semi-Fowler Position Research Articles

Pengaruh Teknik Nafas Dalam dan Posisi Semi Fowler Terhadap Frekuensi Nafas Pada Pasien Asma

<strong><em>Background</em></strong><em>:</em> <em>Asthma is a disease characterized by narrowing and inflammation of the respiratory tract which results in shortness of breath (difficulty breathing). Data from (WHO, 2020) shows that the prevalence of asthma in 2019 was 262 million people and caused 455,000 deaths worldwide. The aim of the research is to determine the effectiveness of the deep breathing relaxation frequency technique and semi-Fowler position in the Lung Room of RSU Mayjen H.A Talib, Sungai Full City in 2023. <strong>Methods: </strong>This type of research is analytical descriptive with a quasi-experimental research design with a one group pre test – post test design technique on patients. asthma. The respiratory frequency assessment was carried out 2 (two) times, namely before (pretest) intervention and after (posttest) intervention. The sample taken by purposive sampling was 21 respondents. <strong>Results: </strong>The results of this research were that there was an influence of deep breathing techniques and the semi-Fowler position on asthma patients at the H.A Talib maijen hospital, Sungai Full City in 2023 with the Wilcoxon test result being a p value of 0.000. <strong>Conclusion: </strong>The conclusion of this research is that there is effectiveness of deep breathing relaxation techniques and the semi-fowler position on respiratory frequency. The results of this research can be input for nursing interventions so that nurses provide education to patients and families on how to carry out deep breathing techniques and adjust the semi-Fowler position correctly to reduce shortness of breath in asthma patients</em>

Systematic Review Therapeutic Positions Are Able To Improve The Hemodynamic Status Of Acute Decompensated Heart Failure (Adhf) Patients

Background: Acute Decompensated Heart Failure (ADHF) is acute heart failure which is defined as a rapid onset of symptoms due to abnormal heart function. These dysfunctions include systolic and diastolic dysfunction, heart rhythm abnormalities, or preload and afterload imbalances. ADHF is a new attack without previous heart defects, or is decompensation of chronic heart failure (Chronic Heart Failure) that has been experienced previously. ADHF occurs when cardiac output cannot meet the body's metabolic needs. Objective: in this study, namely to determine the results of a literature review of the effect of therapeutic positions on hemodynamic status in ADHF patients. The method in this research is a literature review method using a literature search strategy through online media which includes searching on Google Scholar, PubMed, Research Gate, Elsevier, NCBI. Results: Based on the results of the literature review, all studies (4 studies) reviewed showed results of improvement in hemodynamic status, namely respiratory frequency, oxygen saturation (SaO2), blood pressure, heat rate, and CRT in ADHF patients who were given therapeutic position intervention: semi fowlershows increased oxygen saturation, decreased shortness of breath, stable blood pressure, hate rate, and respiratory rate. Conclusion: The therapeutic position, namely the semi fowler position, has an effect on improving the hemodynamic status of ADHF patients

Pemberian Posisi Semi Fowler untuk Meningkatkan Saturasi Oksigen pada Pasien Congestive Heart Failure di Ruang Intensive Care Unit

Congestive Heart Failure (CHF) is a medical condition that affects various body systems and causes the heart to be unable to pump blood properly to meet metabolic needs. To increase oxygen levels in CHF patients, one approach is to change body position. This study used a descriptive method to evaluate the impact of the semi-Fowler position on oxygen levels. This study involved 10 patients in the ICU Room of RSUD Ir. Soekarno Sukoharjo, with the semi-Fowler position at a 45° angle applied for 15 minutes after eating at 13:00, from 23 to 25 May 2023. Patients who met the inclusion criteria were those with oxygen saturation <95%, while patients who refused or experienced complications were not included. The instruments used included the SOP for the 45° semi-Fowler position and the Mindray PM 60 oximeter. The results showed that the 45° semi-Fowler position could increase oxygen saturation by around 2%, with a variation in increase between 2% and 4%. In conclusion, the 45° semi-Fowler position can increase oxygen levels by around 3-4% in CHF patients, as well as help reduce shortness of breath.

