Krabi Medical Journal

Nursing Care of a Parturient with Severe Preeclampsia Complicated by Pulmonary Edema : Case Studies

Pattaraporn Khruayot — 2025-12-08

Objective : This study aimed to compare nursing care in two cases of severe preeclampsia complicated by
pulmonary edema, and to provide practical guidance for nursing management in similar obstetric emergencies.
Methods: A comparative case study was conducted at Krabi Hospital between November 2023 and
September 2024. Two women diagnosed with severe preeclampsia and pulmonary edema were reviewed using
medical records, and their nursing care was analyzed within the framework of the nursing process.
Results of the study: Case 1 was a 36-year-old multigravida with recurrent severe preeclampsia who
presented with uncontrolled hypertension, dyspnea, productive cough, and pulmonary crepitations. She underwent
emergency cesarean section and required intensive care. Case 2 was a 22-year-old primigravida referred from a
community hospital, presenting with headache, dizziness, epigastric pain, oliguria, and pulmonary signs. She also
underwent emergency cesarean delivery with close ICU monitoring. Although both cases shared the same diagnosis,
their clinical severity, complexity of problems, and nursing needs differed.
Conclusion: Comprehensive treatment and individualized nursing care throughout the perinatal period
enabled both mothers to recover safely, ensuring maternal safety and neonatal survival. Effective nursing management
requires thorough risk assessment, vigilant monitoring, and multidisciplinary collaboration to reduce complications and
improve outcomes.

Nursing Management of Patients with Ventilator-Associated Pneumonia Complicated by Multidrug-Resistant Infections: 2 Case study

Kanyarat Wiriyaloedtrakul — 2025-12-08

Background: Ventilator-associated pneumonia (VAP) is one of the most common and severe
complications among critically ill patients receiving mechanical ventilation. VAP caused by multidrug-resistant
(MDR) bacteria not only increases the severity of illness but also prolongs the duration of mechanical
ventilation, length of intensive care unit (ICU) and hospital stay, treatment costs, and mortality rates.
Objective:To compare nursing care processes, nursing diagnoses, care planning, and implementation,
and to analyze risk factors contributing to VAP and outcomes of the nursing process in patients with VAP
associated with antimicrobial-resistant infections.
Methods: This comparative case study involved two patients with VAP and antimicrobial-resistant
infections admitted to the inpatient department of Krabi Hospital from December 2024 to April 2025. Data
were collected from medical records, patient and family interviews, multidisciplinary team reviews, and
hospital infection prevention and control networks. The nursing process was guided by Gordon’s Functional
Health Patterns and Orem’s Nursing Conceptual Framework.
Results: Case 1: A 64-year-old Thai male presented with dyspnea, chest tightness, and cardiac arrest.
Diagnoses included post-cardiac arrest STEMI, acute exacerbation of COPD, sepsis, and LAD stenosis (50%).
The patient was treated with intubation, coronary catheterization, antibiotics, and cardiac medications.
He developed VAP due to Acinetobacter baumannii complex (CRAB–PXDR) and a urinary tract infection.
After 98 days of hospitalization, his condition improved, and he was discharged. Case 2: A 25-year-old Thai
male presented with high-grade fever, chills, mild cough, and worsening dyspnea. Diagnoses included
pneumonia with sepsis. He was treated with intubation, mechanical ventilation, and antibiotics but developed
VAP caused by Acinetobacter baumannii complex (XDR), respiratory failure, renal dysfunction, and pulmonary
embolism. Further evaluation revealed diffuse alveolar hemorrhage due to autoimmune disease. He received
methylprednisolone, prednisolone, and anticoagulants. After 35 days of hospitalization, he improved and was
discharged for follow-up at the rheumatology clinic.
Conclusion: Nurses play a crucial role in monitoring risk factors, implementing infection prevention
and control measures, coordinating multidisciplinary care, and evaluating patient outcomes in cases of VAP
associated with antimicrobial-resistant infections.

