Samutprakan Hospital Journal (SMPK HOS J)

Nursing Care for Patients with Sepsis and Diabetic Ketoacidosis: A Case Study

Jongrak Praysri — 2025-06-30

Sepsis is a critical and life-threatening condition and a major cause of mortality, representing a significant public health concern in Thailand. This study aims to explore the clinical progression, nursing diagnoses, nursing care planning, and nursing outcomes in patients with sepsis coexisting with diabetic ketoacidosis (DKA) within the context of nursing care at a community hospital.

The case was studied in June 2024, with a total management period of four hours. Nursing care included initial assessment, during admission to the emergency department, and the safe transfer of the patient to a tertiary care hospital. The approach addressed the patient’s physical, psychological, social, and economic needs to ensure safety and prevent severe complications associated with sepsis and DKA.

Timely and effective nursing interventions led to the safe and rapid referral of the patient to a higher-level healthcare facility, reflecting high-quality healthcare service delivery within the community hospital setting.

Effectiveness of Ultrasound Therapy in Post-dry Needling Soreness of Myofascial Pain Syndrome in Upper Trapezius Muscle

Suparnee Poorisawatpong — 2025-06-30

This randomized, double-blind, controlled trial aims to evaluate the effectiveness of low-intensity, pulsed-mode ultrasound therapy in alleviating post-dry needling soreness (PNS) among patients with myofascial pain syndrome (MPS) of the upper trapezius muscle. Twenty-four participants diagnosed with upper trapezius MPS were selected using purposive sampling and randomly assigned to either an intervention group (n = 12) or a control group (n = 12). All participants received dry needling treatment. Post-treatment, the intervention group received ultrasound therapy (low intensity, pulsed mode at 1 Hz, 20% duty cycle) for 10 minutes, while the control group received sham ultrasound for 10 minutes as well. Both groups were instructed to perform identical exercises and apply cold compression. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS), pressure pain threshold and the Thai version of the Neck Disability Index (Thai-NDI) at 10 minutes, 24 hours, and 1-week post-treatment.

The results showed that baseline characteristics were similar between groups. At 10 minutes and 24 hours post-treatment, the intervention group demonstrated significantly greater reductions in VAS scores for PNS (mean reduction: 3.75 ± 1.22 and 6.75 ± 1.60, respectively) compared to the control group (0.33 ± 1.30 and 3.67 ± 3.50, respectively). The average recovery time from soreness was significantly shorter in the intervention group (9.33 hours) than in the control group (28.50 hours). While both groups showed significant within-group improvements in neck pain intensity, pressure tolerance, and Thai-NDI scores (p < 0.05), no significant between-group differences were observed for these measures.

Low-intensity, pulsed-mode ultrasound therapy administered after dry needling significantly reduced post-treatment soreness and accelerated recovery time in patients with upper trapezius MPS.

The Effects of Implementing Clinical Practice Guidelines for Acute Postoperative Pain Management in the Post-Anesthesia Care Unit, Anesthesiology Department, Inburi Hospital

Chompunut Benjarat — 2025-06-30

This quasi-experimental study aims to compare postoperative pain levels and patient satisfaction following the implementation of clinical practice guidelines (CPGs) for acute pain management in the Post-Anesthesia Care Unit (PACU), developed by the researcher. A total of 60 postoperative patients admitted to the PACU were enrolled and assigned to either an intervention group, which received nursing care based on the CPGs, or a control group, which received standard postoperative pain management. The CPGs, validated with a content validity index of 0.92. Seven nurse anesthetists participated in guideline implementation. Data collection tools included a demographic data form, a pain assessment scale, a patient satisfaction questionnaire on postoperative pain management (Cronbach's alpha = 0.98), and a guideline user satisfaction form (Cronbach's alpha = 0.97). Data were analyzed using descriptive statistics, independent t-tests, and the Mann-Whitney U test.

Results showed that the intervention group reported significantly lower mean pain scores compared to the control group (M = 2.73, SD = 2.64 vs. M = 3.83, SD = 1.11; p < 0.05). Patient satisfaction scores were also significantly higher in the intervention group (M = 3.92, SD = 0.34) compared to the control group (M = 3.13, SD = 1.18; p < 0.01). Nurse anesthetists reported high satisfaction with the use of the guidelines (M = 4.83, SD = 0.38).

In conclusion, the implementation of the researcher-developed clinical practice guidelines in the PACU significantly improved pain outcomes and patient satisfaction. These findings support the continued application and institutionalization of the guidelines to ensure effective pain management in the PACU.

Prevalence, Clinical Characteristics and Risk Factors of Upper Gastrointestinal Bleeding from High Risk Peptic Ulcer Disease in Samutprakan Hospital

Suvikrom Chatthammanat — 2025-06-30

Upper gastrointestinal bleeding is a common gastrointestinal emergency with a high mortality rate, particularly among patients with peptic ulcer disease (PUD) who are at high risk of rebleeding. In Thailand, data on risk factors for high-risk gastroduodenal ulcer bleeding remain limited. This study aims to investigate the prevalence, clinical characteristics, and contributing factors associated with this condition at Samutprakan Hospital.

A retrospective review was conducted on 328 patients who underwent upper gastrointestinal endoscopy between 2019 and 2022. The prevalence of high-risk gastroduodenal ulcer bleeding, defined by criteria associated with a high likelihood of rebleeding, was found to be 30.79% of all patients with ulcer bleeding.

Multivariate logistic regression analysis revealed several statistically significant risk factors (p < 0.05), including acute kidney injury (odds ratio [OR] 4.31), blood urea nitrogen to creatinine ratio (BUN/Cr) > 30 (OR 2.28), hypoalbuminemia < 3 g/dL (OR 2.23), presence of shock (OR 2.05), and syncope (OR 1.95).

These findings can be applied to develop clinical risk assessment tools for identifying patients at high risk of rebleeding from gastroduodenal ulcers. Such tools would enable timely, accurate, and appropriate treatment to improve patient outcomes.

Developing a Model for Managing Advertising Problems in a Medical Clinic Providing Beauty Services in Samut Prakan Province

Achara Tancharoen — 2025-06-30

This quasi-experimental study employs a one-group pretest–posttest design to develop and evaluate a management model for addressing advertising issues in private medical clinics offering aesthetic services in Samut Prakan Province. A purposive sample of 36 clinics, all of which had previously advertised without official approval and voluntarily participated, was included in the study.

The developed model consisted of six core activities: 1) training on advertising regulations, 2) practice in evaluating advertising content, 3) development of online platforms and clinic websites, 4) provision of both proactive and reactive consultations, 5) on-site monitoring with emphasis on legal enforcement, and 6) continuous follow-up. Research instruments included a knowledge test (KR-20=0.72) and an attitude questionnaire (Cronbach’s alpha = 0.75), both validated by three experts (I-CVI = 1.00 for all items). Descriptive statistics were used to analyze general data, while paired t-tests were applied to assess changes in knowledge and attitude scores.

The results revealed statistically significant improvements in both knowledge (from 5.92 ± 0.46 to 8.03 ± 0.33; p < 0.05) and attitude scores (from 3.51 ± 1.09 to 4.08 ± 0.81; p < 0.05). Additionally, the rate of advertising submission for official approval increased from 0% to 100% (p < 0.001), and the actual Facebook advertising content complied with regulatory standards.

In conclusion, the developed management model proved to be effective, appropriate, and feasible for implementation in private aesthetic clinics. Future studies should explore its application in other regions, evaluate the sustainability of behavioral changes, and compare different training formats to enhance overall efficiency in health service regulation.