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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.

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.

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

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.

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.

Disorders of the musculoskeletal system encompass a wide range of conditions affecting the bones, joints, and muscles. Bone-related disorders include osteoporosis, fractures, spinal deformities, osteopenia, osteomalacia, Paget’s disease of bone, osteopetrosis, achondroplasia, osteogenesis imperfecta, and osteomyelitis. Joint-related disorders consist of arthritis, bursitis, tendinitis, tendon injuries, tennis elbow, and carpal tunnel syndrome, while muscle disorders include myalgia, fibromyalgia, muscle injuries, muscular dystrophy, muscle atrophy, cramps, and spasms (Astuti et al., 2024). Fractures may lead to complications in surrounding tissues, such as soft tissue edema, bleeding into muscles and joints, joint dislocation, nerve damage, vascular injury, and tendon rupture (Rumapea, 2024). A patellar tendon rupture occurs when the fibrous tissue connecting the patella to the quadriceps muscle tears, and complete ruptures typically require surgical repair. The objective of this study was to design and implement a nursing care plan for patient A, who underwent post-operative management of a patellar tendon rupture in Mawar Ward 2 at RSUD dr. Soeselo, Tegal Regency, in 2025. This study applied a descriptive case study method. The findings revealed that the main complaint reported by the patient was pain in the left knee. Three nursing diagnoses were identified: acute pain, impaired physical mobility, and risk of infection. Nursing interventions were structured based on standardized guidelines from SDKI, SLKI, and SIKI, enabling systematic implementation. The results highlight the importance of comprehensive and evidence-based nursing care to optimize recovery outcomes for patients with post-operative tendon rupture.

Liver cirrhosis is a chronic disease characterized by progressive fibrosis, altered liver architecture, and the formation of regenerative nodules. Although it develops slowly, cirrhosis often leads to serious complications such as ascites, variceal bleeding, jaundice, and hepatic encephalopathy. According to the Global Burden of Disease Study 2019, cirrhosis is among the leading causes of death worldwide, with more than 1.4 million deaths annually. In Indonesia, the prevalence of cirrhosis is reported at 0.4% (Riskesdas, 2021) and shows an increasing trend over the years. This case study aims to describe the application of comprehensive nursing care in a patient diagnosed with liver cirrhosis using the nursing process approach. The research design was a case study conducted on Mr. R, who was admitted to Dahlia Ward at RSUD dr. Soeselo, Tegal. Data collection was carried out through interviews, observations, physical examinations, and medical record reviews. The results revealed that the main nursing problems identified were ineffective peripheral perfusion, ineffective breathing pattern, and knowledge deficit. Nursing interventions provided included positioning the patient in semi-fowler, monitoring vital signs, educating the patient about low-sodium diet and fluid restriction, and collaborating in the administration of diuretics and albumin. After three days of nursing care, the evaluation indicated clinical improvement, evidenced by reduced edema, decreased shortness of breath, and increased patient understanding of his disease and treatment plan. In conclusion, nursing care with a comprehensive process approach has a significant positive impact on the condition of patients with liver cirrhosis. Nurses play an essential role in assessment, planning, implementation, evaluation, and providing health education to prevent complications and improve patients’ quality of life.

Heart failure or congestive heart failure (CHF) is a condition where the heart is unable to pump blood optimally to meet the body's metabolic needs, resulting in symptoms such as shortness of breath, excessive fatigue, and edema (Majid, 2017). According to WHO data in 2023, CHF is one of the main causes of death with a total of 17.5 million deaths from a total of 58 million cases recorded worldwide. This paper aims to describe and provide an overview of nursing care for patient Mr. H who experiences cardiovascular system disorders in the form of CHF in the Dahlia room of Dr. Soeselo Regional Hospital, Tegal Regency in accordance with nursing practice standards. The method used is a descriptive method through a case study with data collection techniques using interviews and observations. From the results of the case review, the main complaint experienced by the patient was shortness of breath which was quite disruptive to daily activities. Based on this condition, four main nursing diagnoses were found, namely ineffective airway clearance, hypervolemia, activity intolerance, and knowledge deficits related to the disease and self-care. The interventions provided are based on theoretical references in the Indonesian Nursing Diagnosis Standards (IDHS) and the Indonesian Nursing Outcome Standards (SLHS), and are tailored to the patient's actual condition. The implemented action plan is expected to help reduce symptoms, improve the patient's ability to function, and provide a better understanding of CHF so that the patient can actively participate in the care process.

