Journal of Medical Surgical Nursing Practice and Research

Hyperglycemic Hyperosmolar State Complicated by Acute Kidney Injury and Severe Rhabdomyolysis in a Bodybuilder with Newly Diagnosed Type 2 Diabetes: A Case Report

Farkhanda Amin, Nusrat Aziz, Nuzhat Shafi — Mon, 13 Jul 2026 00:00:00 +0000

Background: Hyperglycemic hyperosmolar state (HHS) is a life-threatening complication of type 2 diabetes mellitus, typically affecting older adults. Bodybuilders represent a unique high-risk population due to high-protein diets, anabolic steroid use, intense exercise, and frequent use of supplements. Acute kidney injury (AKI) and rhabdomyolysis are underrecognized complications of HHS that are exacerbated by these bodybuilding practices.

Case Presentation: A 28-year-old male competitive bodybuilder with no prior history of diabetes presented with a 4-day history of extreme thirst, inability to train, dark urine, and progressive confusion. On admission, the bodybuilder was lethargic (Glasgow Coma Scale 11), severely dehydrated, with blood glucose 1,240 mg/dL, serum osmolality 385 mOsm/kg, creatinine 6.8 mg/dL (estimated baseline 1.3 mg/dL for a muscular male on creatine, representing a 5.2-fold increase), blood urea nitrogen 145 mg/dL, potassium 7.1 mEq/L, creatine kinase 68,000 U/L, and urine dipstick positive for blood without red blood cells. The bodybuilder was reported to have used anabolic steroids (testosterone enanthate, trenbolone) for 18 months, high-protein supplements (250 g protein daily), and high-dose creatine supplementation. Diagnoses included: (i) Hyperglycemic hyperosmolar state, (ii) Acute kidney injury (KDIGO Stage 3), (iii) Severe rhabdomyolysis, (iv) Newly diagnosed type 2 diabetes (HbA1c 10.8%). Nursing management was organized using Orem’s three nursing systems. The patient required 14 days of hospitalization, including 6 days in intensive care and three hemodialysis sessions. Renal function improved to near baseline (creatinine 1.6 mg/dL at discharge), and the bodybuilder was discharged on insulin therapy with structured education addressing bodybuilding-specific risks.

Conclusion: Bodybuilders with undiagnosed diabetes are at extreme risk for HHS complicated by AKI and rhabdomyolysis due to synergistic effects of hyperglycemia, anabolic steroids, high-protein intake, and intense exercise. Orem’s theory guides nursing interventions across the continuum from critical care to discharge education, emphasizing self-care capacity building for lifelong diabetes management while addressing bodybuilding culture.

Natural Relief for Menstrual Pain: An Evidence-Based Review of Home Remedies for Dysmenorrhea

Janula R, Vidya V Nair — Tue, 21 Jul 2026 00:00:00 +0000

Dysmenorrhea refers to painful menstruation, and it is the most widespread gynecological conditions that affect the women during the reproductive age group. It significantly impacts physical, psychological, and social well-being, often resulting in absenteeism from school and work. While pharmacological interventions like nonsteroidal anti-inflammatory drugs are widely used, most women depend on home preparations because of their cost efficiency, availability, and apparent safety. This review article aims to offer a summary of generally used home preparations for dysmenorrhea and assess the available evidence regarding their usefulness. The literature review included published studies that examined various non-pharmacological approaches for the treatment dysmenorrhea, such as heat therapy, herbal preparations, physical exercise, dietary modifications, adequate fluid intake, and relaxation techniques. The findings suggest that several home-based interventions can successfully lessen menstrual pain and enhance quality of life. Heat application and ginger consumption have been revealed as predominantly effective in pain reduction. Lifestyle changes such as regular physical exercise and healthy food practices also help to reduce menstrual pain. Healthcare professionals, particularly nurses, should instruct women regarding evidence-based non-pharmacological preparations and encourage women to get professional healthcare guidance whenever necessary.

