Jurnal Keperawatan

Volume 13 Nomor 2, Juni 2021

e-ISSN 2549-8118; p-ISSN 2085-1049
http://journal.stikeskendal.ac.id/index.php/Keperawatan

FOOT SOAK THERAPY WITH SALT WATER TO DECREASE BLOOD PRESSURE

OF PRE-OPERATIVE CATARACT PATIENTS WITH HYPERTENSION
Amrih Widiati*, Widiyaningsih, Rosdiana Sella
STIKES Karya Husada, Jl. R. Soekanto No.46, Sambiroto, Kec. Tembalang, Kota Semarang, Jawa Tengah
50276, Indonesia
*[email protected]

ABSTRACT
Cataract is a pathological condition of the lens where the lens becomes blurred due to hydration of the
lens fluid or the denaturation of the lens protein so that the view is distorted. Preoperative
management of untreated hypertensive patients or in patients with poorly controlled hypertension
tends to have an increased risk of intraoperative myocardial ischemia, arrhythmias, or even
hemodynamic instability and eye blood vessel rupture in preoperative cataract patients. Current
research was done to determine the effectiveness of foot soaking on the blood pressure of preoperative
cataract patients with hypertension at William Booth General Hospital Semarang. This study used a
Quasi-Experimental research with a two-group pretest-posttest design with a sample size of 32
preoperative cataract patients with hypertension taken purposively. Foot soak therapy was given in the
morning for 2 hours preoperatively. Based on the Mann U-Whitney Test, the results obtained P-value
at systolic 0.035 and 0.042 diastolic (> 0.05). The decision was that Ha was accepted and Ho was
rejected, which means that there was a difference in the effectiveness of giving foot soaks to blood
pressure in patients with preoperative cataracts with hypertension at William Booth Hospital
Semarang. Therefore, it can be summed up that there was a difference in the effectiveness of a warm
foot bath and a warm foot bath with a salt mixture on blood pressure.

Keywords: blood pressure; preoperative cataract with hypertension; soak feet in warm salt water

INTRODUCTION
Cataract comes from the Latin cataract which means waterfall because cataract sufferers will
see something as if there is a waterfall in front of their eyes so they are closed (invisible). A
cataract is a vision disorder because the eye lens is cloudy so that the light entering the eye
cannot be received by the retina completely. This causes a person's vision to become blurry
and results in blindness. (Nugroho 2018). Preoperative management of untreated hypertensive
patients or in patients with poorly controlled hypertension tends to have an increased risk of
intraoperative myocardial ischemia, arrhythmias, or even hemodynamic instability and eye
blood vessel rupture in preoperative cataract patients. In patients with hypertension, systolic
pressure <180 mmHg or diastolic <110 mmHg, there is no benefit of surgery so that patients
who want to undergo an operation program if high blood pressure is postponed surgery to
stabilize blood pressure (Nugroho 2018).

The World Health Organization (WHO), systematized cataract prevalence in 2018 currently
affects 20 million people. The main contributors to the increase in cataracts are unhealthy
diet, inadequate physical activity, alcohol consumption, smoking and to achieve the global
target in reducing cataract prevalence, WHO is responsible for 51% of blindness in the world
by performing surgery and is very successful in restoring vision, blurred lenses removed and
replaced with an artificial intraocular lens(WHO 2007). Based on the Ministry of Health of
the Republic of Indonesia in 2018 the prevalence of the population suffering from cataracts in
Indonesia was 1.8% (Kemenkes RI 2019). There are still many patients who do not know if
they suffer from cataracts, this can be seen from the three most reasons that cataract sufferers

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have not been operated on from Riskesdas 2018. namely 51.9% do not know that they suffer
from cataracts, 11.9% because they cannot afford to pay for it and 4.5% are afraid of surgery
(Ministry of Health RI 2018). Giving hydrotherapy feet or soaking feet using warm water to
lower blood pressure because hydrotherapy has a hydrodynamic effect, which is the
movement of water that is useful for emphasizing muscles and ligaments and accelerating
blood circulation and breathing systems while the hydrothermal effect is the warm effect of
water used to prevent muscle spasms, relieves pain and improves blood circulation so that the
oxygenation process to the tissues is smoother and makes the body relax as a whole (Dinas
Kesehatan Provinsi Jawa Tengah 2019).

