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Xavier University-Ateneo de CagayanCollege of nursing
In Partial Fulfillment for the Requirementsof the Subject Gerontology
Submitted to:
Ma’am Jesseca P. Monsanto, RN, MAN
Submitted by:
Legaspi, Rosenblum Louise D.
Rajal, Alnie Fay Camille J.
BSN-4 NCSeptember 16, 2014
I. Introduction
This case study is about Patient SJ, a 90 year old woman, who
was referred at St. Joseph’s Golden Home Foundation because no one
will take good care of her. She had a diagnosis of Coronary Artery disease
moderate; old Myocardial Infarction, arrhythmia-AF (Atrial Fibrillation),
Hypertensive Cardiovascular disease. Patient SJ, is a former nun. At the
age of 33 (1964) she joined Congregation of Daughter of St. Theresa in
Balingasag Mis. Or. At the year 1972 she suffered a heart attack, and was
brought to Lourdes Hospital in Quezon City. She was admitted for 2
months and was advised by the priest to leave the convent due to medical
condition. For 8 years she stayed in Caloocan with sister for 8 years and
went back to Camiguin. She lived with her father and her sister; Asuncion
De la Rosa along with her husband and children. At the year 2010, her
sister died of leukemia, her family could no longer look after her needs.
Her niece, Erlinda took care of her till 2012. By the year 2012, Sr. Marian
L. Tagupa visited Nanay Sofia in her home and offered her to stay at St.
Joseph’s Golden home foundation.
According to WebMD (2014) the heart is mainly made of special
muscle (myocardium). The heart pumps blood into arteries (blood vessels)
which take the blood to every part of the body. Like any other muscle,
the heart muscle needs a good blood supply. The coronary arteries take
blood to the heart muscle. The main coronary arteries branch off from the
aorta (the large artery which takes oxygen-rich blood from the heart
chambers to the body.) The main coronary arteries divide into smaller
branches which take blood to all parts of the heart muscle.
Coronary artery disease, also called coronary heart disease, or
simply, heart disease, is the No. 1 killer in America, affecting more than 13
million Americans. Heart disease is a result of plaque buildup in the
arteries, which blocks blood flow and heightens the risk for heart attack
and stroke. From a young age, cholesterol-laden plaque can start to
deposit in the blood vessel walls. As a person gets older, the plaque
burden builds up, inflaming the blood vessel walls and raising the risk of
blood clots and heart attack. The plaques release chemicals that promote
the process of healing but make the inner walls of the blood vessel sticky.
Then, other substances, such as inflammatory cells, lipoproteins, and
calcium that travel in your bloodstream start sticking to the inside of
the vessel walls. Eventually, a narrowed coronary artery may develop new
blood vessels that go around the blockage to get blood to the heart.
However, during times of increased exertion or stress, the new arteries
may not be able to supply enough oxygen-rich blood to the heart muscle.
In some cases, a blood clot may totally block the blood supply to the heart
muscle, causing heart attack. If a blood vessel to the brain is blocked,
usually from a blood clot, an ischemic stroke can result. If a blood vessel
within the brain bursts, most likely as a result of uncontrolled hypertension
(high blood pressure), a hemorrhagic stroke can result.
In myocardial infarction (heart attack), a coronary artery or one
of its smaller branches is suddenly blocked. The part of the heart muscle
supplied by this artery loses its blood (and oxygen) supply if the vessel is
blocked. This part of the heart muscle is at risk of dying unless the
blockage is quickly removed. When a part of the heart muscle is damaged
it is said to be infarcted. The term myocardial infarction (MI) means
damaged heart muscle. If main coronary arteries are blocked, a large part
of the heart muscle is affected. If a smaller branch artery is blocked, a
smaller amount of heart muscle is affected. After an MI, if part of the heart
muscle has died, it is replaced by scar tissue over the next few weeks.