Nursing Care in Mild Brain Injury Patients on Intracranial Adaptive Capacity Reduction Diagnosis

Introduction: Head injury or Traumatic Brain Injury (TBI) is defined as a disturbance in the normal functioning of the brain that can be caused by a collision, blow, or jolt to the head or a penetrating head injury. Decreased intracranial adaptive capacity is a disturbance of the intracranial dynamics mechanism in compensating for stimuli that can reduce intracranial capacity. This study aims to explore nursing problems in clients with mild brain injury. Methods: This study uses a case report research design. The population in this study were patients admitted to the roudloh room with mild brain injury as many as 4 people. The sample was selected using purposive sampling technique and obtained a sample of 2 patients with a nursing problem of decreased intracranial adaptive capacity. Data collection using surgical medical nursing assessment format. Data was analyzed with descriptive analitic. Results: The assessment results found that both patients experienced headaches, vertigo, nausea and vomiting and blurred vision. The nursing problem raised is a decrease in intracranial adaptive capacity. The intervention given is to provide a 30⁰ head elevation. From the results of the intervention, it was found that the intervention had been resolved. Conclusion: Giving semi fowler position with head elevation 30 ° in patients with nursing problems decreased intracranial adaptive capacity is very effective. The provision of interventions provided for 3 days with a 30 ° head elevation showed that both patients achieved outcome. Keywords: Mild Head Injury, Head Elevation 30⁰, Head Injury

COMBINATION OF HIGHT FLOW NASAL CANULA AND SEMI FOWLER POSITION TO INCREASE OXYGENATION WITH ACUTE LUNGS CARDIOGENIC OEDEMA

Acute cardiogenic lung edema is an emergency condition in which fluid accumulates in the lung cavity due to ventricular failure including blood throughout the body. The most fatal consequence of this condition is the disruption of the gas exchange process in the alveoli. One of the characteristic symptoms of this disease is shortness of breath which must be treated immediately so as not to fall into hypoxic or hypoxemic conditions. Therefore writing this paper aims to test the effectiveness of the combination of high-flow nasal cannula and semi-Fowler's position to increase oxygenation in patients with cardiogenic acute pulmonary edema. The research method used is a case report. This research was conducted for 4 days of treatment from 11-15 May 2022 at the Kanjuruhan Regional General Hospital, Malang Regency. After 4 days of action, there was a positive change in the patient's oxygenation. It can be seen from the results of monitoring SpO2 and RR on day 3 of treatment that there was an increase in SpO2 of 93% and a decrease in RR of 18x/minute which was getting better until day 4 of treatment. Problems related to oxygenation in the lungs, acute cardiogenic edema occurs due to accumulation of fluid in the lung cavity Actions that must be taken to continue to meet the need for adequate oxygenation in patients so that a combination of high-flow nasal cannula therapy and semi -Fowler's position is carried out to improve patient oxygenation. The recommendations for giving this therapy are by considering the replacement of the type of mask and the flow of oxygen given.

Management of Airway Clearance is Ineffective in Patients with Tuberculosis & Mediastinal Tumors

Ineffective airway clearance is a common problem in pulmonary tuberculosis patients. This condition occurs due to an infectious process that causes an inflammatory response and excessive secretion production. The mediastinal tumor experienced by the patient resulted in the patient's condition getting worse because the lump in the mediastinal area pressed on the airway so that phlegm/secretions were difficult to expel. This study aimed to describe the ineffective management of airway clearance in patients with pulmonary tuberculosis, pleural effusion, and mediastinal tumors. This study uses a descriptive observational research design in the form of a case report using a nursing care approach. The subject of this study was a 34 year old woman with a medical diagnosis of pulmonary tuberculosis, pleural effusion, and mediastinal tumor. The intervention carried out, namely managing airway clearance, was not effective. Some of the actions carried out include semi-fowler position, collaborative administration of 3 lpm oxygen, combivent and pulmicort nebulization 3 times/day, and suctioning. After carrying out nursing procedures for 3 x 24 hours, the patient said he felt more comfortable in the semi-Fowler's position, she felt the shortness of breath was reduced after nebulization but the shortness of breath became worse again sometime later, the patient said he had difficulty expelling phlegm so his shortness of breath did not improve, SaO2 100%, RR 18 times/minute, and wheezing (-). It can be concluded that the interventions can reduce symptoms but cannot solve the problem. Management of ineffective airway clearance in this case cannot be done independently by the nurse. Collaboration is needed by considering the need for surgery and pharmacological therapy.

