Xavier University-Ateneo de Cagayan

College of nursing

In Partial Fulfillment for the Requirements

of the Subject Gerontology

Submitted to:
Maam Jesseca P. Monsanto, RN, MAN

Submitted by:
Legaspi, Rosenblum Louise D.
Rajal, Alnie Fay Camille J.

BSN-4 NC
September 16, 2014

I.

Introduction
This case study is about Patient SJ, a 90 year old woman, who was
referred at St. Josephs 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. Josephs 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. Josephs 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. Josephs Home for the
Aged that need correction and intervention.

Work alongside the staff of St.

Josephs 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.
B.
C.
D.
E.
F.
G.

Orient themselves to the protocols, rules and practices at St. Josephs

Familiarize themselves with the elderly patients
Conduct an interview and assessment with their assigned elderly patient
Promote wholeness and well-being including safety and comfort of patient
Set priorities in nursing care based on patients' need
Utilize the nursing process as framework for nursing
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
K.

attitude
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. Josephs Golden home foundation.
Hence, her admission.
Source of Information:

IV.

Sr. Marian L. Tagupa

Sr. Sofia Jagape (the patient herself)
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
History of Present Illness:

Date of Admission: October 8, 2012

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. Josephs 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 doesnt 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 dont 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: Cant be determined.
Patient doesnt 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. Josephs 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. Patients 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.
2.
3.
4.
5.
6.

Ineffective breathing pattern

Chronic pain
Disturbed sensory perception: Visual
Risk for injury/falls
Activity intolerance
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. Josephs Home for the
Aged. At St. Josephs 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 patients 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. Josephs, 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 dont 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 couldnt be supported anymore. I really cant 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 wont become
lonely.
Evaluation
I hope that I was able to make a diffirence in my patients 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. Josephs 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 priests 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 dont 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 didnt just gathered the relevant datas 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 hasnt 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.

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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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