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A Critical nursing care is a process for problem solving, decision making as well as an organized and systematic approach to nursing problems. Nursing care must be carried out completely and accurately because it is the nurse's self-defense against demands as well as proof that the correct nursing care has been carried out. The research objective is to find out the description of the implementation of critical nursing care in Emergency Room of Santa Elisabeth Hospital Medan 2023. The research design used is a descriptive research design. There are two populations in this study, namely nursing actions and documentation of critical nursing care, the sampling technique used purposive sampling 51 respondents and total sampling (critical nursing care documentation) as many as 68 respondents. The data collection instrument uses observation sheets for nursing actions consisting of infusions, ECG usage and oxygen therapy, as well as critical nursing care using observation sheets consisting of assessment, diagnosis, intervention/implementation and evaluation. The results show that the infusion was according to the SOP, the use of ECG was according to the SOP and sufficient oxygen therapy is according to the SOP for 51 respondents (100%). Critical nursing care complete review 65 (96%), diagnosis quite complete 48 (71%), complete intervention/implementation 65 (96%), complete evaluation 67 (99%) and documentation of critical nursing care majority complete 65 (96%) of 68 respondents. It is expected to be able to improve the accuracy and completeness of nursing care documentation through training for each officer.

A Critical nursing care is a process for problem solving, decision making as well as an organized and systematic approach to nursing problems. Nursing care must be carried out completely and accurately because it is the nurse's self-defense against demands as well as proof that the correct nursing care has been carried out. The research objective is to find out the description of the implementation of critical nursing care in Emergency Room of Santa Elisabeth Hospital Medan 2023. The research design used is a descriptive research design. There are two populations in this study, namely nursing actions and documentation of critical nursing care, the sampling technique used purposive sampling 51 respondents and total sampling (critical nursing care documentation) as many as 68 respondents. The data collection instrument uses observation sheets for nursing actions consisting of infusions, ECG usage and oxygen therapy, as well as critical nursing care using observation sheets consisting of assessment, diagnosis, intervention/implementation and evaluation. The results show that the infusion was according to the SOP, the use of ECG was according to the SOP and sufficient oxygen therapy is according to the SOP for 51 respondents (100%). Critical nursing care complete review 65 (96%), diagnosis quite complete 48 (71%), complete intervention/implementation 65 (96%), complete evaluation 67 (99%) and documentation of critical nursing care majority complete 65 (96%) of 68 respondents. It is expected to be able to improve the accuracy and completeness of nursing care documentation through training for each officer.

Liver cirrhosis is a pathological condition that describes the end stage of progressive hepatic fibrosis. More than 40% of cirrhosis patients are asymptomatic. Based on research, 4% of patients with fatty liver will develop non-alcoholic steatohepatitis, and 0.3% of these patients will end up experiencing liver cirrhosis. A 48 year old man came to the emergency room at Cut Meutia Hospital with complaints of an enlarged stomach accompanied by pain since ± 2 weeks. The patient also complained of swelling in both legs. The results of the physical examination of the abdomen revealed icteric sclera (+/+), shifting dulness and leg edema (+/+). Based on laboratory examinations, it appeared that there was an increase in liver function, then the ultrasound examination showed the impression of ascites and liver cirrhosis. Based on the history, physical examination and supporting examinations, the patient was diagnosed with hepatic cirrhosis, relative decompensated stage of hepatitis B + CHD. Non-medical management is carried out in the form of bed rest, balanced nutrition and consumption of a low sodium diet. Then the patient's medical management consists of a 500ml hepatic Aminofuscin infusion, symptomatic management and antiviral treatment for the hepatitis he is suffering from.  