The influence of semi-fowler sleeping position education on sleep quality in congestive heart failure patients at Subang General Hospital

Background: Patients with congestive heart failure (CHF) frequently experience nocturnal dyspnea, leading to poor sleep quality, which can slow down recovery and prolong hospital stays. The semi-Fowler sleep position may alleviate breathing difficulties and improve sleep quality in CHF patients. Purpose: This study aimed to evaluate the impact of semi-Fowler sleep position education on the sleep quality of CHF patients. Methods: A quasi-experimental design with a pre-test and post-test control group was used, involving 26 CHF patients selected through accidental sampling from the inpatient ward of Subang General Hospital. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the intervention involved educational booklets and demonstrations on the semi-Fowler sleep position. Results: Data analysis using the Mann-Whitney test showed a significant improvement in sleep quality post-intervention, with a p-value of 0.000, indicating a meaningful difference in sleep quality between the intervention and control groups. Conclusion: Educating CHF patients on the semi-Fowler sleep position significantly improved their sleep quality. These findings suggest that incorporating semi-Fowler position education into patient care may help reduce nocturnal discomfort and promote better recovery in CHF patients. This approach could be a practical intervention for improving patient outcomes and reducing hospital stays.

Training on The Application of Nebulisation with The Semi Fowler Position in Controlling The Breath Frequency of Bronchial Asthma Patients At The GM Hospital

Respiratory disorders can attack anyone indiscriminately. It is often found that types of respiratory diseases such as asthma and ARI. The causes are varied, such as dirty air, bacteria, and viruses. The world death rate of 20% is caused by asthma which is estimated for the next 10 years if it is not treated properly. Bronchial asthma is a type of non-communicable but chronic disease of varying severity in the respiratory tract. Pharmacological therapy such as nebulization and non-pharmacological therapy such as the semi-Fowler position are appropriate treatments to be given to patients with bronchial asthma so that they can regulate the patient's respiratory frequency. Giving a nebulizer can overcome shortness of breath, relax bronchial spasms, liquefy phlegm, and clear the airways. Meanwhile, the semi-Fowler position can provide comfort in breathing so that the lungs become wider. This training activity was attended by PkM participants, namely 20 nursing staff. The series of PkM activities include the delivery of material, discussions, therapy demonstrations, and simulations of treating bronchial asthma patients using nebulization and the semi-Fowler position. The media used are a nebulizer, teaching aids, and SOP. The results of the PkM implementation show that the PkM participants have understood the benefits of nebulization in the semi-Fowler's position. Apart from that, PkM participants were also able to carry out the two treatments by the SOP which was implemented through simulation.

Dyspnea management in patients with pneumonia and coronary artery disease: A case study

Background: Cardiovascular disease, particularly Coronary Artery Disease (CAD), is strongly linked to pneumonia. Patients suffering from both pneumonia and CAD frequently experience dyspnea as a symptom. Dyspnea, caused by both conditions, can significantly impact the patient's quality of life. Consequently, it is crucial to address and manage dyspnea in individuals with pneumonia and CAD. Purpose: To provide a thorough overview of managing dyspnea in patients with pneumonia and CAD in public hospitals in West Java, Indonesia. Method: Employing a case study methodology using a nursing care approach, encompassing nursing assessment, data analysis, diagnosis, intervention, implementation, evaluation, and documentation. The assessment indicated that the patient experienced shortness of breath, with a blood pressure of 145/86 mmHg, a respiratory rate of 24 breaths per minute, a pulse rate of 95 beats per minute, and an oxygen saturation level of 88%. The patient received 5 liters per minute of oxygen via a nasal cannula, and their body temperature measured 36.4ºC. Results: In this case study, dyspnea management involved positioning the patient, administering oxygen therapy in stages, and providing pharmacological treatments, including diuretics and antibiotics. Additional therapies included respiratory muscle training and effective cough exercises. These interventions successfully reduced the patient's respiratory rate to 18 breaths per minute and increased their oxygen saturation to 97% with a nasal cannula. Additionally, the patient's Medical Research Council (MRC) dyspnea scale score decreased to 1 out of 5. Conclusion: Nursing care management that includes positioning the patient in a semi-Fowler's position while resting and a Fowler's position when awake, administering oxygen therapy in stages, providing pharmacological treatments such as diuretics and antibiotics, and conducting respiratory muscle training, can lower the breathing rate and alleviate symptoms of shortness of breath in patients with pneumonia and coronary artery disease.