Normally you will be advised to take regular medication for the rest of your
life. Normally, normally be advised to take the antiplatelet medicine
clopidogrel or ticagrelor in addition to aspirin. However, this is usually only
advised for a number of weeks or months, depending on the type and
severity of your MI.
II. Objectives
General objectives:
At the end of 4 hours of exposure at St. Joseph’s Home for the Aged, the
student nurses will:
Apply the concepts, terms and theories regarding elderly care to
the assigned patient. Utilize the knowledge acquired from the 4 walls of
the classroom to distinguish the appropriate nursing interventions.
Conduct a comprehensive interview to the assigned patient in a proper
environmental setting. Apply the skills from previous clinical experiences to
provide the patient with holistic nursing care. Identify 3 major problems at
St. Joseph’s Home for the Aged that need correction and intervention.
Work alongside the staff of St. Joseph’s Home for the Aged and Block NC
to promote the elderly patients health and well-being. Maintain the proper
student nurse attitude all throughout the exposure.
Specific objectives:
At the end of 2 hours of exposure at St. Josephs Home for the aged, the
student nurses will:
A. Orient themselves to the protocols, rules and practices at St. Josephs
B. Familiarize themselves with the elderly patients
C. Conduct an interview and assessment with their assigned elderly
patient
D. Promote wholeness and well-being including safety and comfort of
patient
E. Set priorities in nursing care based on patients' need
F. Utilize the nursing process as framework for nursing
G. Formulate a plan of care in collaboration with patients and other
members of the health team
H. Implement planned nursing care to achieve identified outcomes
I. Develop health education plan based on assessed and anticipated
needs
J. Project a professional image of the nurse and maintain the appropriate
attitude
K. Establish collaborative relationship with colleagues and other
members of the health team for the health plan
III. CLIENT PROFILE
Name: Jagape, Sofia C. Nickname: Sofia
Age: 90 y.o Gender: Female
Civil Status: Single Date of Birth: July 8,
1924
Address: Mainit, Catarman Camiguin
Birthplace: Mainit, Catarman Camiguin Religion: Roman
Catholic
Date of Admission: Ocyober 8, 2012
Reasons for Referral: No one will take good care of her.
History of the situation:
Nanay Sofia is a former nun. At the age of 33 (1964) she joined
Congregation of Daughter of St. Theresa in Balingasag Mis. Or. At the
year 1972 she suffered a heart attack, brought to Lourdes Hospital in
Quezon City. She was admitted for 2 months and was advised by the
priest to leave the convent due to medical condition. For 8 years she
stayed in Caloocan with sister for 8 years and went back to Camiguin. She
lived with her father and her sister; Asuncion De la Rosa along with her
husband and children. At the year 2010, her sister died of leukemia, her
family could no longer look after her needs. Her niece, Erlinda took care of
her till 2012. By the year 2012, Sr. Marian L. Tagupa visited Nanay Sofia
in her home and offered her to stay at St. Joseph’s Golden home
foundation. Hence, her admission.
Source of Information:
Sr. Marian L. Tagupa
Sr. Sofia Jagape (the patient herself)
IV. ASSESSMENT PARAMETERS
I. Demographics
Name: Jagape, Sofia C. Date of Birth: July 8,
194
Age: 90 y.o Gender: Female
Diagnosis: Coronary Artery disease moderate; old Myocardial Infarction,
arrhythmia-AF (Atrial Fibrillation), Hypertensive Cardiovascular disease
Attending Physician: Dr. Hedy L. Coruna Language spoken: Cebuano
Informant: Jagape, Sofia Date of Admission: October
8, 2012
History of Present Illness:
At the age of 41, she suffered a heart attack, brought to Lourdes
Hospital. Admitted for 2 months, and was advised to leave the convent
due to medical condition.
Had heart attack 3x on her stay at St. Joseph’s Goplden Home
foundation. The last heart attack she experienced was on May 2013.
Food and drug allergies: No known food and drug allergies
Family Medical History: (+) Cancer; Her sister died because of
Leukemia.
