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Murni Aritonang
Universitas Prima Indonesia
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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Nursing Care for XDR-TB Complicated by Infected Bronchiectasis and Malnutrition: A Case Report Robin Ferdiansyah Sitopu; Afeus Halawa; Basri Basri; Murni Aritonang; Fitriyana Br Kaban
Jurnal Keperawatan Priority Vol. 9 No. 1 (2026)
Publisher : Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jukep.v9i1.7886

Abstract

Extensively drug-resistant tuberculosis (XDR-TB) presents a formidable challenge, often exacerbated by irreversible structural lung damage and severe malnutrition. Roy’s Adaptation Model (RAM) was employed as the theoretical framework to address the profound physiological and psychosocial disruptions in a high-complexity case. This report describes the integrated, nurse-led management of a patient with XDR-TB and destroyed lung syndrome during the acute stabilization phase. A 39-year-old woman with a decade-long history of TB treatment failure was admitted to a national referral hospital with XDR-TB, profound cachexia (BMI 13.96 kg/m2), and severe hypercapnia (pCO2 94.7 mmHg). During a 72-hour acute stabilization period, integrated nursing-led interventions including the Active Cycle of Breathing Technique (ACBT), therapeutic positioning, and a high-calorie, high-protein regimen resulted in marked clinical improvement. Respiratory stabilization allowed for oxygen weaning from 5 to 4 L/min with an SpO2 increase to 97%. Breaking the catabolic cycle was evidenced by weight stabilization (maintained at 35 kg) and a positive metabolic shift, alongside significantly improved oral intake (80–90% of requirements).. Functional status progressed from total bed rest to independent short-distance ambulation without desaturation. Comprehensive nursing interventions, focusing on airway clearance and acute metabolic stabilization, play a pivotal role in the rapid stabilization of complex XDR-TB cases. Highlighting outcomes within the first 72 hours demonstrates that structured nursing care acts as a catalyst for physiological adaptation, even in the presence of severe anatomical lung destruction.
Correlation of Anxiety Level to Cimino Puncture Pain Intensity in Patients Undergoing Regular Hemodialysis Marthalena Siahaan; Eka Isranil Laily; Donisman Bu'ulolo; Murni Aritonang
Jurnal Keperawatan Priority Vol. 9 No. 2 (2026)
Publisher : Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jukep.v9i2.8594

Abstract

Patients with chronic kidney failure who undergo regular hemodialysis experience repeated cannulation of the arteriovenous fistula (Cimino), which produces pain arising not only from the physical trauma of needle insertion but also from the patient’s psychological state, particularly anxiety. This study aimed to analyze the correlation between anxiety level and pain intensity during Cimino puncture among regular hemodialysis patients at a hospital in Medan, Indonesia. A quantitative correlational design with a cross-sectional approach was used. Thirty-three respondents were recruited through purposive sampling. Anxiety was measured using the Hamilton Rating Scale for Anxiety (HRS-A), while pain intensity was assessed with the Numeric Rating Scale (NRS). Data were analyzed using the Spearman Rank correlation test. Most respondents experienced mild anxiety (78.8%), and pain intensity was predominantly moderate (57.6%). The Spearman Rank test showed a strong, statistically significant positive correlation between anxiety level and pain intensity (r = 0.590; p = 0.000; p < 0.05), indicating that higher anxiety was associated with greater pain during Cimino puncture. These findings confirm that psychological factors contribute meaningfully to the pain experienced during invasive hemodialysis procedures. Hemodialysis nurses are recommended to conduct routine anxiety assessment before Cimino cannulation and to apply non-pharmacological interventions, such as distraction and relaxation techniques, to reduce both anxiety and pain during the procedure.
Co-Authors Afeus Halawa Basri Basri Donisman Bu'ulolo Eka Isranil Laily Fitriyana Br Kaban Marthalena Siahaan Robin Ferdiansyah Sitopu