The work of warm water is to increase cell activity by the method of flowing energy through
convection (flowing through a liquid medium), besides that, with warm water foot soaking
therapy, a conduction mechanism can occur where the transfer of warm water from warm
water into the body can also function as acupuncture technique. Warm water can also promote
vasodilation of blood vessels and increase heart rate. After further research, it was stated that
there was a therapeutic benefit of warm water soaking in reducing blood pressure, especially
diastolic pressure. This can be explained through the conduction theory, namely the transfer
of heat or warm water from warm water into the body causing the widening of blood vessels
and a decrease in muscle tension to improve blood circulation. Then, in turn, this will affect
the baroreceptors in the arteries and arch of the aorta and will then be conveyed through nerve
fibers to the brain so that it will stimulate systolic pressure (Nur Aini and Santik 2018).

Nursing actions are given at William Booth Semarang General Hospital which is still visible
only provides deep breath relaxation for preoperative patients to stay calm and blood pressure
remains stable, in addition to deep breathing relaxation measures, nurses also take
collaborative actions that are currently appearing at the General Hospital. William Booth
Semarang. Researchers have conducted a preliminary study at the William Booth General
Hospital Semarang for the incidence of cataracts from January to December 2019 totaling 580
people. Meanwhile, 240 patients who wanted to perform cataract surgery had a history of
hypertension. William Booth Semarang General Hospital in controlling blood pressure in
preoperative cataract patients by relaxing deep breaths and administering anti-hypertensive
drugs. Based on the above background, the researchers are interested in researching the
effectiveness of foot soak therapy on the blood pressure of preoperative cataract patients with
hypertension at William Booth General Hospital Semarang.

METHOD
This type of research uses a Quasi-quantitative experiment is scientific research that is
coherent and that is related to phenomena. This study used a two-group pretest-posttest design
approach which then compared the blood pressure of preoperative cataract patients in the two
groups. The sampling technique used in this study was purposive. Inclusion criteria were
preoperative ECCE cataract patients with hypertension, hypertension drugs regularly taken,
hypertension including the classification of mild and moderate hypertension, age 40-60 years,
male, cooperative patients, and willingness to become respondents, the results of Covid-19
screening show that it is not suspected cases, close contact, asymptomatic confirmatory cases
and there is a new term probable cases. The exclusion criteria were injuries to the legs, severe
anxiety. Taking samples of this researcher first observed blood pressure using a
Sifgmomanometer before being given a foot soak in warm water and a foot soak in warm
water mixed with salt, then after being given the sample therapy, blood pressure was observed
again. Giving a warm foot soak and a warm foot soak mixed with salt was done 2 times in the
morning and 2 hours preoperatively. The sample size in this study was 32 patients with

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preoperative cataracts with hypertension at RS William Booth Semarang. The research was
carried out from July to Agustus 2020.

The instruments in this study were SOP for foot soak in warm water, SOP for foot soak in
warm water mixed with salt, blood pressure observation sheets to record the results before and
after blood pressure for preoperative cataract patients, sphygmomanometer to measure BP for
preoperative cataract patients before and after administration. Warm water foot bath therapy
and warm salt water foot soak. The hypothesis test used is the Wilcoxon test. If the data is not
found to have a normal distribution, the Mann-Whitney test is then performed to determine
the comparison of the difference in blood pressure between the two groups.

RESULTS
Blood Pressure Before and after Warm Water Foot Soak in Preoperative Cataract
Patients with Hypertension
Table 1 shows that the blood pressure in preoperative cataract patients before being given
warm water foot bath obtained median cytosolic data of 145, a standard deviation of 5,543, a
minimum value of 135, a maximum value of 155, a mean of 144.06 and a median diastolic
data obtained of 92.5, the standard deviation is 5,390, the minimum value is 85, the maximum
value is 100, the mean is 93.43. Meanwhile, after being given warm water foot soak therapy,
the median systolic data is 130, the standard deviation is 4.031, the minimum value is 130, the
maximum value is 140, the mean is 133.12 and the median diastolic data is 85, the standard
deviation is 5.234, the minimum value is 75, the maximum value is 95, the mean is 84.06.