(+) Hypertension; Paternal
II. Functional Pattern
A. Nutritional/Metabolic Pattern
Meal Pattern: Appetite is fair and patient exhibits changes in the amount
of meal. The patient verbalized “Ginagmay ra akong kina-on ug dapat nay
sabaw kay tungod sa akong sakit sa heart”.
Weight Loss/Gain: There are no significant changes in weight.
Feeding: Per Orem and able to eat independently.
B. Elimination Pattern
Bladder: Patient doesn’t experience difficulty in urinating, thus voids
within her own pattern.
Bowel: Usually defecates once a day but it solely depends on the food
intake of the client. The patient verbalizes “Inig buntag, gakalibang jud ko”.
Character: Yellowish Frequency: Once a day
Amount: Moderate in amount. Usually 50-80 cc
C. Sleep/Rest Pattern
Sleep Difficulty: Patient verbalized sleeping difficulty such as always
awakening in the middle of the night. Presence of eyebags and weakness
noted.
Use of Sleeping Aids: The patient verbalized “Sayo man mi matulog pero
dili straight akong tulog, ga mata-mata jud ko.”
D. Activity/Exercise (D= Dependent)
Activities of Daily Living:
(I) Eating (I) Bathing (I) Dressing
(I) Grooming (I) Toileting (D) Ambulation
Activity level: Sedentary lifestyle
E. Cognitive Perception Patterns
Patient verbalized “Ga lisod jud kog basa, kailangan najud kog antipara”,
the patient don’t use hearing aids and prosthesis. She ambulates with the
help of cane.
F. Behavior Pattern (Coping/Values)
Behavior: Patient is relaxed and responds to our question attentively.
Psychiatric History: None
Substance Abuse: The patient has no history of substance abuse.
G. Pain
The patient verbalized “ang akong tuhod kay gasakit ug ga- poy-poy sa
pamati. Usahay musakit akong tuhod kung mukaon ko ug monggos. Mag
sakit pud akong dughan usahay, pero dili pareha sauna na grabe ang
sakit.” Pain is noted on her chest and knees with a pain scale of 5/10.
H. Sexuality
Menopausal period/age: Can’t be determined.
Patient doesn’t perform self Breast examination and is already sexually
inactive.
I. Role Relationship Pattern
Occupation: Former Nun
With whom does the Patient Live: Lives under the care of St. Joseph’s
Golden Home Foundation, Inc. Home for the Elderly.
Anticipating to return home: No, because no one will be taking good
care of the patient. The patient verbalized “malipay nako sako friends diri, I
will be missing them”.
PHYSICAL ASSESSMENT
A. Neurological Assessment
Patient is oriented to self, place; person and time.
Weakness/paresthesia noted on her both knees. Has no difficulty in
speech or swallowing.
B. Respiratory Assessment
Respiratory rate (as of September 8, 2014) is 17cpm. Respirations are
quiet and regular. Slightly pale nail beds and lips noted. Breath sounds in
both lung fields are clear. No cough noted.
C. Cardiovascular Assessment
The patient verbalized “usahay naa koy mabatian na sakit sakong
dughan dapit pero mutumar rako sakong tambal”. “Haya ra pud
manghupong akong tiil ug magsakit ako dughan kung mukaon ko ug fatty
foods. Dali ra pud ko mahangos tungod sa akong sa sakit sa kasing-
kasing” the patient added. With regular apical pulse and BP of 110/60
mmhg by September 8, 2014 9AM. No edema noted.
D. Peripheral-Vascular Assessment
Both upper extremities are pink, warm and movable within the normal
range of motion. Peripheral pulses are palpable. There is weakness on the
lower extremities and that there are limited ROM. No peripheral edema
noted. No complaints of numbness or any calf tenderness.
E. Genitourinary Assessment
The patient voids without discomfort and voids within own pattern.
There are no usual vaginal irritation and discharge noted.
F. Musculoskeletal Assessment
The patient verbalized “makabati ko ug kasakit sakong likod usahay”.