Comprehensive Management of Duchenne Muscular Dystrophy: A Nursing Perspective

Gowthami B. N — Mon, 04 May 2026 00:00:00 +0000

Duchenne muscular dystrophy (DMD) is a severe X-linked recessive neuromuscular disorder characterized by progressive muscle degeneration resulting from the absence of dystrophin, primarily affecting male children and leading to loss of ambulation, respiratory failure, cardiomyopathy, and reduced life expectancy. The complex and multisystem nature of the disease necessitates a comprehensive and coordinated approach to management. This review aims to provide an in-depth understanding of DMD with a particular emphasis on multidisciplinary management and the integral role of nursing care. A narrative review methodology was adopted, synthesizing evidence from clinical guidelines, standard textbooks, and recent advancements in therapeutic interventions. Current management strategies include corticosteroid therapy, respiratory support, cardiac care, rehabilitation, and emerging genetic therapies such as exon-skipping and gene therapy, which offer promising avenues for disease modification. Despite these advancements, treatment remains largely supportive, with a strong focus on symptom management and prevention of complications. Nursing care plays a pivotal role in continuous assessment, early detection of complications, coordination of multidisciplinary services, patient and caregiver education, and provision of psychosocial support. Holistic nursing interventions significantly contribute to improving functional outcomes and enhancing quality of life. Although a definitive cure remains unavailable, ongoing advancements in genetic therapies and integrated care models hold potential for transforming disease outcomes. Strengthening nursing involvement and adopting a patient-centered, multidisciplinary approach are essential for optimizing long-term care and improving the overall well-being of individuals with DMD.

Evidence-Based Infection Control Practices in Critical Care Units: A Systematic Review of Nursing Interventions

Ishfaq Ahmad Sheikh — Fri, 08 May 2026 00:00:00 +0000

Background: Healthcare-associated infections (HAIs) remain a major concern in critical care units (CCUs), where invasive procedures, prolonged hospitalization, and compromised immunity increase infection risk. These infections contribute to higher morbidity, mortality, healthcare costs, and antimicrobial resistance. Nurses play a crucial role in infection prevention due to their continuous patient care responsibilities, yet adherence to established guidelines remains inconsistent.

Methods: This study was conducted as a systematic review to synthesize evidence on infection control practices in critical care units, with a specific focus on nursing-led interventions. Relevant literature, including WHO and CDC guidelines and peer-reviewed studies published between 2015 and 2025, was systematically analyzed based on predefined inclusion criteria.

Results: Key infection control strategies identified include effective hand hygiene, appropriate use of personal protective equipment (PPE), adherence to aseptic techniques, environmental cleaning, and infection surveillance. Hand hygiene was consistently reported as the most effective intervention. Nurse-led education, standardized protocols, and institutional support were found to significantly improve compliance and reduce infection rates.

Conclusion: Evidence-based nursing practices are essential for reducing HAIs in CCUs. Strengthening education, ensuring the availability of resources, and promoting institutional support can enhance infection prevention outcomes. Integrating structured protocols into routine care and improving compliance mechanisms are critical for improving patient safety and healthcare quality.

Placenta Accreta Spectrum with Antepartum Haemorrhage in a 34-Year-Old Multigravida: A Comprehensive Obstetric Case Study

Jasbir Kaur, Saroj Rani — Mon, 29 Jun 2026 00:00:00 +0000

Placenta Accreta Spectrum (PAS) is a significant obstetric condition defined by aberrant placental adhesion to the uterine wall caused by partial or complete lack of the decidua basalis. It is one of the most common causes of severe obstetric haemorrhage and contributes considerably to maternal morbidity and mortality globally. PAS has become more common in recent decades, owing primarily to an increase in caesarean section deliveries. Early detection and interdisciplinary treatment are critical for better maternal and newborn outcomes. This case study features a 34-year-old multigravida woman who was admitted at 29 weeks and 3 days of gestation with painless vaginal bleeding that suggested antepartum haemorrhage. The patient had undergone one previous lower segment caesarean section. Ultrasonography and colour Doppler imaging revealed features consistent with the placenta accreta spectrum, such as placental lacunae, loss of the retroplacental hypoechoic zone, and enhanced placental vascularity. The patient was treated conservatively, with close maternal and foetal monitoring, blood transfusion preparation, and multidisciplinary care provided by obstetricians, anaesthesiologists, neonatologists, nursing experts, and blood bank workers. The example emphasizes the necessity of prenatal diagnosis, close monitoring, early intervention, and specialist nursing care in managing high-risk pregnancies complicated with PAS. Early detection allowed for the extension of pregnancy while maintaining maternal and foetal stability. This paper emphasizes the critical role of obstetric nurses in monitoring, counselling, emergency readiness, and delivering comprehensive care to women with obstetric difficulties.