Table 1.
Blood Pressure before and after Soaking Feet in Warm Water in Preoperative Cataract
Patients with Hypertension (n = 16)
Blood Pressure Median ±SD Min- Mean
Max
Before soaking feet in systolic 145 ± 5.543 135 -155 144.06
warm water diastolic 92.5 ± 5.390 85 - 100 93.43
After soaking feet in systolic 130 ± 4.031 130 - 140 133.12
warm water diastolic 85 ± 5.234 75 - 95 84.06

Blood pressure before and after soaking feet with warm water + salt in preoperative
cataract patients with hypertension
Table 2.
Blood pressure before and after Soaking Feet in Warm Salt Water in Preoperative Cataract
Patients with Hypertension (n = 16)
Blood pressure Median Min- Mean
±SD Max
Systolic before soaking the
145 ± 5.543 135-155 144.06
feet in warm salt water
Diastoly before soaking the
92.5 ± 5.000 85-100 93.75
feet in warm salt water
Systolic after soaking the
130 ± 4.031 130-140 133.12
feet in warm salt water
Diastolic after soaking the
85 ± 5.737 75-95 83.12
feet in warm salt water

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The Effect of Warm Water Foot Soak on Blood Pressure in Preoperative Cataract
Patients with Hypertension
The blood pressure in preoperative cataract patients before being given a foot soak in warm
water mixed with salt obtained median cytosolic data of 145, a standard deviation of 5,543, a
minimum value of 135, a maximum value of 155, mean of 144.06 and obtained the median
diastolic data is 92.5, the standard deviation is 5,000, the minimum value is 85, the maximum
value is 100, the mean is 93.75. Whereas after being given foot soak therapy with warm water
mixed with salt, the median systolic data was 130, the standard deviation was 4.031, the
minimum value was 130, the maximum value was 140, the mean was 133.12 and the median
diastolic data was 85, the standard deviation was 5.737, the minimum value is 75, the
maximum value is 95, the mean is 83.12 (Table 2).

Table 3.
Effect of Warm Water Foot Soaking on Blood Pressure in Preoperative Cataract Patients with
Hypertension (n = 16)
Blood pressure Mean Rank P value
Systolic 8.50 0.000
Diastolic 8.00 0.001
Table 3, the results showed that the value with the Wilcoxon statistical test obtained the mean
rank of systolic blood pressure of 8.50 and diastolic of 8.00. Wilcoxon test results obtained a
systolic P-value of 0.000 and a diastolic P-value of 0.001 <0.05, so it can be concluded that
there is a significant effect of warm water foot soaking on blood pressure in preoperative
cataract patients with hypertension.

Effect of Warm Salt Water Foot Soaking on Blood Pressure in Preoperative Cataract
Patients with Hypertension
Table 4.
Effect of soaking feet with warm salt water on blood pressure in preoperative cataract patients
with hypertension at William Booth Hospital Semarang (n = 16)
Soak your feet in warm water
Blood pressure
Mean Rank P value
Sytolic 8.50 0.000
Diastolic 8.50 0.000
Table 4, the results showed that the value with the Wilcoxon statistical test obtained the mean
rank value of systolic and diastolic blood pressure of 8.50. Wilcoxon test results obtained a P-
value of 0.000 <0.05, so it can be concluded that there is a significant effect of foot soaking in
warm water with a mixture of salt on blood pressure in preoperative cataract patients with
hypertension.

