria incidence at Bhayangkara Hospital Level II Jayapura (p-value 0.008 <α (0.05). Nighttime activities, knowledge and malaria prevention measures were significantly associated with malaria incidence.

The World Health Organization (WHO) reported in 2019 that 40 million people worldwide require palliative care, including those with cardiovascular disease (38%), cancer (34%), chronic lung disease (10.3%), AIDS (5.7%), and diabetes (4.6%). Palliative care aims to improve the quality of life of patients and families facing life-threatening illnesses by managing pain and physical, psychological, social, and spiritual problems. The main goal of this care is to reduce suffering and help patients cope with the limitations imposed by illness. The principles are to respect life, consider death a normal process, neither hasten nor delay death, and provide support until the end of life. This study aims to determine whether knowledge can influence the level of self-efficacy of nursing students at Awal Bros University. Using a correlational quantitative method, data were collected through the Palliative Care Quiz for Nursing and Self-efficacy Palliative Care Scale questionnaires. The results of the study show a significant relationship between knowledge and self-efficacy among students with p<0.005. These findings can be used as a basis for learning to improve the understanding of nursing students, especially in the context of palliative care, which is important for the quality of health services in the future.

Osteoarthritis of the knee is a degenerative condition of the knee joint characterized by the thinning of cartilage, leading to friction between the femur and tibia. This condition results in pain, limited joint mobility, and reduced strength of the quadriceps and hamstring muscles. Physiotherapy plays a crucial role in reducing these symptoms through modality-based approaches and structured exercise therapy. This study is a case study involving a single patient with right knee osteoarthritis. Data were collected through direct observation and evaluation of therapeutic outcomes. Interventions were conducted over four sessions using Transcutaneous Electrical Nerve Stimulation (TENS) to reduce pain, Ultrasound to enhance blood circulation and reduce inflammation, and exercise therapy focusing on improving muscle strength and joint range of motion. After four therapy sessions, there was a reduction in pain intensity, improved strength of the quadriceps and hamstrings, and increased joint range of motion. These results demonstrate that the combination of TENS, ultrasound, and exercise therapy is effective in improving function and quality of life for patients with right knee osteoarthritis. This study emphasizes the importance of a multimodal physiotherapy approach in managing chronic musculoskeletal disorders.

Rheumatism in the elderly can cause chronic pain that affects the quality of sleep. One of the factors influencing the sleep pattern of elderly patients with rheumatism is the level of physical activity. Insufficient physical activity can worsen joint stiffness and increase sleep disturbances. This study aims to examine the effect of physical activity on sleep patterns in elderly rheumatism patients at the Sumber Pucung Elderly Posyandu, Malang Regency. This study is a quantitative study with an analytical correlational design using a cross-sectional approach. The population of this study consisted of all elderly rheumatism patients at the Sumber Pucung Elderly Posyandu, totaling 33 people. The sampling technique used was total sampling. The study was conducted from July 20 to 27, 2025. Data collection instruments used the Global Physical Activity Questionnaire (GPAQ) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. The results showed that most respondents (90.9%) had low physical activity and all respondents (100%) had poor sleep patterns. The simple linear regression test yielded a significance value of p = 0.479 (p > 0.05) and R Square = 0.016, indicating no significant effect of physical activity on sleep patterns. Based on these results, it is expected that elderly rheumatism patients can increase physical activity according to their abilities to help maintain sleep quality, and Posyandu officers can provide education and elderly exercise programs appropriate for rheumatism conditions.