Pemberian Posisi Semi-Fowler Untuk Meningkatkan Saturasi Oksigen Pasien Congestive Heart Failure Di ICU RSUD Tidar Magelang

Congestive Heart Failure (CHF) is a condition where the heart function is disturbed and is unable to pump enough blood that causes the heart to not provide oxygen to meet the needs of the tissue so that the patient experiences shortness of breath or dyspnea. Objective: To implement a nursing intervention for providing a Semi-fowler position to increase the oxygen saturation on the Congestive Heart Failure patient with dyspnea. Method: This study was a case report (case report) with nursing intervention providing Semi-fowler position, was carried out for 3 times on different days. Results: The oxygen saturation before granted a semi-fowler position on the first and second observations were 94% then on the third observations were 95%. Later after 3 times provided a semi-fowler position, the oxygen saturation up to 98% at the first-time observation and 99% at the second and on the third observation. Conclusion: there is an increase in oxygen saturation on the Congestive Heart Failure patient with dyspnea after 2 times given a semi-fowler position on a different day.

Effect of Nebulization with Semi Fowler Position on Breath Frequency in Bronchial Asthma Patients in Grandmed Lubuk Pakam Hospital

Bronchial asthma is a condition of chronic inflammation of the respiratory tract which triggers bronchial hyperactivity resulting in a feeling of heaviness in the chest and shortness of breath. Asthma patients panic easily by breathing as hard as possible when shallow and short inspirations occur. If asthma occurs for a long duration, apnea will occur and in the worst case it can result in death for the sufferer. Procedures via nebulization using the semi-Fowler position in patients with bronchial asthma can affect respiratory frequency. Nebulizer administration is a type of medication directly on targets such as the lungs so that this action can be carried out more quickly and effectively. The method in this research uses a quasi-experimental pre-test and post-test type by selecting bronchial asthma patients as respondents/sample of 15 participants who were determined using the total sampling method. Research data was collected using an observation sheet instrument containing data regarding respiratory frequency. After the intervention was given, the respondents showed that there was a decrease in respiratory frequency until it was at the normal threshold. Data analysis using a paired T-Test shows that the p-value is 0.000, which means that nebulization in the semi-Fowler position can affect the respiratory frequency of bronchial asthma patients at Grandmed Lubuk Pakam Hospital. It seems that administering nebulization in a semi-Fowler's position could be an appropriate choice in treating bronchial asthma patients in order to achieve better respiratory health.

Providing A Half Sitting Position to Pulmonary Tuberculosis Patients In The Seruni Treatment Room At The Central General Hospital

The lungs are one of the vital organs in the human body. To be precise, it is a respiratory (breathing) organ which is related to the respiratory and circulatory systems (blood circulation). Pulmonary tuberculosis is a contagious infectious disease caused by Mycobacterium tuberculosis. Meanwhile, Relapsed Pulmonary Tuberculosis is a patient with Pulmonary Tuberculosis who is declared cured or has had complete treatment and then comes back for treatment with a positive test result for a cough with phlegm from Acid-Fast Basil. The aim of this study was to determine the risk factors for pulmonary tuberculosis at the Central General Hospital of South Sulawesi. This research uses a cross sectional approach. The population in this study includes the case population, namely pulmonary tuberculosis sufferers who experienced a recurrence and the control population, namely pulmonary tuberculosis sufferers who have been declared cured. The sample in this study was all data on patients with Relapsed Pulmonary Tuberculosis who received treatment at the Central General Hospital of South Sulawesi Province. Data analysis was carried out univariate and bivariate using the chi square test. The results of the study can be concluded that there is no relationship between age and the incidence of relapse of pulmonary tuberculosis. The problem and diagnosis determined is to fulfill the need to breathe normally and the inability to fulfill the need to eat and drink enough. Meanwhile, the nursing intervention that was prepared was directed at helping to control the patient's low-fat and low-salt diet regarding sitting therapy in the Semi-Fowler position. This theory can be applied and applied well in treatment focused on pulmonary tuberculosis cases. For pulmonary tuberculosis patients who experience shortness of breath, improve the quality of their breathing by performing the semi-Fowler position as a non-pharmacological therapy.

