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Background: Congestive Heart Failure (CHF) is a condition in which the heart is unable to pump blood effectively due to structural or functional disorders, commonly manifesting as dyspnea, fluid retention, and peripheral edema. Globally, cardiovascular disease is the leading cause of death, with CHF affecting more than 55-65 million people worldwide. Objective: To perform comprehensive nursing care on patient Ny. A with cardiovascular system disorder: Congestive Heart Failure (CHF) in the Mawar I Ward of RSUD dr. Soeselo, Tegal Regency. Methods: This study used a descriptive method through a case study approach. Data were collected via interview, observation, and physical examination. Results: Four nursing diagnoses were identified: ineffective breathing pattern, hypervolemia, activity intolerance, and knowledge deficit. Interventions included respiratory monitoring, hypervolemia management, energy management, and health education on disease process. After two days of nursing implementation, three diagnoses were resolved and one (hypervolemia) was partially resolved. Conclusion: Nursing care for Ny. A with CHF was carried out through assessment, nursing diagnosis, intervention, implementation, and evaluation. Continued interventions are recommended, including fluid balance monitoring, diuretic collaboration, and edema and ascites monitoring.

Fractures are one of the most common musculoskeletal disorders caused by trauma, repetitive stress, or pathological factors. Supracondylar femur fracture is a type of femur fracture occurring at the distal 12 cm of the femur, and Open Reduction and Internal Fixation (ORIF) is the primary surgical intervention. Post-operative ORIF patients commonly experience impaired physical mobility and impaired skin integrity. This study aimed to provide comprehensive nursing care to a patient post-ORIF for right supracondylar femur fracture in the Mawar 2 Ward of RSUD dr. Soeselo, Tegal Regency. A descriptive method with a nursing process approach was used, employing interview, observation, documentation study, and literature study. Nursing assessments conducted on February 8, 2026 revealed that the patient (Ny. S, female, 68 years) experienced pain at the surgical site with a scale of 7, inability to move both lower extremities (muscle strength score 2), and a post-operative wound approximately 10 cm in length with redness and edema. Two nursing diagnoses were established: impaired physical mobility related to neuromuscular disorders and impaired structural bone integrity, and impaired skin/tissue integrity related to invasive procedure effects. Nursing interventions included mobilization support, pain management, wound care, and collaborative administration of medical therapy. After two days of nursing implementation, both diagnoses were partially resolved. Discharge planning focused on gradual mobilization, independent wound care, and high-protein and high-calorie diet to accelerate recovery.

Introduction: Congestive Heart Failure (CHF) is a complex clinical syndrome caused by the inability of the heart to pump blood adequately to meet the body's metabolic demands. This condition may result in dyspnea, edema, activity intolerance, fatigue, and reduced quality of life. Comprehensive nursing care is essential to address patients' needs and improve health outcomes. Methods: This study employed a descriptive case study approach. Data were collected through interviews, observation, physical examination, and medical record review. Nursing care was provided using the nursing process, including assessment, nursing diagnosis, planning, implementation, and evaluation. Results: The assessment of Mrs. T identified four nursing diagnoses: ineffective breathing pattern, hypervolemia, activity intolerance, and knowledge deficit. Nursing interventions included semi-Fowler positioning, fluid balance monitoring, passive Range of Motion (ROM) exercises, and health education. Following two days of nursing implementation, three nursing diagnoses were resolved, namely ineffective breathing pattern, activity intolerance, and knowledge deficit. Hypervolemia was partially resolved due to persistent fluid imbalance. Discussion: The findings indicate that the application of systematic nursing care can improve several clinical problems experienced by CHF patients. However, fluid balance management remains a challenge, highlighting the importance of patient adherence to fluid restriction and continuous monitoring to prevent worsening symptoms.