Nursing Care for Parturients with HELLP Syndrome: Case Studies

Supawadee thinnongjig — 2025-12-08

Objective: To compare nursing care for parturients with HELLP Syndrome through two case
studies and to identify evidence-based nursing strategies for effective management of this condition.
Methods: A comparative case study design was used to analyze two cases of parturients
diagnosed with HELLP Syndrome admitted to the labor and delivery unit at Krabi Hospital between
October 2023 and September 2024. Data were collected retrospectively from patients’ medical records,
and nursing interventions were analyzed through application of the nursing process.
Results: The first case involved a 34-year-old multigravida with a history of gestational
hypertension who presented with epigastric pain, tea-colored urine, thrombocytopenia, and uncontrolled
hypertension requiring emergency cesarean section. The second case was a 42-year-old primigravida
following conception via ICSI, with a history of miscarriage, who presented with headache, blurred vision,
severely elevated blood pressure, and clinical features consistent with severe HELLP Syndrome
complicated by hepatic and renal dysfunction. She required urgent cesarean delivery and intensive care
unit admission. Both patients were diagnosed with HELLP Syndrome but demonstrated differing degrees
of disease severity, associated complications, and clinical complexity.
Conclusion: Multidisciplinary care and individualized, holistic nursing management facilitated
appropriate and timely interventions throughout the antepartum, intrapartum, and postpartum periods,
including discharge planning. Both cases resulted in favorable maternal and neonatal outcomes. This study
underscores the critical role of the nursing process in HELLP Syndrome management, highlighting the
importance of comprehensive risk assessment, vigilant monitoring for early signs of clinical deterioration,
and collaborative care within a multidisciplinary team to reduce complications and enhance survival
outcomes for both mother and infant.

Development of Nursing Care Model for at Neonates with Sepsis Krabi Hospital

kokaew kasirak — 2025-12-25

This study aimed to develop and evaluate the effectiveness of a nursing model for neonates with sepsis at Krabi Hospital, employing a Research and Development approach based on Donabedian's framework and the Surviving Sepsis Campaign guidelines The sample comprised 20 professional nurses and 14 neonates diagnosed with sepsis, conducted from May to July 2025 in three phases: (1) situational and problem analysis, (2) nursing model development, and (3) effectiveness evaluation. Research tools included a nursing protocol, knowledge tests, practice assessments, and satisfaction questionnaires. The results demonstrated that the developed nursing model reduced mortality rates from 4.5% to 0% (p = > 0.999), complications from 12.1% to 7.1% (p > 0.999), and hospital stay duration from 15.8 to 12.5 days (p = .015). Nurses' knowledge and practice significantly improved (p < .001), with knowledge scores rising from 14.2 to 18.5 and practice scores from 10.8 to 13.9. Nurse satisfaction was high (Mean = 4.59, SD = 0.58). The Development of Nursing Care for Neonates with Sepsis at Krabi Hospital model (SPOT Model) consists of S: Structure, P: Process, Outcome and Multidisciplinary team. The model is suitable for secondary-level hospitals, and its expansion to hospitals in Health Region 11 is recommended, along with the development of digital tools to support continuous care.

Results of discharge planning for renal failure patients receiving peritoneal dialysis at Khian Sa Hospital

Wannadee Suemark — 2025-12-25

This quasi-experimental research employed a one-group pretest-posttest design to examine the effects of a discharge planning program on knowledge and self-care ability among caregivers of patients with end-stage renal disease undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) at Khian Sa Hospital, Surat Thani Province. The sample consisted of 10 caregivers, selected through purposive sampling. The research instruments included: (1) a discharge planning program for CAPD patients, (2) a 20-item knowledge assessment questionnaire, (3) a 15-item skill assessment for CAPD solution exchange, (4) a 15-item skill assessment for exit-site wound care, and (5) a satisfaction questionnaire for caregivers. The content validity index (CVI) of the instruments was 0.90, and the reliability using Cronbach’s alpha coefficient was 0.80.

The results revealed that after participating in the discharge planning program, caregivers had significantly higher mean scores of knowledge (M = 13.10, SD = 1.37, p < .01), solution exchange skills (M = 18.40, SD = 1.07, p < .01), and exit-site wound care skills (M = 11.20, SD = 1.17, p < .01) compared to before the intervention. Furthermore, the overall satisfaction with the discharge planning program was rated at the highest level (M = 4.58, SD = 0.50).

In conclusion, the discharge planning program significantly improved caregivers’ knowledge, skills, and satisfaction. Therefore, this program should be applied as a standard guideline for CAPD patient care in community hospitals to reduce complications, rehospitalization rates, and enhance the quality of life for both patients and their families.