The Effect of Giving Semi Fowler Position in Reducing Ineffective Breathing in Chronic Kidney Disease (CKD) Patients at RSUD Ibnu Sina Gresik Hospital (Case Study Research)

Chronic kidney disease is a condition where the kidneys fail to perform their function to excrete substances that are not needed by the body, resulting in accumulation in the body which can trigger uremia. This scientific work aims to apply nursing care to CKD patients with ineffective breathing patterns at Ibnu Sina Gresik Hospital. The method applied in the preparation of this scientific work is the case study method. The subjects in this scientific work are participants with CKD cases and have problems with ineffective breathing patterns who are undergoing treatment at Ibnu Sina Gresik Hospital. Data collection using interview techniques, observation, physical examination, and documentation and was carried out in the period January to March 2023. The nursing care process for participants was carried out for 5 days, and the assessment results were obtained, namely shortness of breath. The implementation process is carried out in accordance with nursing care planning, one of which is by giving the semi-fowler position. A thorough evaluation was carried out during the provision of nursing care, and it was found that the participants with the problem of ineffective breathing patterns were resolved. Participants do not complain of shortness of breath, breathing frequency improves or is in the normal range, dyspnoea decreases, and there is no use of breathing muscles. The problem of ineffective breathing patterns is resolved by the application of nursing care that is carried out comprehensively. Giving the semi fowler position has an impact on reducing ineffective breathing patterns, because in a tilt angle of 45 degrees and applied during treatment is able to press the diaphragm down so that the lungs can expand and get maximum oxygen supply.
 
 
 
 
 
 Keywords: Chronic Kidney Disease, Ineffective Breathing Pattern, Semi-Fowler's Position.
 
 
 

Impact of Semi-Fowler's Position in Chronic Heart Failure (CHF) Patients: Scoping Review

Epidemic heart failure patients are a scourge of world health which has an increasing trend as old age increase. Heart failure is a state of heart function not adequately supplying blood for the body's metabolism, known as Congestive Heart Failuren the productive age population, CHF patients have high morbidity, frequent exacerbations, and mortality. Treatment in the hospital requires intensive care. One of the forms of treatment in question is positioning. This study aimed to determine the impact of the semi-fowler's position on CHF patients. The research design is a systematic review using Google Scholar, Pubmed, and Garuda searches. Inclusion criteria were the research of the last five years; all articles were available. Exclusion criteria are non-experimental research, such as literature and observational studies—critical review using the JBI checklist for quasi-experimental. The results of the study were seven experimental research articles in Indonesia, three studies only giving semi-fowler's position, two studies recommending semi-fowler's position is better than right/left, and two other studies recommending semi-fowler's + Fowler's and semi-fowler's' positions. This study concludes that the semi-fowler's position is the correct position in the treatment of CHF patients.

Pengaruh Penerapan Posisi Semi Fowler terhadap Frekuensi Napas pada Pasien TB Paru di RS TK II Robert Wolter Mongonsidi

Indonesia is ranked 3rd with the highest TB sufferers in the world after India and China. According to data from the Ministry of Health (Kemenkes 2021), there are 397,377 cases of tuberculosis (TB) throughout Indonesia. Tuberculosis is a direct infectious disease caused by TB germs (Mycobacterium Tuberculosis). Most TB germs attack the lungs but can also attack other organs. The purpose of this study was to determine the effect of semi-fowler positioning on breathing frequency in pulmonary TB patients in hospitals. R.W.Mongosidi This study used a cross-sectional analytical descriptive method. The sample in Ambel was based on the number of respondents as many as 14 people using one group pre-post test design. Data analysis was tested using Wilcoxon. Based on the results of Wilcoxon test analysis, it can be known that the significant value of p value = 0.001 where α = 0.05 can be concluded that there is an effect of semi-fowler positioning on respiratory frequency in pulmonary TB patients. The conclusion in this study is that there is an effect of giving semi-fowler positions on breathing frequency in pulmonary TB patients in hospitals. Robert Wolter Mongosidi. Advice for nurses to use the semi-fowler position on the effectiveness of breathing patterns can be continued or applied to pulmonary TB patients.