Intracerebral hemorrhage (ICH) is the most common type of hemorrhhagic stroke and a leading cause of death and disability in Indonesia. The prevalence of stroke in Indonesia reached 0.83% in 2023, with ICH cases at RSUD dr. Soeselo, Tegal Regency recording 203 cases in 2024 and increasing significantly to 304 cases in 2025. This study aims to describe comprehensive nursing care for a patient with Intracerebral Hemorrhage. The method used was descriptive narrative through a nursing process approach. Nursing assessment of Ny. S (73 years old) revealed subjective data including headache, nausea and vomiting, and weakness in the left hand and foot, while objective data showed blood pressure 180/80 mmHg, MAP 113.3 mmHg, muscle strength of left extremities 2/2, and CT scan results showing a hyperdense lesion (volume 17.17 cc) with perifocal edema in the right thalamus and right corona, partially filling the ventricular system. Four nursing diagnoses were established: decreased intracranial adaptive capacity related to cerebral edema, impaired physical mobility related to decreased muscle strength, knowledge deficit related to lack of information exposure, and risk of falls. Nursing interventions included intracranial pressure management, mobilization support, health education, and fall prevention. After three days of nursing implementation, three nursing diagnoses were resolved, while impaired physical mobility was partially resolved, resulting in discharge planning recommendations including ROM exercises, gradual mobilization, and family involvement in patient care.

Heart failure is a clinical syndrome characterized by shortness of breath and fatigue resulting from structural or functional abnormalities of the heart.  Acute Decompensated Heart Failure (ADHF), also known as decompensated heart failure, is a condition of worsening chronic heart failure that can occur acutely, subacutely, or insidiously, with symptoms progressively worsening over several days or weeks. A 1-year-old male patient presented to the Dermatology Clinic at Cut Meutia General Hospital with the chief complaint of A 60-year-old female patient was brought to the Cut Meutia Emergency Department with the complaint of shortness of breath that had worsened 1 day prior to admission; the shortness of breath worsened during light activity and when the patient was lying down. She also complained of swelling in both legs for one week prior to admission, which had progressively worsened. On examination, skin turgor was slow to return in the left and right lower extremities; palpation of the neck revealed jugular vein distension. Inspection showed a normal chest contour; auscultation of the lungs revealed rhonchi. Cardiac percussion revealed enlargement of the upper, left, and right borders of the heart, as well as the cardiac border at the level of the waist. Auscultation revealed a murmur at the fourth intercostal space on the left side. Examination of the lower extremities revealed pitting edema on both the left and right sides.  Supportive X-ray examination revealed severe cardiomegaly. An ECG revealed sinus rhythm, an irregular rate of 80 beats per minute, LAD axis, P wave not identifiable, PR interval 0.20 seconds, QRS complex 0.6 seconds, inverted T waves in I and AVL, LVH (+), RVH (-), PVCs, AF, and lateral ischemia. Echocardiography revealed severe aortic stenosis due to RHD and an LVEF of 21%. The patient has been prescribed furosemide, warfarin, bisoprolol, and spironolactone.

Background: The management of hemorrhagic shock in obstetrics typically involves aggressive fluid resuscitation, often leading to iatrogenic fluid overload and pulmonary edema. Implementing a timely fluid de-escalation (deresuscitation) strategy is critical to facilitate ventilator weaning and achieve early extubation. Case Illustration: A 31-year-old female (G5P3A1) was admitted to the ICU following emergency Re-Cesarean Section due to Grade IV hemorrhagic shock caused by postpartum hemorrhage (PPH) and placenta previa totalis. Intraoperative aggressive resuscitation triggered iatrogenic fluid overload, manifesting as bilateral pulmonary edema and severe gas exchange impairment (initial AaDO2 of 459 mmHg and lactate level of 2.8 mmol/L). Management and Results: Following initial hemodynamic stabilization, an active fluid de-escalation strategy was initiated on Post-Operative Day 1 (POD 1) using continuous furosemide infusion at 10 mg/hour targeting a negative fluid balance. The patient achieved a negative fluid balance of -1485 mL within 24 hours, accompanied by a significant increase in urine output (7.8 mL/kg/hour). This approach successfully reduced the AaDO2 to 162 mmHg and improved lactate clearance to 1.8 mmol/L without compromising hemodynamic stability. The patient was successfully extubated within 18 hours of ICU admission. Conclusion: Early transition from resuscitation to fluid de-escalation, guided by perfusion targets (lactate) and oxygenation markers (AaDO2), is safe in critical obstetric cases. This strategy effectively resolves pulmonary edema and accelerates early extubation.