Nasopharyngeal Carcinoma (NPC) is a squamous cell carcinoma (SCC) originating from the nasopharyngeal epithelium. In Indonesia, NPC is the 4th most common malignancy after breast cancer, cervical cancer, and lung cancer. A 40-year-old woman came to the Emergency Room of Cut Meutia Hospital with complaints of left-sided nosebleeds for approximately 2 weeks before entering the hospital. The results of the physical examination found hair that was easily pulled out, then from the results of the supporting examination in the form of a non-contrast head CT-Scan, an expansion of the mass in the nasopharynx was found. Based on the anamnesis, physical examination and supporting examinations, the patient was diagnosed with nasopharyngeal carcinoma. The management that can be given to patients is non-drug, namely consuming nutritious food, and managing stress and sleep patterns, in addition the patient is also given symptomatic management.

Relapsing Pulmonary Tuberculosis is a patient with pulmonary TB who has received TB treatment and has been declared cured or finished treatment, then re-diagnosed as positive pulmonary TB through BTA examination or sputum culture by Mycobacterium tuberculosis. In high incidence settings, this figure is as high as 7850 cases/100000 person-years. A 66 year old patient came to the emergency room at Cut Meutia Hospital with complaints of coughing up blood which had been felt since 3 days SMRS, and worsened after 1 day SMRS, phlegm was fresh red, blood was mixed with phlegm when coughing. Previously the patient had been coughing up phlegm without blood since 2022 coughing felt to come and go. The patient also complained of chest pain on the right side, shortness of breath when doing activities, the patient also complained of night sweats that soaked clothes and bed, denied nausea, vomiting, defecation and urination. there were no complaints, the patient had a history of DM. On physical examination it was found that the patient's general condition appeared to be moderately ill, consciousness was compos smentis, blood pressure was 110/70 mmHg, pulse rate was 66x/minute, respiration was 22x/minute, with a body temperature of 36.7°C and SpO2 98% on room air. Auscultation revealed vesicular breathing sounds (+/+), rhonchi (-/-), wheezing (-/-). Blood laboratory examination: HB decreased (12.00), MCV decreased (76.78 fL), MCH decreased (23.2 pg), MCHC decreased (30.30 thousand/uL).

Paranoid schizophrenia is a condition of mental and behavioral disorders characterized by disturbances in thoughts, perceptions, feelings and awareness of patients who are fully conscious and intellectually can still be maintained. According to WHO, the prevalence of schizophrenia in 2021 will reach 24 million people, and the prevalence of schizophrenia experienced from 2019-2021 has increased by 54%. The 47 year old patient was taken by his family to the emergency room at Cut Meutia Hospital with complaints that the patient often had tantrums. This complaint began 13 when the family felt a change in the patient's behavior. Based on the family's information, 2 days before entering the hospital, the patient took their child away for 1 day, without being given food, the patient also carried a sharp weapon. From the patient's confession, he said he wanted to go to Saudi Arabia with his child. The patient is also restless, pacing back and forth, without a clear goal. Patients also often wander around at night and have difficulty sleeping, patients often bring home objects that do not belong to the patient when they return home after wandering around. Psychiatric status obtained a general impression of appearance according to age with medium stature, brown skin, clear consciousness, dull affect, auditory hallucinations, non-realistic thought forms, coherent thought flow, and delusional thought content, view 1 (the patient completely denies that he is sick). The diagnosis was adjusted to PPDGJ III and the patient was diagnosed as paranoid schizophrenia. Inpatients at RSCM in the UPIP room are given therapy with lodomer 5mg/ml extra, risperidone 2x2mg, diazepam 1x2mg.