Absence of joint swelling and tenderness, no evidence of inflammation,
weakness on both knees noted. The patient is able to flex all joints.
G. Integumentary Assessment
The patient verbalized “kaluoy sa diyos wala sad koy samad-samad
sakong lawas”. Patient’s skin is within her norm, it is warm, dry, and intact.
H. Psychological/Psychosocial
The patient verbalized that she is happy and satisfied with her life. She
always pray and have many friends.
Priority Nursing Problems Identified
1. Ineffective breathing pattern
2. Chronic pain
3. Disturbed sensory perception: Visual
4. Risk for injury/falls
5. Activity intolerance
6. Disturbed Sleeping Pattern
Medications:
Multivitamins + Iron 1 tab OD PO
Ventolin 2mg TID, via inhalation
Losartan 50mg 1 tab OD PO
Meloxicam (Mobic) 15mg 1tab OD PO
Trimetazidine 35mg 1tab OD PO
Salbutamol 2mg 1tab BID via inhalation
Procedures done
ECG
CBC
Urinalysis
Blood Chemistry
V. CERAE/REFLECTION PAPER
Rosenblum Louise D. Legasp
Context
For our Gerontology subject we had an exposure at St. Joseph’s Home
for the Aged. At St. Joseph’s we had an orientation to their facilities as to
how they ran the place, as well as the rules, protocols and guidelines of
the area. After that we then had a tour of their building. My assigned
patient’s name was Sofia. When I first met her I was amazed to know that
she was 90 years old. Me and my partner, Ms. Rajal took her outside to
conduct an interview and assessment with her. We asked her many
questions about her life, as to how she got to St. Josephs and how she
was feeling regarding her family. Eventually we came to know patient
Sofia more than a patient, but more like a Lola who needed our
companionship.
Experience
It was not my first time to go to St. Joseph’s, the last time I was there
was during high school wherein we threw a culminating activity with the
elderly patients. However it was my first time to actually meet and
interview an elderly patient. The experience taught me a lot of things. It
taught me that the elderly have so much wisdom and knowledge and it
taught me that when you get older you become content with life and the
materialistic things don’t matter anymore. I was finally able to learn how to
properly interview an elderly patient. My previous exposures with elderly
patients were not good, there were times when I really lost my patience.
However, with patient Sofia, I felt at ease with her, it felt so natural talking
to our patient. I found myself genuinely wanting to get to know her better
Reflection
Looking back, I felt sad for the elderly patients at St. Josephs ward. I
know that there were some patients who were abandoned or left behind by
their families because they couldn’t be supported anymore. I really can’t
imagine doing that to my own Lolo and Lola who I love so dearly. I feel
happy to have interview patient Sofia, not only was she very kind-hearted
and spoke to us gently, I learned many things from her. She would always
talk about God, and she welcomed her death calmly. She told me that she
was very satisfied with her current life of just being around with her friends
at St. Josephs. I really liked her way of thinking of just learning and
appreciating the simple things in life.
Action
As a student nurse, I need to identify and provide patient Sofia
appropriate nursing interventions. Because I may only have a few more
chances to see patient Sofia again, I will try to get to know her even more.
And as a class, we must be able to identify 3 major problems that need
corrections so that we could give the elderly patients at St. Josephs a
better life. The best thing I can do for our patient is to just talk to her and
become her friend so that she won’t become lonely.
Evaluation
I hope that I was able to make a diffirence in my patient’s life. Someday
when I become a registered nurse, I will remember patient Sofia when I
give care to the elderly patient. This exposure taught me a lot of things
about the elderly and hopefully I am able to apply these not only to my
patients to my lolo and lola as well when it becomes my turn to care for
them.
