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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.

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.

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.

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

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.

Social and environmental responsibility as part of business ethics. Corporate Social Responsibility (CSR) is an important strategy in building and maintaining a company's image in the public eye. This study aims to analyze how the CSR strategy implemented by PT. Kompas Gramedia through the Kampung Koran program maintains the company's image. This study uses a descriptive qualitative approach. Data collection techniques were carried out through in-depth interviews and documentation. The theory used is the CSR strategy from Coombs and Holladay which includes five stages: scanning, conducting, creating, communicating, and evaluating. In addition, the image formation theory from John M. Tiedemann was also used to analyze the process of forming a company's image. The results show that the Kampung Koran Program of PT. Kompas Gramedia demonstrates a planned and participatory CSR strategy. Through scanning and monitoring as well as conducting formative initiatives, the company is able to map community needs and design programs based on local potential. At the create CSR stage, the focus is directed at empowering housewives with skills in processing used newspapers, then strengthened through communicate CSR with communicative narrative techniques that touch public emotions, and is periodically evaluated at the evaluation stage to maintain relevance and sustainability. This process contributes directly to the formation of the company's image. Starting with a creative idea to recycle newspapers, a positive perception emerged that the program brings tangible benefits.