Achilles tendon rupture is a common lower extremity injury that significantly affects functional mobility and gait performance. Post-operative patients frequently experience pain, edema, limited range of motion (ROM), muscle weakness, and impaired ambulation. Physiotherapy rehabilitation plays a crucial role in restoring tissue integrity and functional capacity. This case study aimed to analyze the effectiveness of combined electrotherapy modalities and therapeutic exercises in a post-operative left Achilles tendon rupture patient. The intervention included ultrasound therapy, Transcutaneous Electrical Nerve Stimulation (TENS), infrared therapy, dry needling combined with Percutaneous Electrical Nerve Stimulation (PENS), and progressive therapeutic exercises such as isometric training and calf raises. Clinical outcomes were evaluated through ROM measurement, Manual Muscle Testing (MMT), edema observation, and gait analysis across four therapy sessions. Results demonstrated gradual improvement in dorsiflexion and plantarflexion ROM, reduction of edema, increased gastrocnemius-soleus muscle strength, and restoration of independent ambulation without assistive devices. The multimodal physiotherapy approach appears to support tendon healing, enhance neuromuscular activation, and accelerate functional recovery during the subacute post-operative phase.

The postpartum period is a crucial phase for mothers to recover after childbirth. One of the common problems is perineal wounds, caused either by episiotomy or spontaneous rupture, which require proper care to prevent infection and accelerate healing. This case study aimed to provide midwifery care for Mrs. M, 28 years old, P3A0H3, with a second-degree perineal wound at PMB Bd. Silvi Ayu, S.Keb. The SOAP approach was applied through assessment, diagnosis, intervention, implementation, and evaluation over five days (June 12–16, 2025). Interventions included education on perineal hygiene, encouragement of nutritious food intake, light mobilization, and perineal wound care using boiled binahong leaves. The results showed decreased pain, reduced edema, a dry wound, and complete healing on the fifth day, with the REEDA score decreasing from 11 to 0. The discussion emphasized that flavonoids, saponins, and ascorbic acid in binahong leaves contribute to tissue regeneration and faster healing. Limitations of this study included the short monitoring period, limited sample, and reliance on maternal compliance. In conclusion, binahong leaf decoction was found to be effective, practical, and able to enhance maternal independence in wound care. This study is expected to serve as a reference for midwifery practice and as a basis for further research with a wider scope.

A fracture occurs when bone continuity is disrupted due to external pressure or force that exceeds the bone's capacity. Fractures constitute a medical emergency requiring immediate treatment. A primary surgical intervention for this condition is the Open Reduction and Internal Fixation (ORIF) procedure, which aims to reposition broken bone fragments to their normal anatomy. This procedure is considered crucial for achieving proper bone union and minimizing the potential for postoperative complications. As a consequence of the surgical incision and tissue trauma, patients commonly experience postoperative pain. The management of this pain can broadly be categorized into two approaches: pharmacological and non-pharmacological. Among non-pharmacological methods, cold compress therapy has proven effective in alleviating pain in patients following ORIF surgery. The sensation of pain can be alleviated through the application of a cold pack by inhibiting sensory nerve conduction and suppressing local inflammation. Simultaneously, cryotherapy also reduces blood flow to the injury site, which in turn limits blood extravasation and the accumulation of edema fluid. A descriptive case study analysis of four patients with acute pain after lower extremity ORIF surgery. The effectiveness of the intervention was measured using the Numeric Rating Scale (NRS).: The application of cold compresses using cold packs for 3 days to 4 respondents before the cold compress was applied was on a pain scale of 6–7 (moderate to severe category), after the intervention the pain scale became 2–3 (mild category). The results indicate that cold compress therapy in patients with lower extremity post-ORIF fractures is effective in reducing pain levels. Therefore, cold compress therapy is recommended as a non-pharmacological therapy to reduce pain in patients with fractures after ORIF.

