Buddhasothorn Hospital Journal

The results of the program provide knowledge and skills in the use of individual inhalers in patients with chronic obstructive pulmonary disease in the COPD Clinic, Phanomsarakham Hospital. Chachoengsao Province

2025-02-16T21:23:32+07:00

Background and significance: Patients with COPD who have knowledge and skills in using inhalers correctly can prevent acute asthma attacks, which are life-threatening.

Objective: To compare the mean knowledge and skills in using inhalers before and after using the individual knowledge and skills program.

Study method: This is a quasi-experimental research with a single group post-test outcome measure. The study was conducted in patients with COPD who were treated at the COPD Clinic, Phanomsarakham Hospital, between April and June 2024. The sample consisted of 29 patients, selected by purposive sampling. The study was conducted before and after using the individual knowledge and skills program. The results were assessed using a knowledge and skills questionnaire before and after using the program. The analysis was performed using the T-Test dependent statistic (P<0.05).

Results: The use of the individual knowledge and skills program in using inhalers in patients with COPD found that the sample group The mean score of knowledge on inhaler use before and after using the program (M=2.79 (S.D.1.16)) and 7.96(S.D.1.81)) and the mean score of practice skills (M=3.20 (S.D.1. 50) and 7.86 (S.D 1.00)). The mean score of knowledge and practice skills on inhaler use after using the program increased significantly (p =0.015 and p =0.018), respectively.

Recommendations: From the research results, this program can be used with patients with chronic obstructive pulmonary disease to reduce acute asthma attacks and readmissions to the hospital.

The Accuracy of liver enzymes as a predictor of Screening for liver injury in patients with blunt abdominal injury

2025-03-02T15:29:00+07:00

Introduction: Elevated levels of AST and ALT are associated with liver injury resulting from blunt abdominal trauma. These biomarkers can aid in diagnosis and indicate the severity of the injury, leading to more effective and timely treatment.

Objective: To study the accuracy of liver enzyme levels in screening for liver injury in patients with blunt abdominal trauma

Methods: This retrospective study collected data from patients with blunt abdominal trauma who were treated in the emergency room and admitted to Chonburi Hospital between January 1, 2019, and July 31, 2021. A total of 162 patients were included. Statistical analysis was performed to assess the accuracy of liver enzyme levels using diagnostic tests. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, and the area under the receiver operating characteristic curve (AUROC) were calculated. Logistic regression was used to identify predictors of liver injury.

Result: Among the 162 patients, 78 (48.14%) had liver injuries. The optimal cut-off point for AST was ≥185 U/L, with a sensitivity of 84.6% and specificity of 88.0% (AUROC 0.92). For ALT, the optimal cut-off was ≥127 U/L, with a sensitivity of 84.6% and specificity of 89.2% (AUROC 0.93). Multiple logistic regression analysis showed that female gender, age, AST ≥185 U/L, and ALT ≥127 U/L were significant predictors of liver injury in patients with blunt abdominal trauma.

Conclusion: AST ≥185 U/L and ALT ≥127 U/L can be used as cut-off values to help screen for potential liver injury in patients with blunt abdominal trauma. However, decisions regarding the need for a CT scan should not rely solely on AST and ALT levels, but also consider gender, age, and vital signs.

Comparing the effect of Ondansetron versus combined Ondansetron and Dexamethasone for prophylaxis postoperative nausea and vomiting in elective cesarean section receiving intrathecal morphine in Buddhasothorn Hospital : RCT ,double-blind, Phase II

2025-03-09T23:14:10+07:00

Background: Postoperative nausea and vomiting (PONV) is common issue in cesarean section patients receiving spinal anesthesia with intrathecal morphine. Prophylactic use of antiemetics is more effective than treating them symptoms after onset.

Objective: To compare the incidence of PONV between patients receiving Ondansetron alone and those receiving Ondansetron combined with Dexamethasone. Secondary objectives included duration of stay in the recovery room, postoperative pain score, and Metoclopramide use within 24 hours postoperatively.

Methodology: A randomized, double-blind study was conducted with 80 patients divided into two groups of 40. Group O received Ondansetron 4 mg, while Group OD received combination of Ondansetron 4 mg and Dexamethasone 5 mg. Data on PONV and antiemetic use were collected from the operating room, recovery room, and inpatient ward. Recovery room duration and pain levels at 24 hours were recorded. Statistical analysis was performed using the Chi-square test and SPSS version 29.0.1.

Results: The incidence of PONV within 24 hours was 27.5% in Group O and 20.0% in Group OD (P = 0.43), showing no statistically significant difference. However, pain severity differed significantly between the groups, with Group OD experiencing less severe pain (P = 0.032).

Conclusion: The combination of Ondansetron and Dexamethasone was more effective in reducing the incidence and severity of PONV compared to Ondansetron alone, although the difference was not statistically significant. However, the combination significantly reduced the severity of postoperative pain.

Nursing Care for Pregnant Women Over 35 with Hypertension and Gestational Diabetes: A Case Study

2025-03-16T00:02:52+07:00

Background and significance Pregnant women over 35 years old with hypertension and gestational diabetes are considered to be at high risk of complications affecting both the mother and the fetus. These conditions are common medical complications during pregnancy and may increase the risk of serious complications, including mortality rates for both the mother and the fetus.

Objectives 1) To study the nursing process and care for pregnant women over 35 years old with hypertension and gestational diabetes through a case study. 2) To provide nursing procedures for nurses in the antenatal care unit when caring for pregnant women over 35 years old with hypertension and gestational diabetes. 3) To develop practical nursing instruction for caring of high-risk pregnant women who attending to antenatal clinics.

Study method Select 1 case study specifically for pregnant women over 35 years old with hypertension and gestational diabetes. Start by collecting data from medical records, interviewing patients along with observation, reviewing literature and related research. The collected data were analyzed to plan nursing care that covers physical, mental, emotional, social and economic aspects.

Results of the study From the case study of pregnant women over 35 years old with hypertension and gestational diabetes Received quality prenatal care according to prenatal care standards. Was screened for specific disease risks. Able to carry out pregnancy up to 37 weeks of pregnancy. Prevented premature birth and dangerous complications for pregnant women and infants. Duration of care: 7 months, 1 week, 3 days

Summary Nursing process and care for pregnant women over 35 years old with high blood pressure and gestational diabetes to enable pregnant women to act correctly and be safe from serious complications during pregnancy until they can carry out their pregnancy up to 37 weeks or as close to the due date as possible. Nurses must have good relationships with pregnant women and their families, be intentional, sincere, friendly, and motivated by providing alternative information that leads to overcoming hesitation and making decisions that are right for them, by motivating pregnant women. To feel confident that you can take care of your health correctly and safely, which requires conversation techniques to create motivation. (Motivation Interviewing : MI) To support pregnant women to change their health behavior, reduce complications and death of pregnant women and infants, and nurses must have knowledge and skills in providing nursing care to pregnant women at high risk. Quality prenatal care according to prenatal care standards, holistic nursing, assessment skills covering risk factors, including assessment of past obstetric history, current pregnancy history, illness history, body mass index level. Weight gain, blood sugar levels and blood pressure