Differences in the Effectiveness of Warm Water Foot Soak and Warm Salt Water Foot
Soak for Blood Pressure in Patients with Preoperative Cataracts with Hypertension
Table 5.
Differences in the Effectiveness of Foot Soaking in Warm Water and Warm Salt Water on
Blood Pressure In Preoperative Cataract Patients with Hypertension (n = 32)
Variabel Blood pressure Mean Rank P value
Soaking feet in warm water, 13.38
Systolic .035
soaking feet in warm salt water 19.63
Soaking feet in warm water, 13.31
Diastolic .042
soaking feet in warm salt water 19.69

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Table 5, the results of the bivariate statistical test using the Mann U-Whitney Test showed the
results in the group treated with a warm water foot soak and warm water foot soak mixed with
salt for systolic blood pressure, the mean rank values were 13.38 and 19.63, while for blood
pressure diastole mean rank 13.31 and 19.69. Based on the results of the bivariate statistical
test, the P-value results were 0.035 and 0.042 (<0.05). So Ha accepted Ho rejected, which
means that there is a difference in the effectiveness of giving foot soaks to blood pressure in
patients with preoperative cataracts with hypertension at William Booth Hospital Semarang.

DISCUSSION
Blood pressure before and after warm water foot soak in preoperative cataract patients
with hypertension at William Booth Hospital Semarang
Based on the results of research conducted on 16 respondents preoperative cataract with
hypertension before warm water foot bath therapy at William Booth Hospital Semarang, the
average systolic blood pressure was 144.06 mmHg and a diastolic pressure of 93.43 mmHg
was included in the moderate hypertension category. Factors that influence the occurrence of
an increase in blood pressure are age, gender, and anxiety. At the age of the respondents who
carried out the study of soaking feet in warm water, including the age of 47-59 years, this is
one of the factors that affect blood pressure because the age of 55-59 years with the age of 60-
64 years there is an increase in the risk of hypertension by 2.18 times, whereas in age 65-69
years 2.45 times and age> 70 years 2.97 times. This occurs because at that age the large
arteries lose their flexibility and become stiff because the blood at each heartbeat is forced to
pass through the blood vessels that are narrower than usual, causing a rise in blood pressure
(Purqoti 2021).

Gender is also one of the factors that influence the increase in blood pressure, the respondents
who are made into the study are male. In men, hypertension is more closely related to work,
such as feeling less comfortable about work and unemployment. If women and men have
entered their 40s there is no difference in blood pressure (Di Giosia et al. 2018). Women who
are not yet menopause are protected by the hormone estrogen which plays a role in increasing
the levels of High-Density Lipoprotein (HDL). Low HDL cholesterol levels and high LDL
cholesterol (Low-Density Lipoprotein) affect the atherosclerosis process and result in high
blood pressure (El Khoudary et al. 2018; Purqoti 2021).

The anxiety score experienced by respondents was a mild anxiety score of 8 respondents and
a moderate anxiety score of 8 respondents. Anxiety is considered pathological when it
interferes with daily functions, goal achievement, and normal satisfaction or pleasure.
Although it is a normal thing to experience, anxiety should not be allowed because over time
it can become anxious neurosis through a mechanism represented by acute anxiety, which
develops into chronic anxiety due to unconscious repression and conflict, the trigger stress
can cause decreased endurance and mechanisms for overcoming it, resulting in anxious neuro
saw. Cataracts can only be treated with surgical procedures or surgery, surgery often creates
anxiety because unfamiliar surgery and surgery rooms have the potential to make individuals
uncomfortable (Ramirez et al. 2017). The effects of the discomfort stimulate the sympathetic
nerves, one of which is to increase blood pressure or hypertension (Guerrier et al. 2020;
Pristiyani and Mujahid 2020).

Based on the study, the results obtained from the results of blood pressure values after being
given a warm foot soak for 2x treatment, namely morning and 2 hours preoperatively, the
average systolic blood pressure was 133.12 mmHg and diastolic pressure was 84.06 mmHg
including normal blood pressure. Giving hydrotherapy feet or soaking feet using warm water

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to lower blood pressure because hydrotherapy has a hydrodynamic effect, which is the
movement of water which is useful for strengthening muscles and ligaments and improving
blood circulation and respiratory system while the hydrothermal effect is the warm effect of
water used to prevent muscle spasms, relieving pain and improving blood circulation so that
the oxygenation process to the tissues is smoother and makes the body relax as a whole
(Pristiyani and Mujahid 2020).