Severe preeclampsia is a condition characterized by systolic blood pressure exceeding 160 mmHg and diastolic pressure exceeding 110 mmHg, occurring after 20 weeks of gestation and accompanied by edema and proteinuria. One intervention used to save both mother and fetus is a cesarean section. This final nursing scientific paper analyzes the implementation of evidence-based practice, specifically warm foot soak therapy, for mothers with severe preeclampsia during the pre- and postpartum periods who are at risk for ineffective cerebral perfusion. This descriptive case study method used a nursing care approach. Assessment results identified five major nursing problems, including the risk for ineffective cerebral perfusion. After four days of warm foot soak therapy, this problem was resolved, as blood pressure decreased from 147/101 mmHg to 120/88 mmHg. Conclusion: Warm foot soak therapy effectively lowers blood pressure in pre- and postpartum mothers with severe preeclampsia. Recommendation: Nurses can implement warm

Electrolytes are essential minerals that play a critical role in various physiological processes within the body, including the maintenance of fluid balance, proper neuromuscular function, and the transmission of nerve impulses. They are vital for the stability of the heart and other crucial organs. When electrolyte levels become imbalanced, as seen in conditions such as hyponatremia (low sodium), hypernatremia (high sodium), hypokalemia (low potassium), hyperkalemia (high potassium), and hypocalcemia (low calcium), serious health issues can arise. These imbalances can result from factors like malnutrition, excessive losses through the kidneys or gastrointestinal tract, hormonal disorders, and certain systemic diseases. Understanding the underlying pathophysiological mechanisms and clinical manifestations of these disturbances is essential for effective diagnosis and treatment. Healthcare providers must identify the root causes of electrolyte imbalances while assessing their severity to implement appropriate management strategies. This often involves gradually correcting electrolyte levels to mitigate the risk of life-threatening complications such as arrhythmias, cerebral edema, and neurological impairment. By fostering a comprehensive understanding of electrolyte imbalances, healthcare professionals can improve diagnostic accuracy and therapeutic effectiveness, ultimately leading to better patient outcomes. This knowledge is crucial in minimizing morbidity and mortality associated with these disruptive conditions, ensuring that individuals receive prompt and effective care to restore balance and maintain overall health.

Nephrotic syndrome (NS) is a kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, and hypercholesterolemia, most commonly occurring in children. This disease can be caused by various conditions, such as minimal change disease, FSGS, or lupus nephritis. This case report discusses a 16-year-old boy who experienced nephrotic syndrome with symptoms of swelling throughout his body, accompanied by decreased appetite and a productive cough. The patient presented with complaints of swelling throughout his body that began 7 days after hospitalization and was accompanied by coughing and shortness of breath. A physical examination revealed massive edema, abdominal hypertympany, and shifting dullness. Laboratory tests revealed proteinuria, hypoalbuminemia, and decreased serum albumin. Other supporting tests confirmed nephrotic syndrome. The patient received medication therapy including diuretics, corticosteroids in the form of methylprednisolone, and albumin. Nephrotic syndrome in children can develop gradually and requires management that includes steroids, diuretics, and close monitoring of kidney function and electrolytes. Early detection and appropriate treatment can help improve the patient's prognosis.

