Community nursing: care of elderly clients with coronary heart disease in

Brgy.604 Sta, Mesa Manila

A thesis presented to the faculty of nursing

College of the Holy Spirit Manila

In partial fulfilment of the requirements for the degree of

Bachelor of Science in Nursing

By
Jenivieve A. Garzo
June 2012

CHAPTER I: INTRODUCTION
BACKGROUND OF THE STUDY

The elderly represent the fastest-growing segment of the American population. By the
year 2000, it is estimated that people over age 60 will account for more than 15
percent of all U.S. citizens; those over 80 will constitute about 4 percent, or some 10
million Americans As a person ages, the heart undergoes subtle physiologic changes,
even in the absence of disease (Yale Med, 2005). The muscles of the aged heart may
relax less completely between beats; as a result, the pumping chambers become stiffer
and may work less efficiently, especially if specific cardiac diseases are present. In
old age, the heart also may not pump as vigorously or as effectively as it once did.
The older heart also becomes less responsive to adrenalin and cannot increase the
strength or rate of its contractions during exercise to the same extent it could in youth.
Coronary heart disease remains a leading cause of mortality in the United States, with
84 percent of persons 65 years or older dying from this disease. Secondary preventive
measures, including lifestyle modification and pharmacotherapy, are important for
elderly patients because of the variable impacts on morbidity and mortality rates and
quality of life. Participating in light to moderate activities significantly decreases
mortality rates in elderly patients. Smoking cessation translates into a reduction in
overall mortality and morbidity rates at least equal to that of other preventive
measures such as aspirin or beta-blocker therapy. Recent studies on the effects of
lowering low-density lipoprotein cholesterol levels to below 100 mg per dL have
shown a substantial reduction in coronary heart disease mortality and nonfatal
myocardial infarction rates, with a persistent effect in patients older than 75 years.
Hypertension, manifesting mostly as isolated systolic blood pressure elevation, also
should be treated aggressively. Conventional medical therapies for hypertension (e.g.,
diuretics, beta blockers) and newer agents (e.g., calcium channel blockers,
angiotensin-converting enzyme inhibitors), together with sodium restriction, have had
a positive effect on cardiovascular mortality and morbidity rates in older patients.

With the increasing prevalence of obesity, insulin resistance, and Type-2 diabetes,
interventions targeting weight reduction and glucose control should be emphasized.
Whereas weight-loss strategies are poorly defined in this population, the management
of diabetes through dietary modification, exercise, and medications is similar across
age group

STATEMENT OF THE PROBLEM

This study aimed to determine the Community nursing care of elderly clients with
Coronary Heart Disease in Brgy. 604 and to provide necessary intervention to the
clients to help them
This study aims to answer the following questions:
1. What are the most common factors that greatly influence the condition of the
eldery clients with CHD?
2. How do these factors affect the condition of the elderly clients with CHD
3. What are the lifestyles of the elderly clients with CHD
4. What are the specific nursing care and health teachings needed to be rendered to
the elderly clients with CHD?
5. Is there a significant difference between elderly clients who exercises between
clients who prefers to stay indoors

PURPOSE OF THE STUDY

General Objective:
This study aims to know the different lifestyle, diet, health history and the
environment in the community of the elderly clients in Brgy.604 suffering from
CHD and how that affects their health.
Specific Objectives:
This study aims to:
1. Determine the care/ interventions done by the clients or their relatives
regarding their disease
2. Determine the ways how clients make up or cope with their daily lives in
terms of diet and exercise
3. Determine if the clients follow the medicinal regimen of the physician and
follow their advice regarding health

Hypothesis
H1: in this study the client will be able to state the care they receive or the
interventions they have been following regarding the disease.
H0: that the client doesnt follow the medicinal regimen of the physician and is
disregarding his/her health

Conceptual framework
This framework will show us how the clients care of themselves and how they
respond to the regimen and advice of the physicians.

INPUT

PROCESS

INPUT

The clients will be

struggling to adjust
with the various
medicinal regimens,
change of diet and
exercise presented by
the physician

The client will be able

to experience a step
by step adjustment in
the change in diet,
lifestyle and will be
able to follow the
physicians medicinal
regimen and health
teaching

Adjustment follows,
and the client will be
able to follow the
presented regimen of
the physician without
difficulties

Significance of the study

This study aims to inform and made the readers be aware:
1. For the students, this will serve as a basis in the care of the elderly clients with CHD.
2. For the organizations, to develop special health programs that will guide and promote
health especially for the mid-aged and the elderly
3. For the researchers, the findings of this study will give them enough knowledge about the
elderly clients with CHD of Brgy.604.

Scope and Limitation

This study on the care of elderly clients with CHD in the city of Manila, Philippines targets the
age of participants in their senior years of 60 and above in the area of Brgy.604 Sta. Mesa,
Manila. The researcher conducted this study during the second semester of the school year 2012.