Effects of postoperative lateral positioning on outcomes of patients with subarachnoid hemorrhage

Purpose: This study was conducted to investigate the effects of postoperative lateral positioning on the patients’ outcomes with subarachnoid hemorrhage. 
 Materials and Methods: This study, which is a randomized controlled intervention study, was conducted with 42 (experimental group: 21, control group: 21) patients who underwent subarachnoid hemorrhage surgery in the neurosurgery intensive care unit of a university hospital and met the sampling criteria. In the study, "Patient Descriptive Information Form" and "Patient Results Form" were used as data collection tools. A total of 42 patients operated on for subarachnoid hemorrhage were included in the study. While the patients in the intervention group were placed in the left lateral, right lateral, and semi-fowler position (30 degrees) every 2 to 4 hours for the first 72 hours, those in the control group were routinely placed in the semi-fowler position (20 to 45 degrees). 
 Results: The power of hydrogen value and partial oxygen pressure and arterial oxygen saturation at the 48th hour in the intervention group were statistically significantly higher than the control group at the 72nd hour. In the intervention group, a slight decrease was observed only in the heart rate at 72 hours, which was near normal.
 Conclusion: Lateral and semi-fowler positions with a 2 to 4 hour interval contributed to improved oxygenation and prevented secondary complications of subarachnoid hemorrhage.

THE EFFECTS OF DIFFERENT POSITIONS ON PHYSIOLOGICAL MEASUREMENT AND PERFUSION INDEX IN PEDIATRIC INTUBATED PATIENTS

The aim of this study is to determine the effects of four different body positions applied to paediatric intubated patients on physiological variables and perfusion index.The sample of this study, which was conducted as a quasi-experimental study in a single group in a paediatric intensive care unit, consisted of 44 intubated and monitored patients. The patients were given supine, right-lateral, left-lateral and Semi Fowler positions at intervals of two hours, and each position’s measurements were evaluated separately. In the analysis of data, number, percentage, mean, standard deviation, ANOVA, and post-hoc (Tukey HSD) tests were used. Fifty per cent of the patients were under 1 year old, 56.8% were male, and the mean patient age was 20.61±21.72 months. Peripheral oxygen saturation, systolic blood pressure and perfusion index mean values in the supine and Semi Fowler positions given to the patient were found to be statistically significant (p

Facilitated Intubation: Time to Re-examine an Old Technique With Its Associated Risks Mitigated by New Technology.

Facilitated intubation (FI) refers to intubation performed using a sedative or anesthetic drug as an induction agent, without the use of a paralytic (neuromuscular blocking agent). In comparison, rapid sequence intubation (RSI) employs both an induction agent and a paralytic drug. RSI has been seen to outperform FI in terms of first-pass success when performing direct laryngoscopy and was quickly adopted as the gold standard in all situations. Recently, ketamine-only intubation has been used in situations where there is distorted anatomy or apnea intolerance (physically and physiologically difficult airways) resulting in an increased risk of a can't intubate/can't oxygenate scenario or significant hypoxemia. Frequent and recurring national ketamine shortages have resulted in renewed interest in whether or not other forms of FI are feasible in an era where other factors that mitigate complictions in achieving first-pass success (video laryngoscopy, bougie use, semi-Fowler positioning) are commonly used. We present a case series with outcomes for profoundly hypoxic patients with coronavirus disease 2019 (COVID-19) (physiologically difficult airways) undergoing FI during a time of national ketamine shortage, using modern techniques and technology to maximize first-pass success and minimize peri-intubation complication. We included patients with COVID-19 pneumonia with pre-intubation oxygen saturations of less than 80% (significant hypoxemia) requiring intubation who presented to a tertiary care center in southern United States between August 25, 2021, and October 22, 2021.In this specific cohort, patients underwent endotracheal intubation with midazolam for induction without the use of paralytic agents.We used video-assisted laryngoscopy to increase the success of the first-pass attempt as well as placing the patients in a semi-Fowler position (head of bed elevation 30-45°) and bilevel positive pressure pre-oxygenation to minimize peri-intubation complications. Our case series included 29 consecutive patients that met the inclusion criteria.The mean ± standard deviation (SD) age of the patients was 49.5±15.0 years. The mean±SD pre-intubation oxygenation of our cohort was 73.1±5.9%.All 29 intubations were successful on the first-pass attempt.Only one patient (3.4%) required a rescue paralytic to facilitate oral opening. Of note, 27/29 (93%) of the patients did not receive any immunizations (including partial) for COVID-19.There were no incidents of peri-intubation arrest (cardiac arrest within 30 minutes of induction) or aspiration. In 29 physiologically difficult patients with acute respiratory failure, in whom the physician determined that RSI posed a higher than normal risk, FI assisted by VL, semi-Fowler positioning, and bilevel positive pressure pre-oxygenation resulted in excellent successful first-pass intubation rates without any incidencesof peri-intubation arrestor aspiration.While this cohort was small, our study reveals that FI with midazolam does not likely pose a higher risk than ketamine-only intubationand warrants further study.