Prevalence and Factors for postoperative complications after Total Thyroidectomy in Krabi Hospital

kamonchanok posiw — 2025-12-08

Background: Total thyroidectomy is widely performed regarded as a safe treatment option; however, postoperative complications such as hypocalcemia and recurrent laryngeal nerve injury may still occur.
Objective: This study aimed to determine the prevalence of postoperative complications and identify associated factors among patients undergoing total thyroidectomy at Krabi Hospital, with the goal of informing postoperative surveillance and reducing both the incidence and severity of complications.
Methods: This retrospective study included 149 patients who underwent total thyroidectomy at Krabi Hospital between January 1, 2020, and December 31, 2024. Data were collected from medical records on patient characteristics, operative details, and postoperative complications assessed at 24 hours, 1 month, 3 months, and 6 months following surgery. Descriptive statistics and inferential analyses, including logistic regression, were used to evaluate factors associated with complications.
Result: Transient hypocalcemia was the most common complication 41.61%)and was associated with female sex (p-value=0.032, OR 1.17, 95%CI 0.09-2.24). The second most frequent complication was transient recurrent laryngeal nerve (RLN) injury 30.87%, with female sex (p-value=0.044, OR 5.37, 95%CI 1.04-27.71) identified as risk factors. Permanent RLN injury occurred in 11.41% of patients, particularly among those with intraoperative blood loss ≥100 ml (p-value=0.002, OR 5.82, 95%CI 1.94-17.44). Permanent hypocalcemia occurred in 7.38% of patients and was significantly associated with age ≥45 years (p-value=0.027, OR 6.17, 95%CI 1.23-30.87). Only one case of surgical site infection was observed, and no cases of postoperative hematoma were reported.
Conclusion: The most common complications following total thyroidectomy were transient hypocalcemia and transient recurrent laryngeal nerve injury. High-risk patients should receive appropriate pre- and postoperative counseling particularly regarding symptom recognition, calcium monitoring, and voice changes and should be closely monitored after surgery to prevent or reduce the severity of potential complications.

Comparative Effectiveness of 0.1% Dexamethasone Sodium Phosphate + 0.5% Neomycin Sulfate versus 1% Prednisolone Acetate Eye Drops in Postoperative Inflammation after Cataract Surgery at Krabi Hospital

parida yotharak — 2025-12-16

Objective: This study aimed to compare the efficacy of 0.1% Dexamethasone Sodium Phosphate combined
with 0.5% Neomycin Sulfate (DexOph®) and 1% Prednisolone Acetate (Pred Forte®) in controlling
postoperative anterior chamber inflammation following cataract surgery at Krabi Hospital.
Methods: This retrospective study reviewed medical records of 160 patients who underwent
phacoemulsification with intraocular lens implantation. Patients were divided into the DexOph® group
(n = 88) and the Pred Forte® group (n = 72). Postoperative outcomes were assessed in terms of anterior
chamber inflammation (using the SUN grading system), visual acuity (VA), and intraocular pressure (IOP) at
days 7–10 and 30–42 after surgery.
Results: There were no statistically significant differences between the two groups in VA, IOP, corneal
condition, or anterior chamber inflammation at any follow-up time points. Although the DexOph® group
had a higher proportion of patients with hypertension and demonstrated significantly different initial
postoperative anterior chamber inflammation, multivariable analysis identified initial cell grade 4 on the first
postoperative day (aOR = 6.00, 95% CI: 1.59–22.67, p = 0.008) as an independent risk factor for persistent
inflammation on days 7–10 post-surgery. Subgroup analysis suggested a trend toward greater efficacy of 1%
Prednisolone Acetate in patients with grade 3 inflammation on the first postoperative day (p = 0.054).
Conclusion: Both 0.1% Dexamethasone Sodium Phosphate with 0.5% Neomycin Sulfate and 1%
Prednisolone Acetate demonstrated comparable overall efficacy in reducing postoperative inflammation
after cataract surgery. However, individual clinical factors—particularly the degree of initial postoperative
inflammation—should be considered when selecting the optimal treatment to achieve personalized and
effective anti-inflammatory management.

Quality Improvement of Discharge Planning for Patients with Chronic Obstructive Pulmonary Disease in Medical Female 1 Patients Unit, Nakornping Hospital, Chiang Mai Province

wijitra norasing — 2025-12-09

Discharge planning is a critical process aimed at preparing patients, from the initial phase of hospital admission through to discharge. Appropriate discharge planning for patients with chronic diseases can reduce 28-day readmission rates and average length of stay. This research aimed to improve the quality of discharge planning for patients with Chronic Obstructive Pulmonary Disease (COPD) in Female Medical Ward 1, Nakornping Hospital, Chiang Mai Province, using the IDEAL framework. The sample consisted of 33 COPD patients admitted to Female Medical Ward 1 and 17 healthcare professionals. Research instruments included personal data recording forms for healthcare providers and patients, a developed COPD patient discharge planning record, service quality records, a COPD discharge planning implementation checklist, and a COPD discharge planning manual based on the IDEAL framework. Data were analyzed using descriptive statistics including frequency, percentage, and mean.