Cardiopulmonary Resuscitation (CPR) or CPR is help for patients experiencing a heart attack where basic living rock is needed by applying pressure to the chest. Nurses have an important role in implementing cardiopulmonary resuscitation (CPR), especially in the emergency room. Skills in carrying out actions can have a direct impact on patient safety. Steps can be taken to improve the overall quality of medical treatment by increasing the education, knowledge and skills of attached nurses. The aim of this research is to find out the relationship between education and PK level with the accuracy of nurses in carrying out cardiopulmonary resuscitation measures in the ICU and emergency rooms at Prikasih Hospital in 2024. The research method that will be used is an analytical research design with a correlational design with a cross-sectional approach, a population of 40 technical respondents total sample and sample size of 40 respondents. Using the non-parametric Rank Spearman Rho test. The results show a relationship between education and the accuracy of nurses in carrying out cardiopulmonary resuscitation (CPR) in the ICU and ER with a P-Value of 0.026 < 0.05. And there is a relationship between the PK level and the accuracy of nurses in carrying out cardiopulmonary resuscitation (CPR) in the ICU and ER with a P-Value of 0.002 < 0.05. The conclusion is that education and level PK are very important in carrying out actions, because a person's knowledge can be seen from the abilities or skills they have, therefore education and level PK greatly influence the accuracy of cardiac resuscitation actions.    

Vertigo is a sensation or sensation of movement from the body and surrounding environment that is described as a circular sensation, usually accompanied by complaints of nausea and vomiting, and balance disturbances. Vertigo is the third most common complaint by patients who come to general practice, after headaches, and strokes. A 31-year-old man came to the emergency room of Cut Meutia Hospital with complaints of dizziness since 5 days ago and disappeared. Patients also complained of nausea but were not accompanied by vomiting since complaints of dizziness appeared. Dizziness is felt by patients when looking at the surrounding environment and is not triggered by a change in head position. In addition, the patient also has a buzzing tingling tingling tingling along with spinning dizziness attacks. The patient's hearing begins to fade when the patient's ears ring and finally settle down. Based on anamnesis, physical examination and extenuation examination, the patient was treated with peripheral vertigo et causa meniere disease. Governance is carried out in the form of inf. RL 20 gtt/min, inj. Omeprazol 2x1, inj. Ondansetron 2x1 and oral in the form of betahistin 2x1 and hydrochlorothiazide 1x1.    

Liver cirrhosis and nephrolithiasis are significant health problems with different pathophysiological mechanisms. Liver cirrhosis, the final stage of chronic liver disease, is characterized by fibrosis and regenerative nodules, leading to severe complications, including portal hypertension and liver failure. Nephrolithiasis, commonly known as kidney stones, is a common urological condition characterized by the formation of stones in the renal system. Although these conditions are distinct, metabolic and physiological changes in cirrhotic patients may predispose to nephrolithiasis.  It was reported that a man came to the emergency room of RSUD Dr. Suhatman MARS with complaints of left-sided low back pain that had been felt for 1 week. The complaint was accompanied by shortness of breath which was getting worse over time. The patient also felt cough, headache, nausea, fatigue, urine slightly coloured like tea, weight loss. The patient has a history of untreated kidney stones. The patient has a history of hepatitis 31 years ago. The main objective of investigating the coexistence of liver cirrhosis and nephrolithiasis is to understand the relationship between these two conditions and to develop effective management strategies that can address their combined impact on patients.      

Diabetic ketoacidosis (DKA) is a life-threatening form of diabetes mellitus emergency. Rapid and appropriate management is needed to prevent worsening condition. Fluid management in DKA is important to improve tissue perfusion, correct electrolyte imbalance, reduce blood glucose concentration and counterregulatory hormones. This case report aims to describe the fluid management in a client with instability of blood glucose levels in DKA. A 42-year-old woman was rushed to the emergency room with decreased consciousness for 3 hours. Laboratory examination results: blood glucose >600mg/dL, Base Excess <-30mmol, urine ketones +3, urine protein +2, urine glucose +4, pH 6.8, HCO3 1.9mmol/L. The client had unstable blood glucose levels while in the treatment room. Fluid management was performed by combining 0.9% NaCl, WIDA 2A, 40% dextrose bolus, and continuous insulin drip, that was adjusted according to the client's blood glucose level. After receiving fluid management, the client's blood glucose levels are stable in the range of 100 - 200mg/dL on the fifth day until the client recovered. Providing fluid management tailored to the management of DKA and client needs can improve the stability of blood glucose levels so that this fluid management intervention can be utilized for DKA clients with similar complaints.