THE EFFECT OF THE COMBINATION OF SEMI FOWLER POSITION AND RIGHT LATERAL ON HEMODYNAMIC CHANGES IN HEART FAILURE PATIENTS IN THE CVCU ROOM GRANDMED HOSPITAL LUBUK PAKAM

The results of a survey of the world community and in Indonesia, the most common disease and the most common cause of death is heart disease. Data from the World Health Organization (WHO) shows the prevalence that males experience more heart disease than females. Systemic and pulmonary disorders often occur because blood flow fails to enter the tissues due to failure of the heart pump, which affects the patient's hemodynamics. Changes in position have an impact on changes in central venous pressure values. The purpose of this study was to determine whether or not there was an effect of giving a combination of semi-Fowler's position with right lateral to changes in hemodynamic status of heart failure patients. Quasi experiment with one group pre test and post test method was used in this study. There were 10 respondents who were sampled using the quota sampling technique. This research was conducted at GrandMed Lubuk Pakam Hospital. The measuring instrument used in this study is an observation sheet. Data analysis was performed using paired simple T test. The results of this study obtained a p value = 0.001, this indicates that there is an effect of giving a combination of semi-Fowler's position with right lateral to changes in hemodynamic status in heart failure patients. Semi-Fowler's and lateral position actions help reduce oxygen consumption and increase maximum lung expansion and overcome damage to gas exchange so that it can reduce tightness and affect hemodynamic status. It is expected that nurses will provide education to patients so they want to change the semi-fowler's position with a right lateral combination in order to improve the patient's hemodynamic quality.
 

Effects of body positions on arterial stiffness as assessed by pulse wave velocity.

Assessing arterial stiffness through pulse wave velocity (PWV) usually requires participants to be in a supine position. If this position is not feasible, adjustments such as tilting the bed or bending the knees may be made. The Vicorder device also recommends tilting the upper body to prevent jugular vein interference in the recorded carotid pulse. To examine the impact of varying body positions on PWV. Seventy adults were studied in the fully supine (0°) to 40° upper body tilted-up positions with and without knee bend. Carotid-femoral PWV (cfPWV) was measured using two different testing devices (Omron VP-1000plus and Vicorder) and brachial-ankle PWV (baPWV) was measured using Omron. cfPWV measured at 10° tilt-up was not different from 0° position while baPWV increased significantly from 10°. Elevations in cfPWV were 7% at 20° and 15% at 40° compared with 0° position. Knee bend did not affect cfPWV but decreased baPWV at each angle ( P < 0.05). Jugular vein interference on the Vicorder was observed in 78% of participants in supine position, decreasing as body angle increased (7% at 30°). However, cfPWV values measured by Vicorder were consistent with those obtained by Omron even with jugular vein interference. Arterial stiffness assessed by PWV increased gradually and significantly in semi-Fowler's position ≥20°. Knee bend decreased baPWV but did not seem to affect cfPWV. PWV should be measured in supine position if possible. If the supine posture is not tolerated, knee bend followed by a slight incline position may be recommended.