The findings indicated that, following implementation of the IDEAL-framework-based discharge planning, the multidisciplinary team was able to follow the discharge planning guidelines at a rate exceeding 80%. The 28-day readmission rate decreased to 6.06%, and the average length of stay decreased to 5.45 days. The study results provide guidelines for discharge planning of COPD patients in Female Medical Ward 1, Nakornping Hospital, Chiang Mai Province. Hospital administrators can adapt this approach for the discharge planning of patients with other chronic diseases.

Development of a warming Care Protocol to Prevent Hypothermia and Shivering in Pregnant Woman Undergoing Elective Cesarean Section with Spinal Anesthesia

Butsaya Poonkerd — 2025-12-25

Abstract

This research and development aimed to study the situation, develop guidelines and effectiveness of body warming methods to Prevent Hypothermia and Shivering in Pregnant Woman Undergoing Elective Cesarean Section with Spinal Anesthesia. This study consisted of 3 steps. First step explored the situation, problems and needs of anesthetists using document analysis and qualitative methods from 15 anesthetists. Content analysis were applyied. Step 2 was develop a warm-up guideline by lifting the draft before sending it to 3 experts for review, revising and creating a manual. The last step evaluated the effectiveness by using the quasi-experimental research method with a two-group pre- and post-test design. The sample consisted of 40 women who underwent emergency cesarean section. Data were analyzed using descriptive statistics, Independent t-test, Mann-Whitney U-test, Linear Mixed Effects Model, Chi-square test and One-sample t-test. The research results found that:

The incidence of shivering during 2021-2024 was expected to increase by 29%, 40.74% and 45.18%, respectively. The problems for anesthesia nurses in caring for this group of patients are the lack of clear care guidelines, insufficient warming equipment, longer care time in the recovery room, overcrowding, and inadequate care.
Clinical practice guidelines for warming up to prevent hypothermia and shivering include three phases. Preoperative, intraoperative and postoperative periods by providing warmth at all stages and treating chills and monitoring for complications.
Comparison of body temperature at the time of patient entering the operating room, 15 minutes after spinal anesthesia injection, at the time of patient arrival in the recovery room and before discharge from the recovery room had statistically significant differences (p-value < 001). Moreover, the results of the comparison of chills in patients entering the operating room after spinal anesthesia injection for 15 minutes, patients arriving in the recovery room, and before discharge from the recovery room showed statistically significant differences (p-value < 0.001). Furthermore, anesthesia nurses' satisfaction with the practice guidelines was significantly higher than the 80% (p-value < 0.001)

Keywords : warming protocol,spinal anesthesis,cesarean section,shivering,hypothermia

Factors affecting Compliance with Law-Enforced Good Manufacturing Practice (GMP 420) of Drinking Water in Sealed Containers Production: A Study in Nakhon Si Thammarat Province

Korakot Kienvaree — 2025-12-30

This cross-sectional analytical study aimed to investigate factors influencing compliance with law-enforced Good Manufacturing Practices (GMP 420) among entrepreneurs of drinking water in sealed containers production facilities in Nakhon Si Thammarat Province. A total of 138 facilities were selected through simple random sampling. Data were collected using a questionnaire and on-site GMP 420 assessment between December 2024 and February 2025. Descriptive statistics, Chi-square test and binary logistic regression were used for data analysis. The results showed that 94.2% of the facilities were non-factory operations, with an average business duration of 10.8 years (S.D. = 7.5). About 34.1% had an average monthly income of 30,000–70,000 baht. Most facilities (91.3%) had a certified production supervisor. Entrepreneurs have an overall agreement with GMP 420 (average = 3.7, S.D. = 0.4). Knowledge of GMP 420 is at the level of Fair (mean = 13.9, S.D. = 2.4 full score 20). Compliance with GMP 420 was observed in 58.0% of the facilities, with higher adherence to general requirements (73.2%) than specific ones (59.4%). Statistically significant factors associated with GMP 420 compliance included age 31–60 years (OR = 5.4, 95% CI = 1.5–19.5, p = 0.010), working more than 8 hours per day (OR = 6.5, 95% CI = 1.7–23.9, p = 0.005), monthly income of 50,001–90,000 baht (OR = 5.8, 95% CI = 1.6–20.8, p = 0.007), income over 90,000 baht (OR = 2.7, 95% CI = 1.1–6.7, p = 0.037), and a positive attitude toward GMP 420 (OR = 2.8, 95% CI = 1.1–7.4, p = 0.037). The findings indicate that entrepreneurs still face challenges in fully complying with GMP 420. Government agencies should provide targeted support and develop incentive mechanisms to promote sustainable compliance with the regulations.