Stunting is a problem that is increasingly found in developing countries, including Indonesia. According to the United Nations International Children's Emergency Fund (UNICEF), one in three children is stunted. The aim of this community service activity is to provide additional food to children under five. The method used was lectures and questions and answers to mothers about eating tambhana. This activity was carried out in the Bonomangape Village Office Room, Takalar Regency on June 10 2024, which was attended by 12 mothers who have toddlers. The results of supplementary feeding activities using leaflets and plipcharts on supplementary feeding behavior showed that only 4 people (33.33%) had good knowledge in the pre-test knowledge, and after education and mentoring, then a post-test was carried out, those who had good knowledge increased to 10 people (83.33%) so that by providing education and mentoring will increase motivation and change behavior in providing additional food to toddlers

To prevent disability and even death, the emergency unit must immediately carry out medical action, therefore the need to implement an efficient and effective emergency response time is important in determining whether or not it is necessary to provide medical assistance from the time the patient arrives at the ER until the patient enters the operating room or hospital ward. . The aim of this research is to determine the effect of response time on patient and family anxiety in the emergency unit. The methods used in this secondary research are literature review, article search through the Google Scholar, PubMed, Science Direct, SINTA, and Garuda databases. The results found 7 articles in which there was an influence of response time on patient anxiety in the Emergency Unit and other factors that influenced patient anxiety in the emergency unit included gender, age, education, triage, and the role of nurses. Conclusion: The results of the synthesis of 7 research articles are that response time influences patient anxiety in the emergency unit. Other factor that influence patient and family anxiety when in the Emergency Unit are length of response time, gender, age, education, triage, and the role of the nurse.  

With the increasing need for medical services and developments in technology, doctors and patients are often faced with various legal issues related to health care. The role of doctors in society is crucial because of the knowledge and skills needed to diagnose and treat disease, as well as maintain patient health. A surgeon is a specialist doctor who treats diseases, injuries or emergency conditions in the body through surgical methods (operatives) carried out in the operating room installation. The doctor's legal responsibility towards patients in the operating room installation is based on several relevant legal principles, the principle of informed consent or consent in treatment is an important factor in determining whether the doctor is responsible or not. Patients must be given adequate information about the diagnosis, procedures, risks, and treatment alternatives before giving consent for medical treatment. What are the rights and obligations between the doctor and patient in the agreement before surgery, as well as the agreement between the doctor and patient after the patient has received this information. Research methods using normative law are methods used to study legal rules as a system that can be linked to certain legal events. Secondary data uses tertiary legal data, secondary legal data and tertiary legal data from books, literature, publications and statutory sources related to all discussions. From this research it was found that every human being has the human right to live a healthy life and a doctor has ethical and professional responsibilities in carrying out his duties. The relationship between doctors and patients is regulated by applicable laws and regulations. It can be concluded that the legal responsibility of doctors towards patients in operating rooms is very important in medical practice. As health professionals, physicians have an ethical and legal obligation to provide safe, competent, and responsible care to their patients. If a doctor fails to meet expected standards of care or commits negligence that results in injury or harm to a patient, they may be legally liable.

Background: Sepsis is characterized by the body's excessive inflammatory response to infection, potentially leading to life-threatening organ dysfunction. Additionally, sepsis can induce hypotension involving both pro-inflammatory and anti-inflammatory body responses. One non-pharmacological intervention for hypotension is Passive Leg Raising (PLR), where the patient lies flat while the legs are raised at a 45-degree angle. Objective: To determinethe effect of increasing blood pressure in septic shock patients after PLR therapy. Methods: A case study conducted on May 12, 2024, at the Emergency Room of PKU Muhammadiyah Yogyakarta, observed patients blood pressure and mean arterial pressure (MAP) every 30 minutes over 1 hour using bedside monitoring before and 30 minutes after vasopressor administration. Results: PLR for 60 minutes increased systolic blood pressure by 8mmHg, diastolic by 7mmHg, and MAP by 8mmHg. Subsequent vasopressor addition for 30 minutes yielded more significant increases: systolic blood pressure rose by 35mmHg, diastolic by 26mmHg, and MAP by 37mmHg. Conclusion: PLR administration increases blood pressure, but combining it with vasopressors proves more effective in septic shock management.

