IMPLEMENTATION OF THE SEMI-FOWLER POSITION IN CHF PATIENTS WITH GAS EXCHANGE DISORDERS IN THE CVCU ROOM AT ARIFIN ACHMAD REGIONAL GENERAL HOSPITAL, RIAU PROVINCE

Abstract

Congestive Heart Failure (CHF) is a chronic syndrome in which the heart is unable to meet tissue oxygenation needs, resulting in pulmonary congestion, alveolar edema, and impaired gas exchange. A preliminary study at the CVCU of Arifin Achmad Hospital showed that the average oxygen saturation in CHF patients was only <94% despite supplemental oxygen use, with a respiratory rate >20 breaths/minute and a tendency to return to the supine position during sleep. Based on scientific evidence, the Semi-Fowler position (30–45°) has been shown to increase ventilation, reduce diaphragmatic pressure, and improve oxygen saturation. This case study aims to evaluate the effectiveness of the Semi-Fowler position on improving oxygenation in CHF patients with impaired gas exchange. The method used was the implementation of evidence-based practice in one CHF patient who met the inclusion criteria. The intervention was conducted over three consecutive days (June 6–9, 2025), with observation durations of 30–45 minutes per session. Data were collected through observation of vital signs, the Borg scale, and oxygen saturation values ​​before and after the intervention. The results showed consistent improvement. On the first day, the respiratory rate decreased from 28 breaths/minute to 25 breaths/minute, and the SpO₂ increased from 92% to 95%. On the second day, the respiratory rate decreased from 24 breaths/minute to 22 breaths/minute, and the SpO₂ increased to 97%. On the third day, the respiratory rate decreased from 21 breaths/minute to 20 breaths/minute, and the SpO₂ stabilized at 98%. The Borg scale also decreased from "very severe" (7) to "mild" (2). In conclusion, the Semi-Fowler position effectively improves gas exchange, reduces dyspnea, and improves respiratory comfort in patients with CHF. This simple intervention is recommended as an applicable, evidence-based, non-pharmacological nursing practice.