The The effects of Electronic Medication Reconciliation System development in the inpatient department of Krabi Hospital

Suchada Buakaew — 2025-12-30

Objective: To study the effect of the development of an electronic medication reconciliation system on medication errors and to study the satisfaction of personnel working in the medication reconciliation system in the inpatient department of Krabi Hospital.

Method: This is a descriptive research study comparing medication error reporting data (ME) during 1 year before and after using the electronic medication reconciliation system (EMR) from May 2022 to April 2024. As for the satisfaction assessment, data were collected using a satisfaction assessment form to survey data from personnel involved in the MR process, including doctors, pharmacists, and ward nurses. Results were analyzed using statistics Chi-square, Fisher’s Exact test, Mann-Whtiney U test and independence t-test.

Results: The rate of Medication Errors (Prescribing Error – Medication Reconciliation Type) in the form system and EMR system was significantly reduced at a statistical level of 0.001 (4.93 and 2.43 times per 1000 bed days, respectively). The C-D level was significantly reduced at a statistical level of 0.05 (0.35 and 0.08 times per 1000 bed days, respectively). When considering the issues of drug use, it was found that the number of reports of inappropriate drug selection (Wrong drug and substitute) of the form system and EMR system was significantly different (p-value 0.005), as was the duplicate drug order (Duplication) (p-value 0.01). In terms of overall satisfaction with the EMR system, it was at a very satisfactory level (=4.20, SD=0.75). The issue with the highest satisfaction was the “Med-reconcile system Currently, it is beneficial to the safety of patients' medicines" (=4.33, SD=0.64)

Conclusion : The development of the electronic medication consistency system in the inpatient department of Krabi Hospital can prevent medication errors with statistical significance. The personnel are satisfied with the benefits to the safety of patients' medicines and the convenience of MR operations. There are suggestions for the medicine system to link the history of medication use between hospitals and increase the speed of recording the coordination of medication lists in the admission process.

Factors Predicting Health Care Behaviors of Elderly Thai Muslims in Krabi Municipality

Rungsuree Butsu — 2025-12-08

This research aimed to study: 1) the factors that influence health care behavior of elderly Thai Muslims in Krabi Municipality. 2) The factors that can predict health care behavior of elderly Thai Muslims in Krabi Municipality.

The study sample group of 138 elderly Thai Muslims aged 60 years and over living in Krabi Municipality. By collecting data from a questionnaire on factors predicting health care behavior of Thai Muslim elderly in Krabi Municipality. The statistics used in the study were frequency, percentage, mean, standard deviation, minimum, maximum, and multiple regression analysis.

The research results found that the leading factors in terms of health care knowledge were at a moderate level 78.3%. The attitudes and values ( = 4.43, 4.42), the enabling factors in terms of access to health services ( = 4.30), and the supporting factors in terms of participation of people around them in health care were at the highest level of agreement ( = 4.38). Their health care behavior was at the level of sometimes practicing. It was also found that the leading factors and values of the elderly could be used to predict health care behavior of the elderly Thai Muslims in Krabi Municipality by 18.60% (R² = 0.186). The supporting factors in terms of access to health resources could be used to predict health care behavior of the elderly Thai Muslims in Krabi Municipality by 16.80% (R² = 0.168) with statistical significance at the .05 level. The supporting factor in terms of participation of people around them could be used to predict health care behavior of the elderly Thai Muslims in Krabi Municipality by 25.60% (R² = 0.256) with statistical significance at the .05 level. Therefore, the results of this study can be applied to the local area to plan activities to promote health for the elderly that better meet the needs of the target group. It also promotes the participation of communities, families, religious leaders and volunteers in caring for the elderly.