Cold compresses or cryotherapy are one of the non-pharmacological therapies often used in nursing practice to help reduce pain, especially in patients with fractures. Fractures are often accompanied by acute pain that can inhibit mobilization, prolong recovery time, and reduce patient comfort. Therefore, a safe, effective, and easy-to-use pain management method is needed. This article was compiled with the aim of identifying and mapping scientific evidence regarding the effectiveness of cold compresses in reducing pain intensity in fracture patients. This study used the Arksey and O'Malley model in conducting the analysis, with articles searched through PubMed, ScienceDirect, and Google Scholar for the 2021–2025 publication period. The article selection process followed the PRISMA flow. A review of ten articles showed that most studies used quantitative designs, both experimental and quasi-experimental. The results of the analysis of 11 articles consisted of 8 quantitative articles with experimental and quasi-experimental designs, while 2 articles were case studies. These articles generally discuss the effectiveness of cold compresses in reducing pain intensity in fracture patients using various measurement instruments, such as NRS, VAS, Wong-Baker Faces Scale, and Bourbanis Pain Scale. In addition to reducing pain, several studies also reported that cold compresses can reduce edema, increase mobility, and improve patient comfort. However, variations in the duration, frequency, and method of cold compress application were still found, so there is a need to develop a more standardized protocol in nursing practice.

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.  

Inflammation is a common condition that affects everyone and can affect quality of life. Candlenut leaves (Aleurites moluccanus) are known to contain flavonoid compounds, such as swertisin and 2''-O-rhamnosylswertisin, which are thought to have anti-inflammatory activity. This study aims to test the anti-inflammatory activity of candlenut leaves using four treatment groups, namely positive control (sodium diclofenac), negative control (Na-CMC), n-hexane fraction (200 mg/KgBW), and ethyl acetate fraction (200 mg/KgBW). Leg edema volume measurements were carried out periodically for up to 6 hours using a digital caliper. The results showed that the percentage of edema inhibition in the negative control group reached 64.13%, positive control 38.91%, n-hexane fraction 39.99%, and ethyl acetate fraction 39.82%. Although the ethyl acetate fraction showed better anti-inflammatory activity than the n-hexane fraction, its inhibition percentage was still lower than that of the positive control. These findings suggest that candlenut leaves have potential as a source of anti-inflammatory compounds, particularly the ethyl acetate fraction. Further research is needed to evaluate its efficacy and mechanism of action.

Open fractures are serious orthopedic injuries with a high risk of infection and soft tissue complications. A 20-year-old male patient presented to the Emergency Department with severe pain in his left leg and wrist, accompanied by a laceration on his face, following a traffic accident. Physical examination revealed deformity and an open wound on the left leg, along with severe swelling and tenderness. Radiographic results showed an open fracture of the proximal third of the left tibia and fibula, an open fracture of the left pedal metatarsal, a closed fracture of the distal phalanx of the third digit of the left foot, and a closed fracture of the distal third of the left radius with distal radioulnar joint dislocation. Based on the Gustilo–Anderson classification, the case was categorized as type IIIB. The patient received initial management including debridement, broad-spectrum antibiotics, analgesics, and splinting. Surgical intervention was performed in stages, comprising Open Reduction External Fixation (OREF) for the tibia–fibula and left foot, followed by Open Reduction Internal Fixation (ORIF) for the distal left radius. Postoperative evaluation showed clinical improvement with reduced pain, decreased edema, and improved extremity function. This case emphasizes the importance of rapid and appropriate management of multiple open fractures to prevent infection, maintain bone stability, and accelerate the healing process.