Blood pressure before and after foot soaking in warm water mixed with salt in
preoperative cataract patients with hypertension at William Booth Hospital Semarang
Based on the results of research conducted on 16 respondents preoperative cataract with
hypertension before the foot soak therapy with warm water mixed with salt at William Booth
Hospital Semarang, the average systolic blood pressure was 144.06 mmHg and a diastolic
pressure of 93.75 mmHg was included in the moderate hypertension category. Factors that
influence the occurrence of an increase in blood pressure are age, gender, genetics and
anxiety. At the age of the respondents who carried out the research, soaking feet with warm
water mixed with salt, including the ages of 45-60 years, this is one of the factors that affect
blood pressure because at that age there is a loss of tissue elasticity and arterisclerosis and
dilation of blood vessels which causes an increase in blood pressure (Fhayli et al. 2019).

Gender is also one of the factors that influence the increase in blood pressure, the respondents
who are made into the study are male. Hypertension is easier to attack men than women, this
is that men have the driving factors for hypertension such as stress, smoking, fatigue, and
uncontrolled eating, while hypertension in women increases the risk of occurring after
menopause, which is around 50 years and over. As for genetic factors, individuals who have a
family history of hypertension are at a higher risk because of an increase in intracellular
sodium levels and a low ratio of potassium to sodium. Parents with hypertension have twice
the risk of suffering from hypertension (Di Giosia et al. 2018; Kritz-Silverstein et al. 2017).

The anxiety score experienced by respondents was a mild anxiety score of 5 respondents and
a moderate anxiety score of 11 respondents. Mild anxiety is anxiety related to stress in
everyday life. This anxiety causes the individual to be alert and increases the field of
perception. This anxiety can motivate learning and generate growth and creativity. The
feeling that something is different and needs special attention. Sensory stimulation enhances
and helps individuals focus their attention on learning, solving problems, thinking, acting,
feeling, and protecting themselves. Meanwhile, moderate anxiety is anxiety that allows
individuals to focus on important things and ignore others. This anxiety narrows the field of
individual perception so that the individual experiences, not selective attention but can focus
on more areas if directed to do so. It is a disturbing feeling that something is completely
different and the individual is nervous or agitated (Ramirez et al. 2017). Cataracts can only be
treated with surgical procedures or surgery, surgery often creates anxiety because unfamiliar
surgery and surgery rooms have the potential to make individuals uncomfortable. The effects
of the discomfort stimulate the sympathetic nerves, one of which is to increase blood pressure
or hypertension (Ramirez et al. 2017).

Based on the results of the research that has been carried out, the results of the blood pressure
values after being given a foot soak in warm water mixed with salt as much as 2x treatment,
namely in the morning and 2 hours preoperatively the average systolic blood pressure is 133
mmHg and diastolic pressure is 83.12 mmHg including normal blood pressure. . Soaking in
warm water mixed with salt is also no less effective because salt contains sodium and sodium,
which are important elements for regulating fluid balance in the body, besides serving in

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nerve transmission and muscle work. Soaking your feet in warm water needs to be done so
that the feet that function as the second heart become warm and the blood flow throughout the
body also becomes smooth (Pristiyani and Mujahid 2020).

The Effect of Warm Water Foot Soak on Blood Pressure in Preoperative Cataract
Patients with Hypertension
Based on the results of research from 16 respondents who were given warm water foot
soaking treatment for 10-15 minutes carried out for 2 treatments, namely in the morning and 2
hours preoperatively. The results showed that the mean rank systolic blood pressure was 8.50
and the mean rank diastolic blood pressure was 8.00 with the Wilcoxon statistical test, the
systolic P-value was 0.000 and the diastolic P-value was 0.001 <0.05, so it could be
concluded that there was an effect. significant warm water foot soak against blood pressure in
preoperative cataract patients with hypertension.