Pharmacology is the study of drug interactions with living organisms. This study aims to evaluate the anti-inflammatory effects of several drug preparations, including Hemilon (methylprednisolone), Lupred (prednisolone), Kamathasone (dexamethasone), neem leaf infusion, and snakehead fish extract, on mice (Mus musculus) induced with inflammation using carrageenan solution via intraplantar injection. Edema volume was observed using a plethysmometer at 15, 30, 45, and 60 minutes post-induction. Data were analyzed using normality, homogeneity, ANOVA, and Tukey tests via SPSS. Results showed that Hemilon had the highest anti-inflammatory effect, followed by Kamathasone and Lupred, while neem leaf and fish extract showed weaker activity. Statistical tests revealed normal distribution (sig. 0.197 > 0.05), non-homogeneous data (sig. 0.022 < 0.05), and no significant difference between groups (ANOVA sig. 0.366 > 0.05). Despite this, descriptive results confirmed strong anti-inflammatory potential of synthetic drugs. This practicum provides valuable insights into drug mechanisms and emphasizes methodological accuracy in pharmacological testing.

The study entitled “Cream Formulation of Methanol Extract of Tapak Kuda (Ipomoea pes-caprae (L.) R. Br.) Leaves) As an anti-inflammatory in male white mice (Mus musculus)” using laboratory experimental methods with posttest control group design, data analysis using SPSS 25.0 with One Way ANOVA test and Duncan test. The percentage of extract yield obtained was 3.12%, phytochemical screening test showed the presence of secondary metabolite compounds alkaloids, terpenoids, flavonoids, saponins, tannins and steroids. Cream preparation of methanol extract of Tapak Kuda leaves at concentrations of 2.5%, 5% and 10% showed anti-inflammatory activity and the maximum dose to reduce edema diameter was 10% concentration with a percentage inhibition of 87.97%. Data analysis with One Way ANOVA test with a significance value ≤ 0.05 which indicates the presence of anti-inflammatory activity in Ipomoea pes-caprae tread leaf methanol extract cream.

This study aims to improve the health status of families so that a healthy and prosperous family is realized in the family of Mr. "Z" with menorrhagia in adolescent girls in Ngalong Hamlet, Kuta Village, Pujut District. The study was carried out by collecting all available data sheet formats through interview techniques and systemic observation. Subjective data, especially on the main complaint of menstruation for more than 10 days and changes, Blood Pressure (BP): 98/80 mmHg, Respiration (P): 18 x / i, Pulse (N): 88 x / i, Temperature (S): 36.5o C, eyes are not edematous, pale conjunctiva, white sclera. The potential diagnosis in this case is endometrium but it did not occur because it has been handled properly. Immediate action that can be taken is to collaborate with health workers and patients. The planning carried out on Ms. M aged 14 years is: informing about the results of the examination, explaining the signs and symptoms, handling menorrhagia and consulting a Sp.OG doctor. The implementation given to Ms. M with Hypermenorrhea is: informing about the results of the examination that Ms. M's general condition informs about the results of the examination, explains the signs and symptoms, treatment of menorrhagia, and consultation with a Sp.OG doctor. Evaluation is a stage of assessment of the success of the maintenance given in overcoming consultation with a Sp. DAN doctor.

Background: The highest cause of maternal death is hypertension in pregnancy which includes severe preeclampsia or what we know as PEB. Preeclampsia itself is a pregnancy condition that has problems characterized by hypertension, protein in the urine, and edema that occurs in pregnant women at 20 weeks. If the preeclampsia condition worsens and does not receive proper treatment, pregnant women can experience eclampsia with additional symptoms of seizures. Research Objective: To determine the most influential determinants of the incidence of severe preeclampsia in pregnant women at RSIA Anugrah Kubu Raya. Method: This study used a case-control study design with a retrospective approach. The study sample consisted of 76 respondents (38 controls and 38 cases). Data analysis used logistic regression tests. The study was conducted at RSIA Anugrah Kubu Raya. Results: The most influential determinants were a history of hypertension and a history of preeclampsia. Conclusion: The most influential variable in the incidence of preeclampsia was a history of preeclampsia.