Fracture is one of the causes of disability caused by trauma due to an accident. Fractures can be caused by direct trauma, for example a collision or blow that results in a broken bone. Splinting is an action carried out as first aid for musculoskeletal injuries so that the injured body part can rest, avoid shifting of the injured bone and reduce the level of pain. By using a splint, the skeletal muscles that are experiencing spasm will slowly relax, thereby reducing the level of pain and holding parts of the body from shifting and reducing pain. To determine the application of splint therapy to reduce the pain level of femur fracture patients in IGD at RSUD Tidar Magelang. The research method used a case report with the nursing intervention of providing splints on the pain level of fracture patients. Conducted 3 observations every 30 minutes on the patient Mr. M, 27 years old, who was involved in a traffic accident. From the results of the research, a nursing intervention was carried out, namely by providing a splint dressing for 3 observations every 30 minutes. The result was that there was a decrease in the level of pain before and after the splint dressing. Based on research conducted with Mr. Therefore, the reduction in pain levels in femur fracture patients with splint dressing in the emergency room at Tidar Hospital Magelang can be concluded that splint therapy has an effect on the pain level of fracture patients by reducing the level of the pain scale.

The resuscitation is an attempt to provide the oxygen the brain, heart and other important vital organs; through an action, which consist of heart massaging and guarantying the adequate of ventilation. Infant Mortality Rate (IMR) is amount of infant mortality under 1 year per 1000 alive-nativity. The highest cause of infant mortality and children under-five year is prenatal disturbs and respiration system sickness, low-weight of newborn infant (BBLR), asphyxia on newborn infant, stiff and squeezed breath. This research is intended to identify the nurse’s knowledge about the resuscitation of lung-heart on neonates that facing emergency respiration. The kind of used research is descriptive, both population and sample in this research are whole nurses who work in Neonates Room that are for 15 people, which taken by sampling total technique. The result of this reseach that obtained is wherein the nurse’s knowledge about the resuscitation of  lung-heart, it is whose having good knowledge for 9 nurses (60%) and  whose having sufficient knowledge is for 6 nurses (40%). It is can be concluded that nurse’s knowledge about the resuscitation of lung-heart in Neonates Room is good. It is expected for whole nurses in order to more increase their knowledge about the resuscitation of lung-heart, and be active in participating of  resuscitation training for better. This reseach, on the other hand, may motivate the student nurses in increasing both their capability and knowledge about the resuscitatiion

Introduction: Response time or speed in treating patients in emergency situations has a crucial role in saving lives. This includes the time required from when a patient experiences an emergency incident until the patient receives an appropriate medical response. In this context, it is important to understand that response times differ for different types of emergency cases. The aim of this research is to determine the relationship between the implementation of the Triage Protocol and Response Time and the Level of Patient Satisfaction in the Emergency Room at PMI Bogor Hospital.This research was quantitative using a correlation method involving 57 patients in the emergency room at PMI Bogor Hospital. To collect data, this study used prepared observation sheets, and statistical analysis was carried out using the Chi Square test. Patient Satisfaction Level effectively. With this approach, it is hoped that this research will provide valid and useful findings in supporting efforts to improve the quality of services at the Emergency Room at PMI Bogor Hospital.The results of chi-square statistical analysis showed that there was no significant relationship between the implementation of the triage protocol and patient satisfaction (p-value = 0.003 < 0.05). On the other hand, there is a significant relationship between the implementation of response time and patient satisfaction (p-value = 0.002 < 0.05). The faster the response time, the higher the level of patient satisfaction, in accordance with previous research findings    