The procedure is done by soaking the feet in a basin containing 2 liters of warm water with a
temperature of 37-400C for 10-15 minutes. The work of a warm water foot soak will
stimulate the nerves in the soles of the feet to stimulate the baroreceptors which are the main
reflex in determining regulatory control on heart rate and blood pressure. As arterial blood
pressure increases and arteries stretch, these receptors rapidly send their implants to the
vasomotor center resulting in vasodilation, venous, and pressure changes (Priyanto,
Mayangsari, and Nurhayati 2020).

Arteriolar dilation decreases peripheral resistance and venous dilation causes blood to
accumulate in the veins thereby reducing venous return and thereby decreasing cardiac output.
The afferent surplus of a baroreceptor that reaches the heart stimulates the activity of the
parasympathetic nerves and blocks the sympathetic center, causing a decrease in heart rate
and cardiac contractility. Changes in blood pressure after a warm foot soak are due to the
benefits of a warm foot soak, which is to dilate blood vessels and improve blood circulation
(Hardianti, Nisa, and Wahyudo 2018).

Warm water has a physiological impact on the body, first, it affects the blood vessels where
the warmth of the water makes blood circulation smooth, the second is the loading factor in
the water which will strengthen the muscles and ligaments that affect the joints of the body.
Warm foot soak is useful for vasodilation of blood flow so that it is expected to reduce blood
pressure. The hydrostatic pressure of water against the body pushes blood flow from the legs
to the chest cavity and the blood will collect in the large blood vessels in the heart, after
further research has shown that there is a therapeutic benefit of warm water soaking in
reducing blood pressure, especially in diastolic pressure. This can be explained through the
conduction theory, namely the transfer of heat or warm water from warm water into the body
causing the widening of blood vessels and a decrease in muscle tension so that it can improve
blood circulation, then this will affect the baroreceptors in the arteries and aortic arch and will
then be conveyed through nerve fibers to the brain so that it will stimulate systolic pressure
(Hardianti et al. 2018).

Warm water foot soak therapy has many benefits including dilates blood vessels, improves
blood circulation, and triggers the nerves in the soles of the feet to work. The nerves in the
soles of the feet go to the vital organs of the body such as the heart, lungs, stomach, and
pancreas. Has a good impact on blood vessels because the sensation of warm water makes
blood circulation smooth, the loading factor in the water will strengthen the muscles and
ligaments that affect the joints of the body and the last benefit is that soaking the feet in warm

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water has a positive impact on the heart and lung muscles -Lungs because it makes respiratory
circulation better and provides a hydrostatic and hydrodynamic effect on this therapy also
helps support body weight during walking exercises . (17)

Effect of Soaking Foot Warm Water with a mixture of salt on Blood Pressure in
Preoperative Cataract Patients with Hypertension at William Booth Hospital Semarang
Based on the results of research from 16 respondents who were given warm water foot
soaking treatment for 10-15 minutes carried out for 2 treatments, namely in the morning and 2
hours preoperatively. The results showed that the mean rank of systolic and diastolic blood
pressure was 8.50 with the Wilcoxon statistical test, the P-value was 0.000 <0.05, so it could
be concluded that there was a significant effect of soaking feet in warm water with a mixture
of salt on blood pressure in patients. preoperative cataract with hypertension.

Salt is a white solid in the form of crystals, with a salty taste, which is the compound with the
largest amount of sodium chloride (> 80%) and other compounds such as magnesium
chloride, magnesium sulfate, calcium chloride, and sodium. Salt has hygroscopic
characteristics, which means it easily absorbs water. The procedure is done by soaking the
feet in a basin containing 2 liters of warm water at 37-400C mixed with 3 tablespoons of table
salt for 10-15 minutes. 15,17,23) According to the Indonesian nutrition journal, 1 tablespoon
is equivalent to 10 grams of salt-containing 4 grams of NaCl, if you use 3 tablespoons, the
NaCl content in warm water is 12 grams of NaCl (Priyanto et al. 2020).