Edema is a common physiological complaint experienced by pregnant women, particularly during the third trimester, which may affect maternal comfort and daily activities. Prenatal exercise is considered a safe, non-pharmacological intervention that can improve maternal circulation and reduce fluid retention. This study aimed to analyze the relationship between the frequency of prenatal exercise and the incidence of edema in third trimester pregnant women in the working area of Benoa Public Health Center. A cross-sectional analytical design was employed, involving 30 pregnant women selected using purposive sampling. Data were collected through structured questionnaires and physical examination to assess the presence of edema, while the frequency of prenatal exercise was categorized into regular (≥3 sessions per week) and irregular (<3 sessions per week). Descriptive statistics summarized participant characteristics, and the Chi-square test was used to evaluate the association between prenatal exercise frequency and edema, with a significance level of p < 0.05. The results indicated that 26.7% of women who exercised regularly experienced edema, compared to 66.7% of those who exercised irregularly. Statistical analysis confirmed a significant relationship between exercise frequency and edema occurrence (χ² = 5.33, p = 0.021). These findings suggest that consistent participation in prenatal exercise is associated with a lower incidence of edema among third trimester pregnant women. Integrating structured exercise programs into routine antenatal care is recommended to enhance maternal well-being, prevent pregnancy-related discomforts, and support overall health during late pregnancy.

Introduction: Pregnancy is a natural process that every woman experiences. During pregnancy, pregnant women experience many changes, both physiological and psychological. These changes can cause various symptoms in each pregnant woman. Some common complaints during pregnancy include nausea and vomiting, back pain, edema, and shortness of breath. Method: This activity was conducted through counseling aimed at explaining the condition and understanding it to pregnant women. This activity used leaflets and live demonstrations so that participants could perform exercises correctly. Conclusion: After conducting counseling on the role of physiotherapy in pregnancy problems at the integrated health posts (Posyandu) for pregnant women in Sempulang Village, Janju Village, and Keluang Lolo Village, it can be concluded that education is important regarding understanding good exercises to do during pregnancy, such as child pose, cat and camel exercise or yoga for pregnant women, and breathing exercises. This is useful for reducing and preventing symptoms during pregnancy by always paying attention to signs of when to stop the exercise.

Pregnancy is frequently associated with discomforts such as back pain, edema, and postural changes that may interfere with daily activities. Approximately 50–70% of pregnant women experience back pain due to hormonal changes and increased body weight. The use of a Birth Ball is considered one of the non-pharmacological alternatives to alleviate these complaints, as it improves pelvic muscle flexibility and supports postural correction. Proper education is essential to ensure appropriate and effective utilization. This study aimed to evaluate the effectiveness of education using lecture and demonstration methods on the understanding of Birth Ball use among pregnant women. A pre-experimental design with a one-group pre-test post-test approach was applied. The sample consisted of 28 third-trimester pregnant women selected through purposive sampling. Findings revealed that the respondents’ understanding prior to education was 0%, which significantly increased to 96.43% following the intervention. Statistical analysis using the Wilcoxon Signed Rank Test yielded Z = -4.873 with p < 0.05, indicating a significant difference between pre- and post-education. It can be concluded that education delivered through lecture and demonstration methods is effective in enhancing pregnant women’s understanding of Birth Ball use.

An autoimmune condition that targets the joints is rheumatoid arthritis. The joints and surrounding tissues are inflamed due to this disease. Symptoms of this arthritis include joint stiffness, edema, and persistent discomfort. Women are more likely to suffer from rheumatoid arthritis than men, especially those between the ages of 40 and 75. Chronic pain is a sensory or affective experience that lasts >3 months, has mild to severe intensity, and can begin suddenly or gradually. This is related to real or functional tissue damage. To minimize the chronic pain experienced by rheumatoid arthritis patients, this case study aims to assess the effectiveness of cutaneous stimulation, also known as skin stimulation (foot massage). The nursing care method provided to patients with rheumatoid arthritis who complained of discomfort during five morning sessions using skin stimulation therapy (Foot Massage) is described in this case study using descriptive methodology. The application questionnaire was used to measure pain levels before and after the procedure, and the Rheumatoid Arthritis Pain Scale (Raps) was used to evaluate the results. After five sessions, the patient's pain level decreased, according to the case study findings. Conclusion: Discomfort is reduced by applying cutaneous stimulation (foot massage). Since foot massage helps alleviate pain, it can be used as an intervention for RA patients experiencing chronic pain.