Introduction: Nursing services as the front line play a very high role in the satisfaction received by patients One of the determinants of patient satisfaction is the quality of nursing services towards the quality of health services, even becoming one of the determining factors for the image of health service institutions. Objective: to analyze the relationship between the quality of nursing services and patient satisfaction in the Emergency Room of Dr Hafiz Cianjur Hospital Method: The design used is descriptive analytics with a cross-sectional approach The sample taken was 94 respondents using accidental sampling techniques Research data was taken using a questionnaire sheet in October - December 2023. Results: After analyzing the data, it was tabulated using chi square test with a significance level of 005 The research results showed that the Quality of Nursing Services (564%) had 53 respondents in the moderate category and Patient Satisfaction (543%) had 51 respondents in the moderate category The statistical test results obtained a significance value of 0002 Based on the value of p <0005, it can be concluded that there is a relationship between the quality of nursing services and patient satisfaction in the Emergency Room of the Hospital.

It can be said that patient satisfaction is an abstract thing and the results vary greatly because basically it really depends on each individual's perception. Patient satisfaction can be said to be fulfilled if the services provided are in accordance with their expectations. The aim of the research is to analyze the Quality of Emergency Room Services on Patient Satisfaction at RUMKIT TK II Iskandar Muda Banda Aceh. The research design used in this research is an analytical survey with a cross sectional design. The population in this study was all 2,058 emergency room patients. The number of samples to be studied is 95 people. Data analysis was carried out using univariate, bivariate and multivariate analysis. The statistical tests used are the chi square test and logistic regression. The results of the chi square test research show that there is an influence of 5 variables, namely reliability, responsiveness, assurance, empathy and physical evidence, which have a p-value <α 0.05, meaning that reliability, responsiveness, assurance, empathy and physical evidence influence patient satisfaction in the RUMKIT TK ER. II Iskandar Muda Banda Aceh and the multivariate test shows that the 5 variables of reliability, responsiveness, assurance, empathy and physical evidence influence the results of the multiple logistic regression test showing that the responsiveness variable is the most dominant with an odds ratio (OR) of 15,104, meaning 15 times influencing patient satisfaction. The conclusion was that the dominant responsiveness variable had the most influence on patient satisfaction at the RUMKIT TK II Iskandar Muda Banda Aceh emergency room. It is recommended for hospitals to adopt policies to increase patient responsiveness in the ER in order to produce optimal patient satisfaction.      

Background: Acute Lung Oedema (ALO) is an emergency condition that requires immediate action and has fatal and more dangerous consequences which will disrupt the gas exchange process in the alveoli due to the alveoli being filled with fluid. Based on the results of the initial survey in the ICU room at Tangerang Regional Hospital, it was found that the number of ICU patients with cases of pulmonary edema or ALO in 2023 was 14 people and from June to January 2024 there were 14 people. Nursing actions as an evidence base that can be provided include sucking mucus for less than 15 seconds and emptying the ETT cuff periodically. This implementation can increase airway clearance, thereby preventing accumulation of secretions that can cause aspiration. Proving the theory through providing nursing care carried out 5x with results showing that providing mucus suction in less than 15 seconds, and emptying the ETT cuff periodically, can improve the airway clearance status as indicated by a decrease in sputum production, color and consistency. Method: This writing method uses patient intervention and observation carried out for five days, to determine the patient's condition and provide appropriate nursing care which is then documented. Results: Based on the results of the monitoring carried out, it can be concluded that there are differences in the conditions of secretion production before and after the suction intervention was carried out by deflating the ETT (Cuff) balloon for 5-15 seconds. With the results criteria, secretion production is reduced. Conclusion: for patients with thick and purulent secretions, suction by deflating the ETT balloon (Cuff) becomes more effective and secretion production decreases. Nursing actions as an evidence base that can be given include sucking mucus for less than 15 seconds and emptying the ETT cuff periodically.