Based on SNI 01-3556-2000, the minimum content of NaCl for consumption salt is 94.7%, so
the salt used to soak feet can be an active ingredient (addition) consisting of a mixture of
NaCl salts with other inorganic chemicals that are easily dissolved. Saltwater contains more
electricity than fresh water and reduces the elemental water and salt to negative ions. These
compounds will enter the body from the feet through the meridian network that crosses the
skin of the feet, while positive ions are in the form of toxins and free radicals. These negative
ions also permeate and cause the body's cells to recover, when the cells reach their balance
they will get rid of toxins and release them through the pores. This can help someone who is
experiencing an increase in blood pressure will decrease and besides helping to lower blood
pressure values it can also be for someone who is experiencing insomnia (Andri Setyorini and
Asmaul Husna 2019; Andri Styorini, Adelia Riza Ihfi Fauzia 2019; Wungouw et al. 2018).

Soaking in warm water mixed with salt is also no less effective because salt contains sodium
and sodium, which are important elements for regulating fluid balance in the body, besides
serving in nerve transmission and muscle work. Soaking your feet in warm water is necessary
so that your feet, which function as the second heart, warm your feet and smooth blood flow
throughout the body. This occurs when the diastolic pressure is in isovolumic ventricular
relaxation, when the ventricles relax, the pressure in the ventricles drops dramatically, the
blood flow is smooth with the dilation of blood vessels so that it will lower the diastolic blood
pressure. All information is processed in the brain, the signal is marked by the expansion of
blood vessels to ensure that blood flows in the circulation smoothly and allows the tissue to
get nutrients to function properly and reduce muscle tension, increase capillary permeability
so that it will lower blood pressure. Hydrotherapy soaking feet in warm water mixed with salt
here will affect the small arteries in the skin to dilate so that the systolic and diastolic blood
pressure will decrease (Pratiwi 2018).

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The Effectiveness of Warm Water Foot Soak and Warm Water Foot Soak with Salt
Mixture Against Blood Pressure in Preoperative Cataract Patients with Hypertension at
William Booth Hospital Semarang.
Based on the Mann U-Whitney Test, the results in the group treated with foot soaking in
warm water had a mean systolic rank of 13.38 and a mean diastolic rank of 13.31, while in the
group of foot soaking in warm water mixed with salt the mean value of systolic rank was
19.63 and mean diastolic rank of 19.69. The results obtained P-value at systolic 0.035 and
diastolic 0.042 (> 0.05). So Ha accepted Ho rejected, which means that there is a difference in
the effectiveness of giving foot soaks to blood pressure in patients with preoperative cataracts
with hypertension at William Booth Hospital Semarang.

The results of this study can be seen from the mean rank of foot soak in warm water mixed
with salt, namely 19.63 systolic and 19.69 diastolic compared to 13.38 systolic and 13.31
diastolic warm water foot soaks in this explanation it can be concluded that a warm foot bath
mixed with salt is more effective for lowering blood pressure in preoperative cataract patients.
This is because the work of warm water is giving a biological effect. Heat or warm can cause
dilation of blood vessels which results in increased blood circulation. Physiologically, the
body's response to heat is to cause blood vessel dilation, reduce blood clotting, reduce muscle
tension, increase tissue metabolism and increase capillary permeability, this response from
warmth is used for therapeutic purposes in various conditions and conditions in the body
(Pratiwi 2018).

Salt contains sodium and chloride which play an important role in the extracellular space as a
regulator of osmotic pressure and normal blood pressure. Sodium is the main cation in
extracellular fluid and 35-40% of sodium is present in the body's skeleton. Digestive tract
fluids such as bile and pancreas contain a lot of sodium, while another function of sodium
itself is as the main cation in extracellular fluids because sodium maintains fluid balance in
the compartments. Natrium largely regulates the osmotic pressure, which keeps fluids from
leaving the blood and entering the cells. Normally the body can maintain a balance between
sodium outside the cells and potassium in the cells, if the blood sodium level will increases,
the kidneys will excrete the excess fluid and sodium in the body. The aldosterone hormone
keeps the sodium concentration in the blood at a normal value. The fluid balance will also be
disturbed if a person loses sodium and water will enter the cells to dilute the sodium in the
cells so that the extracellular fluid will decrease, this change can lower blood pressure
(Fildayanti, Tuti Dharmawati 2020; Pristiyani and Mujahid 2020).