Conjunctivitis is an inflammation of the conjunctiva, the mucous membrane covering the back of the eyelids and the eyeball, which can be acute or chronic. This condition is characterized by conjunctival hyperemia, edema, and discharge. Causes of conjunctivitis include bacteria, chlamydia, allergies, viruses, and systemic diseases. The incidence of conjunctivitis varies by age, sex, and season. Although slightly more common in women in emergency departments, the seasonal pattern of conjunctivitis is consistent across regions. Allergic conjunctivitis, which affects 15-40% of the population, is most common in the spring and summer. Bacterial conjunctivitis is most common from December to April. Acute bacterial conjunctivitis is generally self-limited, with symptoms lasting 1-3 days if treated appropriately, but can last 10-14 days if left untreated. Staphylococcal and gonococcal conjunctivitis can lead to chronic complications or serious problems such as corneal perforation. Viral conjunctivitis usually gets worse in 4-5 days and resolves in 1-2 weeks. Complications are rare but can include corneal problems and life-threatening conditions such as meningitis or sepsis.

Chronic Kidney Failure (CKD) is a kidney disease caused by damage or dysfunction in the kidneys. A common problem in CKD sufferers is excess fluid which causes swelling in the extremities (edema). The causes of edema in CKD patients are failure to comply with fluid restrictions, lack of dietary control, fluid and sodium retention. One of the independent nursing interventions that is very effective for treating edema is ankle pump exercise therapy with leg elevation at 30 ̊. The case study was carried out in the hemodialysis unit at Dr. Tjitrowardojo Purworejo. The aim of the study was to identify the effect of providing ankle pump exercise therapy and 30° leg elevation intervention to reduce edema in CKD patients. The research design used is a descriptive method with a case study approach. The subjects of this case study are CKD patients undergoing hemodialysis who experience edema and patients who have signed an informed consent form. The instrument used is a monitoring sheet for the degree of edema. The intervention given in this case study was ankle pump exercise therapy and 30° leg elevation which was carried out for 7 minutes in 3 meetings over 7 days. Evaluation was carried out on days 1, 4, 8. The results showed that the degree of edema on the first day was grade III (5mm), on the second day it was grade II (4mm), on the third day it was grade I (2mm). Based on the results of the case study, it can be concluded that the application of ankle pump exercise and 30° elevation has proven effective in reducing the degree of edema in chronic kidney failure, so that this independent nursing intervention can be carried out by nurses for CKD patients undergoing hemodialysis.

Chronic Kidney Disease (CKD) is a condition in which kidney function decreases so that it is no longer able to filtrate the body's metabolic waste and maintain electrolyte fluid balance. In CKD an increased amount of fluid can result in edema. Edema is a condition of blocked veins due to an increase in intravascular hydrostatic pressure that causes enlargement or buildup of plasma fluid into the interstitium space. Therapy that can be applied to reduce edema in CKD is with Ankle Pump Exercise and Elevation 30⁰. This therapy is done by pumping the ankle and elevating the foot for 5-10 minutes. The goal of this study was to identify Ankle Pump Exercise and 30⁰ Elevation interventions to reduce edema in CKD patients in the ICU. The type / research design used is a descriptive method with a case study approach. The subjects of this case study were patients who met the inclusion criteria, namely patients with edema and were willing to be respondents. The data collection instrument uses the format of Nursing Care. The results of this study showed that Ankle Pump Exercise and 30⁰ Elevation interventions effectively reduced edema in CKD patients. Based on the results of the case study, it can be concluded that the application of a combination therapy of ankle pump exercise and 30⁰ foot elevais has been proven effective in reducing the degree of edema in Chronic Kidney Disease (CKD) patients.

Papilloedema is a disease that refers to swelling of the optic disc due to increased intracranial pressure (ICP). The etiology of papilledema is things that increase intracranial pressure. Idiopathic intracranial hypertension can cause increased intracranial pressure. Increased intracranial pressure can be seen in clinical and radiological manifestations such as headaches and decreased cerebral blood flow. So to diagnose someone with papilledema, anamnesis, physical examination, and supporting examinations such as fundoscopy, Optical Coherence Tomography / OCT, and perimetry can be carried out. Management for papilledema is aimed at addressing the causes of increased ICP. In cases of masses, surgical management may be indicated. the term idiopathic intracranial hypertension was used, and management of the patient's symptoms was with acetazolamide and weight loss. Surgical procedures such as optic nerve sheath fenestration are considered when vision is considered to be seriously compromised. Ventriculoperitoneal and lumboperitoneal shunts are other surgical interventions that can reduce ICP by draining CSF. Venous sinus stenting is considered in patients with IIH where there is significant transverse venous sinus stenosis.