Alnie Fay Camille J. Rajal
Reflection Paper:
It was my first time to go to a nursing home, it made me feel
somehow excited. When we arrived at St. Joseph’s Golden
Foundation, there was an ongoing mass. The mass was headed by an
old priest. The mass went quite long, far different from the mass that I
used to attend to, because it took time for the priest to deliver the
words clearly, read the bible, and move from a place to another. The
priest’s actions somehow gave me an idea on how the patients from the
nursing home will be like. After the mass we were given the chance to meet
and greet the elderly patients from the nursing home, visit their rooms and
observe the setting of the nursing home. As I notice the nursing home was
just like an ordinary house the difference is just the kind of people who live on
it. I was imagining myself to be on the shoes of the patients, and I felt sad for
them because it might be sad for them to live in a house where you don’t
have your family taking care for you.
When the chart of the patient assigned to us was given, I got amazed
when I read that our patient is 90 years old. People rarely reach such age.
And I got more amazed when I personally meet our patient and converse with
her, because her memory is still intact that she can remember everything that
happened from the past events of her life. Upon assessment I didn’t just
gathered the relevant data’s needed for our care plan, but I also gain lessons
in life from her and especially in spiritual aspects of life. It just shows that she
still hasn’t forgotten her former duty which is a nun.
On the other hand, as what I have observed to nanay Sofia, she has
difficulty in hearing. She tends to let me repeat my questions and/or answer
differently. As a health care provider, what I did was I speak in a normal tone,
slowly and clearly.
I admire how optimistic and satisfied nanay Sofia is. When she was
asked about feeling as of the moment, she said she feels happy to where she
is right now. She feels like she found a new family in the nursing home.
I think what nanay Sofia need right now is a health care provider that
will assist her physically and emotionally; and most especially in reminder her
to take her medications for her medical condition. Aside from her health
codition, she reports no other concerns to her situation. She seem to be
happy and contented. Someday, when I grow old, I would want to be like her;
happy and contented like she lived her life without regret.
VI. Recommendation and Evaluation
Myocardial Infarction means damage on the heart muscle.
patients who are diagnosed with MI are given regular medications for life
to prevent recurrence and exacerbation of disease condition. Considering
the age of the patient, she needs a health care provider that would
constantly remind her to take her medications. Once diagnosed, the
patient should fully comply with the regimen given by the healthcare team.
They should follow the medications prescribed, diet, exercise and rest.
Diet of the patient with MI should consist of the following:
Protein, which plays an essential role in protecting the body, for it
produces antibodies to fight infection. Drinking enough fluids is essential to
keep the client hydrated. The recommended fluid intake for MI patients is 2
to 3 liters of caffeine-free liquids per day. Water is essential to the body. It
helps prevent constipation. Drinking plain water may be your best source
of fluid. are also good sources. Milk is a good source of fluid. It has the
added benefit of providing many healthy nutrients. And also patient should
be reminded that she should take light meals with water so that MI attack
would not trigger.
Student nurses and other healthcare personnel should have
thorough assessments so that early diagnosis could be made and
recommended therapy could be given. Healthcare personnel should be
careful about the diet given to the patient and should ensure that the food
provided is in connection with the prescribed diet of the physician/dietician.
Bibliography
ONLINE:
11 Key Area of Responsibility in Nursing - Scribd. (n.d.). Retrieved September 16, 2014.
Zafari, A. (2014) Myocardial Infaction. Medscape Reference.
Retrieved from: http://emedicine.medscape.com/article/155919-
overview
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Doenges, M., & Moorhouse, M. (2002). Nurse's pocket guide
diagnoses, interventions, and rationales (8th ed.). Philadelphia: F.A.
Davis.
Karch, A. (2009). 2009 Lippincott's nursing drug guide.
Philadelphia: Lippincott Williams & Wilkens.
Brunner, L. (2008). Brunner & Suddarth's textbook of medical-
surgical nursing (11th ed.). Philadelphia: Lippincott Williams &
Wilkins.
Kozier, B, & Erb, G. (2008). Kozier & Erb's Fundamentals of
Nursing. Singapore: Pearson Education South Asia Pte Ltd.
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