Soaking in warm water mixed with salt is also no less effective because salt contains sodium
and sodium, which are important elements for regulating fluid balance in the body, besides
serving in nerve transmission and muscle work. This occurs when the diastolic pressure is in
isovolumic ventricular relaxation, when the ventricles relax, the pressure in the ventricles
drops dramatically, the blood flow is smooth with the dilation of blood vessels so that it will
lower the diastolic blood pressure. All information is processed in the brain, the signal is
marked by the expansion of blood vessels to ensure that blood flows in the circulation
smoothly and allows the tissue to get nutrients to function properly and reduce muscle
tension, increase capillary permeability so that it will lower blood pressure. Warm water foot
soak therapy with a salt mixture which is carried out for 10-15 minutes, sodium chloride can
be absorbed by the body between 2-2.5 hours and is supported by previous research from
Fidayanti and Dharmayati in 2020 explained that the therapy of soaking feet with warm water
with a mixture of salt for 10 -15 minutes sodium chloride content can be absorbed by the
body between 2-2.5 hours, this response is used for therapeutic purposes in various conditions

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and conditions in the body. Hydrotherapy soaks feet with warm water mixed with salt here
will affect the small arteries in the skin will dilate so that the systolic and diastolic blood
pressure will decrease (Fildayanti, Tuti Dharmawati 2020; Pratiwi 2018).

The method of soaking the feet with warm water mixed with salt has a physiological effect on
several parts of the body, including the heart will provide hydrostatic pressure to the body,
pushing blood flow from the legs to the chest cavity and blood will accumulate in the large
blood vessels of the heart. The warm water will encourage the enlargement of the skin's blood
vessels and increase the heart rate. In the respiratory organs, a smooth flow of blood will carry
enough nutrients and oxygen to carry the chest cavity and lungs. An increase in lung capacity
can also occur, this can reduce the symptoms of Sleep Disordered Breathing (SDB) (Andri
Setyorini and Asmaul Husna 2019; Wungouw et al. 2018).

In the endocrine system, soaking your feet in warm water mixed with salt can release and
increase the secretion of the body's growth hormone. The circulation of the hormone cortisol
in warm water mixed with salt can increase the secretion of these hormones and cause a
feeling of "joy" for a person (Andri Setyorini and Asmaul Husna 2019; Andri Styorini, Adelia
Riza Ihfi Fauzia 2019). In this foot soaking therapy, it can cause a soporific effect (the effect
of wanting to sleep), this may be caused by an increase in the secretion of the hormone
melatonin as a result of soaking warm water with a salt mixture on the feet so that someone
who soaks their feet can improve their sleep quality and can relax the muscles at once has an
analgesic effect because the tired body will be refreshed and reduce excessive fatigue. This
can reduce the symptoms of tingling or Restless Legs Syndrome (RLS) in the elderly (Andri
Styorini, Adelia Riza Ihfi Fauzia 2019; Didato et al. 2020). Soaking feet in warm water mixed
with salt can also help improve the risk of anxiety, insomnia, sore shoulders, hypertension,
and stroke, so the flow in the heart will improve, urination becomes smooth and swelling is
gone. Also, soaking feet mixed with salt is good for smoothing the skin, improving blood
circulation, overcoming arthritis, muscle pain, increasing concentration, and eliminating foot
odor (Andri Styorini, Adelia Riza Ihfi Fauzia 2019; Pratiwi 2018; Priyanto et al. 2020).

CONCLUSION
There is a difference in the effectiveness of giving foot soaking to blood pressure in patients
with preoperative cataract with hypertension at the William Booth Hospital Semarang where
the results of the Mann U-Whitney Test showed that the results in the group treated with
warm water foot soak had the mean systolic rank 13.38 and the mean diastolic rank 13.31.
whereas in the foot soak group with warm water mixed with salt, the mean cystolic rank was
19.63 and the mean diastolic rank was 19.69, the P-value was 0.035 systolic and 0.042
diastolic (> 0.05).

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