Knee injuries are often encountered in general practice and in hospitals. One injury that can occur is injury to the meniscus which causes a meniscus tear. The meniscus is a fibro cartilage disc which is the content of the knee joint and is divided into two, namely the lateral meniscus and the medial meniscus. To confirm the diagnosis of injured ligaments is by carrying out an MRI examination. MRI examination of the knee joint using T2* Multi Echo Rechalled Gradient Echo can provide optimal images in cases of meniscus tears. MRI examination of the knee joint using MEDIC is very useful for cervical imaging, cartilage, joint and musculoskeletal examination. The advantage of the MEDIC sequence is that it can be used for 2D and 3D imaging and can reduce chemical shift artifacts. Based on the journal taken by the author, the sequence needed to clinically show a meniscus tear on an MRI Knee Joint examination is sagittal STIR and sagittal T2 MEDIC. then the most optimal sequence in clinically showing a meniscus tear is chosen to increase the efficiency of the examination time. The type of research used is qualitative research with a case study approach. The subjects used in this research were 3 Radiology Specialist Doctors and 3 Radiographers. The STIR and T2 MEDIC sequences on the MRI Knee Joint examination have their respective roles in confirming the diagnosis of Tear Meniscus. The STIR sequence plays a role in assessing the Anterior Cruriated Ligament, Posterior Cruriated Ligament, radiologists also want to see edema or swelling that occurs in the patient's genu. The MEDIC T2 sequence plays a role in assessing the medial and lateral meniscus, the radiologist also wants to see blood production in the patient's genu. The STIR and T2 MEDIC sequences in the MRI Knee Joint examination at the Balimed Denpasar Hospital installation are able to confirm the diagnosis, especially in the clinical Tear Meniscus, because with these two sequences, the picture of the Medial Meniscus, Lateral Meniscus, Anterior Cruriated Ligament, Posterior Cruriated Ligament, product blood and edema can be clearly seen.

Hepatic cirrhosis (SH) is a disease/group of diseases that infects the liver, characterized by loss of liver lobular architecture due to fibrosis and damage to parenchymal cells and their regeneration which ultimately forms a nodular structure. According to its clinical manifestations, this disease has a long latent period but is followed by sudden abdominal swelling, abdominal pain, hematemesis, edema and jaundice. In the next phase, the most prominent symptoms include jaundice, ascites, portal hypertension, and central nervous system abnormalities that end in coma. SH is infecting the whole world. SH is the eleventh leading cause of mortality and the fifteenth leading cause of morbidity worldwide. There are many things that have been proven to cause SH, including infections, toxins, hereditary conditions, and even autoimmune processes. Some of the complications that arise from SH include gastroesophageal varices (affecting the stomach and esophagus), hypersplenism (affecting the splenic organs), hepatorenal syndrome (affecting the kidneys) and even hepatic encephalopathy (affecting the central nervous system).

Chinese betel plant (Peperomia pellucida), an herbal plant belonging to the Piperaceae family, Chinese betel plant (Peperomia pellucida). Research Stages: sample collection, extract preparation, extract standardization, determination of non-specific parameters, phytochemical screening, preparation of test solutions, anti-inflammatory activity tests, treatment of test animals. The results of maceration were filtered using filter paper, then the entire filtrate was concentrated using a vacuum evaporator and water bath at 60℃ to obtain a thick extract. The yield of 96% ethanol extract from Chinese betel powder (Peperomia pellucida) obtained was 4.531%. Based on the results, it has non-specific characteristics, namely drying shrinkage of 9.26%, ash content of 7.9% and water content of 4.15%. Phytochemical screening the compound tested was positive, A dose of 150 mg/kgBB is also an effective dose in inhibiting the formation of edema seen from the effect it gives is stable and has the highest percentage of edema inhibition compared to other doses, which is 34,35%.