Definition of terms
To guide and for easy understanding of this, the following conceptual and operational definitions
of terms were present
Community: According to Blackwells Dictionary of Nursing (2002) it refers to a group of
people living in the same geographic area and under the same government.
In this study, it refers to the selected residents of Brgy. 604 Sta. Manila which they will conduct
this research this study.
Disease: According to Blackwells Dictionary of Nursing (2002) it refers to an illness or a
departure from a state of health caused by an interruption or modification of any of the vital
functions, and characterized by a definite train of symptoms.
In this study, it refers to CHD and its symptoms that elderly people at Brgy. 604 Sta.Mesa Manila
experiences
Prevention: According to Maglaya (2004) it refers to identification of potential problems so that
the nurse can minimize or probably even eradicate possible disability or deformity in a
population-at-risk to a negative exposure factor
In this study, it refers to primary prevention of the elderly residents of Brgy.604 Sta.Mesa,
Manila
Residents: According to Blackwells Dictionary of Nursing (2002) it refers to an occupier,
occupant and inhabitant.

In this study, it refers to the people residing at Brgy. 604 Sta.Mesa Manila
Regimen: A systematic plan (as of diet, therapy, or medication) especially when designed to
improve and maintain the health of a patient/client

REVIEW OF RELATED LITERATURE

According to the CDC Health Disparities and Inequalities Report United States, 2011, Heart
Disease and stroke are the first and third leading causes of death in the United States. Despite
overall decreases in CHD and stroke death rates, those for blacks and men remain particularly
alarming. According to this report, In 2006, CHD was the underlying cause of death for
425,425 persons (all ages) in the Unites States and the rates for males was 41.6% higher than
females. Blacks had higher age-adjusted rates than the other three racial/ethnic groups. "Among
adults aged >45 years, a comparison of rates by race for the younger age groups reveals that
black women and men aged 45-74 years had a much higher CHD death rates than women and
men of the three other races. The proportion of CHD deaths that occurred among persons aged
45-74 years was higher for black women (37.9%) than white women (19.4%) and higher for
black men (61.5%) than white men (41.5%).
Based on Maglaya (2004), promoting health makes up most of the nurse activities in the
community
In communities, diseases like CHD is usually occurring on elderly people with history of the
disease or due to the unhealthy diet they follow.
According to a US Department of health and Human Services article, There is evidence that
women diagnosed with acute myocardial infarction (AMI), or heart attack, are less likely than
men with AMI to receive certain treatments that have been reported to improve outcomes.
Research also suggests that physicians are less likely to counsel women about modifiable risk
factors, such as diet and exercise, and that after a first heart attack, women are less likely than
men to receive cardiac rehabilitation, though the reasons for these sex disparities are unclear.
Women, black and elderly patients with coronary heart disease (CHD) still receive fewer drugs
than other groups, according to a new study undertaken in East London. In this cross-sectional
study of 10,993 patients aged >35 years with recorded CHD. The odds of prescribing
recommended CHD drugs were assessed by age, sex, ethnicity, social deprivation and comorbidity. Reasons for not prescribing were also recorded. While levels of prescribing for people
with CHD were generally high, prescription rates were lower in women, Black
African/Caribbean patients and those >74 years of age. This pattern was independent of co
morbidity and recorded reasons for non-treatment. (Ethn Health 2011;16(2):107-23.)
Coronary heart disease (CHD) is responsible for significant morbidity and mortality in elderly
patients (i.e., 65 years and older), translating into a substantial financial burden on the health care

system. In recent decades, novel approaches to prevention and treatment have resulted in
increased survival of patients with CHD. These interventions, mostly validated in large,
randomized clinical studies, have provided strong evidence on which to base recommendations.
The limited representation of elderly patients has resulted in fewer data about the effectiveness of
various strategies in this population.1Moreover, the atypical clinical presentations of CHD in
elderly patients, and the consequent difficulty in diagnosis, have resulted in suboptimal
implementation of secondary preventive measures by health care professionals. CHD in the
elderly may manifest as dyspnea or congestive heart failure with pulmonary edema, and some
patients may be asymptomatic. (American Heart Association AHA 2002),

CHAPTER III
METHODOLOGY

Research design
The descriptive method of research was used for this study. Descriptive research
is a type of research that is mainly concerned with describing the nature or
condition and the degree in detail of the present situation. This method is used to
describe the nature of a situation, as it exists at the time of the study and to
explore the cause/s of a particular phenomenon. The aim of descriptive research
is to obtain an accurate profile of the people.

Subject
This study focusing on the care of elderly clients with CHD here in the Philippines, the target
ages would be 60 and above living in Brgy.604

Sampling techniques
Quota sample was done for the sample section. This quota sampling is one
which the researcher identifies population strata and determines how many
participants are needed from each stratum. By using information about
population characteristics, researchers can ensure that diverse segments are
represented in the sample. This quota sampling is the easiest procedure that
use to a convenience sample by distributing questionnaires in houses.

Setting
This study focuses on elderly clients with CHD in Brgy.604 Sta. Mesa, Manila

Measures/Instruments

The researcher should study the care of the clients with CHD in Brgy.604. The
questionnaire was divided into two main sections: a profile and the survey proper. The
profile contains socio-demographic characteristics of the respondents such as age, gender,
and civil status, family health history, past health history and where they came from. A
Survey Questionnaire used and distributed to the clients.

Survey Questionnaire:
-How are you able to live with the disease?
-Are you observing the proper diet prescribed by the physician?
-What strategy did you use to follow the steps of the regimen prescribed by the doctor?
-What is the medicine regimen prescribed by the physician?
-How are able to socialize with other people who are not experiencing any cardiovascular
illnesses

Data Collection
The researcher gave survey questionnaires to the elderly clients with CHD to gather information
about the disease process and the environmental factors affecting it