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

BOOKS:

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.